News

NHS performance is improving, says Healthcare Commission

Commission to act on organisations “weak” on quality of services

Walker challenges “fair” trusts to reach standards of the best

The Healthcare Commission has published performance ratings for all NHS trusts in England, showing overall improvement in quality of services and use of resources.

In its second year, the annual health check for the first time now gives people the chance to compare performance.

People can see if trusts are improving in meeting the government’s standards and targets in areas of real importance to them, like quality of care, safety and waiting times.

All 394 trusts get an overall rating - on a four-point scale ranging from “excellent” to “weak” – on both quality of services and use of resources.

The results show clear improvement overall, with more trusts scoring “excellent”, as well as fewer scoring “fair” and “weak”. In all, one in three trusts improved on quality of services and a similar number did so on use of resources.

In particular, the Commission noted that 19 NHS trusts scored “excellent” on both parts of the rating, up from just two last year.

Areas of significant improvement include:

every trust achieved the target for cancer patients waiting no more than a month from diagnosis to treatment, except for good clinical reasons

despite increases in attendance, A&E waiting time targets were met nationally with 98 % of 18 million patients in A&E receiving care within four hours

more trusts met the target of reducing the number of cancelled operations, with the proportion of cancellations falling for a third consecutive year.

On quality of services:

16% of trusts were “excellent” and 30 % were “good” – 46% compared with last year’s 41 % in these two categories

45% were “fair” and 8% were “weak” – 53% compared with last year’s 59% of trusts in these two categories.

On use of resources:

14% of trusts were “excellent” and 23 % were “good” – last year 16 % were in these two categories

36% were “fair” and 26% were “weak”- 62% compared with last year 84% in these two categories

Depending on the services provided at each trust, the Commission’s rating on quality of services is based on:

24 core standards (with 44 components) in areas like safety, standards of care and how responsive to patients a trust is

up to 19 existing national targets designed to ensure that trusts are meeting basic levels of service in areas such as waiting times

up to 14 new national targets designed to promote improvement in broader areas of public health and healthcare such as smoking cessation and reducing health inequalities.

Core standards Overall, performance in meeting the core standards improved, with 55% of trusts judged to have “fully met” the standards, up from 49% last year. However, there is still considerable room for improvement as all trusts should have been complying with these standards.

A central feature of this process of assessment is the submission of comments from patients and the public on trusts’ performance in meeting the core standards. In all, 8,000 comments were received from people across the country. The key areas of concern for patients were:

equal access to services (C18)

having accessible information (C16)

healthcare environment and hygiene (C21)

Existing national targets Overall performance improved with 55 % of trusts judged “fully met” on existing national targets, an increase of 18 percentage points compared to last year. This is largely because of the significant improvements in the range of waiting time targets.

But 70 % of PCTs failed the target relating to “convenience and choice”, which says that patients should be able to choose from at least four providers paid for by the NHS.

This was the worst area of performance in any of the existing national targets. The reasons for this include the fact that GPs are not contractually obliged to offer “choose and book”, and the intermittent technical problems with the necessary computer systems.

New national targets Performance on new national targets was broadly similar to last year with 25% of trusts scoring “excellent”, up from 24% last year. But this year a higher proportion of trusts scored “weak”, up to 24% from 17% last year.

The Commission said that trusts had made good progress nationally towards meeting the target whereby no patients referred to a consultant should wait more than 18 weeks for treatment. This target is due to be met in December 2008.

In 2003/04, trusts were set a challenging target to halve rates of MRSA by 2008. Despite a steady decline in rates of MRSA, this remains a challenging target.

Different types of trust Looking across the types of trust, acute hospital trusts and mental health trusts performed the best.

Acute trusts performed extremely well in delivering existing national targets. In addition, 19% of acute and specialist trusts scored “excellent” on quality of services, up from 7% last year.

Mental health trusts were the highest performing type of trust, with more than half scoring “excellent” for quality of services. Mental health trusts performed well on meeting important targets, such as the implementation of crisis resolution teams and the core standards. However, they are currently assessed against fewer targets and, therefore, not challenged to the same extent as other trusts. The Commission is consulting with the sector on strengthening the assessment for future years.

Against a background of tough targets, 62% of PCTs were “fair” and 12% were “weak” for quality of services – the picture was similar for use of resources. Areas of weak performance included “choose and book” and updating practice-based registers, issues of significance to patients. The 72 PCTs reorganised in October 2006 performed the least well.

Foundation trusts performed better than non-foundation trusts across both parts of the rating, notably on use of resources. There were “excellent” scores for 86 % of the 59 trusts that had become foundation trusts prior to April 1 2007. All 19 trusts scoring “excellent” for quality of services and use of resources were foundation trusts.

Strategic Health Authorities Looking across the ten strategic health authorities (SHA), areas with highest performing trusts on quality of services were the East Midlands, which had the highest proportion of “excellent” trusts (26%), and the North East, which had by far the highest combination of “excellent” (13 %) and “good” trusts (61%).

The South West SHA had the highest proportion of “weak” (20 %) trusts. The South East Coast SHA had the lowest proportion of “excellent” trusts and the highest combination of “fair” (58 %) and “weak”(19 %).

Next steps The Commission announced today that it will work very closely with the Department of Health and the strategic health authorities to ensure that action plans are in place for trusts rated “fair” and “weak”. The strategic health authorities have indicated that they would actively follow up these plans. The Commission will regularly monitor progress.

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