01.10.10
Healthcare watchdog to cross-check NHS performance as trusts make declarations on standards
More trusts tell Healthcare Commission they fully meet standards in first stage of annual NHS assessment
The Healthcare Commission has said it will carry out a thorough check of the accuracy of NHS trusts’ declarations on how they have performed in meeting the government’s standards for healthcare.
For the second year running, every NHS trust in England has issued a public declaration on performance in meeting the government’s core standards.
They have made the information available as part of the Healthcare Commission’s annual health check of English NHS trusts, which replaced the system of star ratings.
Patients and the public can see what local trusts say about whether they measure up against 24 standards (with 44 parts) in areas like safety, clinical effectiveness and patient focus.
The boards of all 394 NHS trusts have declared whether their organisation met the necessary level of performance during the year to March 31st 2007.
The government, which sets the standards, has said the aim is to ensure that “health services are provided that are safe and of acceptable quality”.
In its "Standards for Better Health" (July 2004), the Department of Health said the standards describe “a level of service that is acceptable and must be universal”.
The Commission will take a view on whether declarations are accurate but only after carrying out a rigorous cross-checking exercise.
Analysis of this year’s declarations shows:
more trusts say they meet all of the standards, with the total declaring full compliance rising from 34 per cent in 2005/2006 to 40 per cent in 2006/2007
the overall compliance rate is high – above 94 per cent
the most marked improvement appears to be in London and the southeast
a significant number of acute and mental health trusts believe that they have made important steps forward
there was also improvement in two standards that relate to compliance with guidance from the National Institute of Health and Clinical Excellence.
Anna Walker, chief executive of the Healthcare Commission, said: “When it comes to assessing performance, these declarations offer us, and the public, a critical piece of the jigsaw: how NHS trust boards think they are performing.
“If it is confirmed that more trusts are meeting the core standards than last year, then that would be a significant success.
“We also want to applaud trusts that have put their hands up and declared non-compliance in some areas. This shows boards really examining their own performance. That is the action of an honest and responsible board that wants to make improvements and get these standards in place for patients. The first step to sorting out a problem is recognising you have one.
“Where a trust has declared significant non-compliance, we will be following that up with their strategic health authority.
“We will come down harder where we find non-compliance in practice. That is why we will ensure rigorous analysis of the accuracy of what organisations are saying, using the array of data we hold and targeted inspection where necessary.”
The declarations also show:
60 per cent of trusts acknowledge they need to do more to achieve full compliance
there are three standards that relate to the Hygiene Code and in all three cases more trusts are declaring non-compliance compared to last year
there was a slight decline in the number of trusts saying they met two standards that deal with treating patients with dignity and respect
other standards trusts struggled cover issues such as patient records, mandatory training and decontamination of equipment.
The Commisison’s checks on core standards are part of a pioneering system of NHS assessment that uses self-declaration, performance data and inspection to target regulatory efforts where there is evidence of a problem.
The Commission cross-checks the declarations using information such as clinical audits, surveys and performance data from other regulators. It holds some 2,000 items of data, including information from over 30 different bodies.
The Commission also takes into account local intelligence, gathered by some 200 assessment managers across the country.
It systematically collects comments from representatives of patients and the public such as patient and public involvement forums and the overview and scrutiny committees of local authorities.
Using all of this information, the Commission's regional teams target inspections to check that trusts have performed at the level declared.
Around half the visits are at trusts where there is a discrepancy between what the organisation has declared and other sources of information. The rest are random spot checks, designed to monitor the self-assessment system.
Where it finds lapses, the Commission’s response can vary, ranging from requiring an action plan to launching a formal investigation.
Trusts that declare a problem are less likely to face an inspection as long as there is evidence that the organisation recognizes, and is taking steps to tackle, the issue.
By a risk-based and targeted approach to inspection, the Commission aims to ensure that it works efficiently and effectively.
The annual health check aims to provide patients and the public with a more comprehensive picture of NHS trusts’ performance than was possible under the old star ratings.
However, it still looks at performance in meeting the government’s targets. But it also includes assessments of standards and use of resources and priority areas of healthcare such as dignity on hospital wards and how trusts manage complaints.
Each year the Commission will produce an annual performance rating, the first of which was published in October 2006.
The rating reports on two areas of performance: quality of services and use of resources. For each of these, the Commission gives trusts a score on a four-point scale, ranging from excellent to weak.
The NHS annual performance ratings for 2006/2007 was published on October 18th 2007.
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