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the annual health check in 20062007 by lindash


									    Attach 9

                    REPORT TO TRUST BOARD
                                   31st January 2007
                                    Agenda No. 7.4

Title of Document:
The Annual Health Check in 2006/2007
Report Author:
Yvonne Connolly, Simon Harris

Lead Director:
Di Caulfeild-Stoker, Director of Provider Services

Contact details:,
This paper describes the Healthcare Commission’s approach to managing the annual
health check in 2006/2007. It contains a number of recommendations in light of the
changes to this assessment and the PCT’s new Integrated Governance Structure

The Board are asked to approve the recommendations outlined in this paper.

Committees which have previously agreed the report:
PEC Comments where appropriate:

Financial Implications:

Other Implications including patient and public
involvement/Legal/Governance/Diversity/ Staffing

Equality Impact Assessment
   Has an EIA been carried out?
   (If not, state reasons)

Yes: Phase 1 impact assessment carried out. (No adverse impact anticipated) This
has been passed onto Diversity Manager.
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           The Annual Health Check in 2006/2007
The purpose of this paper is to inform the Board of the Healthcare
Commission’s (HCC’s) annual assessment process and performance ratings
of NHS organisations in 2006/2007. (Please refer to the glossary for full
terms). This document will outline the key processes and timescales and
suggests a number of recommendations for the Board to approve.

Wandsworth PCT received its annual performance rating for 2005/2006. It
received a rating of ‘fair’ for quality of services and ‘weak’ for use of
resources. All five PCTs in South West London received the same rating of
‘fair’ for quality of services. Two PCTs received the rating of ‘good’ for use of
resources and two others, like Wandsworth PCT received the rating of ‘weak’
for this element.

Information about the assessment in 2006/2007
The diagram below demonstrates what elements the HCC will use to calculate
their annual performance rating in 2007.

 Figure 1. taken from ‘The annual health check in 2006/2007, assessing and rating the NHS’

In the first year of the annual health check (2005/06), The HCC focused much
of their activity on ensuring that basic, core standards were being met. This
time they will continue with this approach but will increase their focus on
whether NHS organisations are driving improvement in the commissioning
and delivery of healthcare.
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As in 2005/2006, they will assess organisations in a range of ways. Firstly,
they will assess whether Trusts are getting the basic standards of care right.
They assess how Trusts are performing on:

     o core standards (core standards assessment)

     o long standing targets set by Government (existing national targets)

     o effective management of resources, including finance (use of

     o newer targets set by Government (new national targets)

            (It is these four elements that will dictate the PCT’s annual
                           performance rating in 2006/2007)

Secondly they will assess whether improvements are being sought. They will
do this by assessing performance on:

     o service reviews and national studies

     o developmental standards (developmental standards assessment)

    (These form part of the annual health check but do not contribute to
                   the performance rating in 2006/2007)

      Where does accountability currently lie within the
   organisation and what are the deadlines for submission?

                     The annual health check in 2006/2007
                                                               Deadline for
                                             Does it feed
                                                             submitting this to
                                           into 2006/2007
    Element           Responsibility                          the Healthcare
                     Clinical Governance
Core Standards                                  Yes                April 2007
                     & Risk Department
Meeting existing         Performance                            HCC have not yet
national targets         Management                               confirmed this
Meeting new              Performance                            HCC have not yet
national targets         Management                               confirmed this
                                                               Various milestones,
Use of Resources          Finance               Yes            rough timescales of
                                                            dates shown in ‘Figure 5.’
Service Reviews
and national                                                Dependent on particular
studies (formerly     Services involved         No            review. Detailed in
called improvement                                                 ‘Figure 3’
                                                               PCT to self assess
Standards (through   Clinical Governance
                                                No            against these in April
shadow and pilot     & Risk Department
Figure 2.
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  Timeframe of deadlines for Service Reviews and National

    Service Review                    Date for Submission                        Lead
Diabetes                           Healthcare Commission                 Nigel Everson
                                   have not confirmed this
Race Equality                      Healthcare Commission                 Margaret Adjaye
                                   have not confirmed this
Substance Misuse                   1st December 2006                     Ian Wilson
Acute Inpatient Mental             February 2007                         Stephen Warren,
Health                                                                   Paul Chapman
Maternity Services                 N/A for PCT
Heart Failure                      Healthcare Commission                 Stephen Warren
                                   have not confirmed this
     National Study                  Date for Submission                          Lead
Audit of Learning                  Begins January 2007                   Peter Warburton/
Disabilities                                                             Alastair Bearne
Audit of Handling of               Healthcare Commission                 Shona Ruff
Complaints                         have not confirmed this
National study of                  Healthcare Commission                 Yvonne Connolly
healthcare associated              have not confirmed this
infection                          yet
Figure 3.

            Calendar for entire Annual Health Check Process
                             Oct 06 – Oct 07
   Timeline for submission of elements       O   N   D   J   F   M   A    M   J   J   A   S   O
                            2006- 2007       C   O   E   A   E   A   P    A   U   U   U   E   C
                                             T   V   C   N   B   R   R    Y   N   L   G   P   T
 Board agree status of Core &
 Developmental Standards                                         *
 Board make public declaration on Core &
 Developmental standards                                             *
 Use of resources information submitted?
 Existing National Targets Data submitted?

 New National Targets Data submitted?

 Service Reviews
 National Studies                                    * * *
 Annual Performance rating awarded
                                             *                                                *
Figure 4.
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Key information about the elements that make up the annual
                 health check in 2006/2007

Core standards – The Board will be required to agree the level of compliance
with the core and developmental standards at their March meeting. This will
then need to be shared with the Overview and Scrutiny Committee, the
Patient Public Involvement Forum, Internal Audit and the Strategic Health
Authority. Once these groups have had a chance to comment on it, the Board
will review these comments and formally sign off the declaration at their April
meeting and submit it to the Healthcare Commission by no later than midday
1st May 2007.

There are likely to be a few changes to the declaration process this year and
we are awaiting final guidance from the HCC. So far we are aware that:

     o There will be no draft declaration process this year.

     o The HCC will further develop their methods of surveillance and local
       intervention to give greater assurance that organisations are meeting
       basic standards of care.

National targets (New and Existing) – More guidance was due be issued by
the HCC in December 2006, as of the date of writing this paper we are still
awaiting this.

   o The HCC have indicated that there will be minor changes to the
     indicators on the existing national targets.

   o They have also indicated that there will be minor changes to the
     indicators on the new national targets. These will be published on their
     website shortly, following approval from the Secretary of State for

 The key change is that in 2006/2007, the ‘quality of services’ part of the
    performance rating will be derived from the assessment of core
  standards and the assessment on existing and new national targets
   only. It will not directly include the results from the programme of
       service reviews and national studies as it did last time, or
                         Developmental Standards.

Use of resources -

   o The HCC’s assessment will continue to be derived mainly from
     information supplied by the Audit Commission and Monitor.

   o They will work with the Audit Commission, Monitor and others to agree
     and publish comparative indicators on productivity.

   o They will develop a programme of work to extend our assessment of
     value for money
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The timetable for ‘use of resources’ last year was:
                        Auditors complete phase one of fieldwork for financial
     March 2006
                        management, internal control and value for money
                         Audit Commission’s quality assurance process for
      May 2006
                         phase one draft scores

                         Audited accounts for non-foundation trusts submitted
      July 2006
                         Audited accounts for PCTs submitted

                         Auditors complete Auditors’ Local Evaluation scores
     August 2006         Quality assurance and query resolution by the Audit
                         Transfer of score to the Healthcare Commission.
                         Healthcare Commission receives, checks and
   September 2006        considers scores. The five auditor scores are
                         reported to NHS organisations. Scores available on
                         Healthcare Commission website for ratification
                         Annual rating published

    October 2006         Audit Commission publishes auditor assessments
                         and commentary on the five areas

 Figure 5.

It is likely that a similar timetable will be in place this year and it is proposed
that these deadlines are monitored by the Audit Committee in the new
Integrated Governance structure. (This is detailed in the recommendations at
the end of this paper).

Programme of service reviews and national studies – The HCC plan to
issue detailed guidance specific to individual service reviews and studies
throughout the year. The guidance will be scheduled to coincide with the
timing of each review.

   o The programme of service reviews and national studies includes those
     reviews previously called improvement reviews and the acute hospital
     portfolio. It also includes national reviews for which the HCC may only
     collect information on a subset of organisations. A number of these
     reviews and studies will provide comparative information on services.

   o In 2006/2007, this programme will include the following major services
     or topics: maternity, diabetes, substance misuse, adult acute inpatient
     mental health, race equality, learning disabilities, complaints handling
     and healthcare associated infection. (The substance misuse review
     took place in December 2006 and we are awaiting the results). The
     other reviews are due to start shortly, please refer to the table titled
     ‘figure 3.’ Earlier on in this document to see when.)
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   o Results of the HCC’s review on heart failure services carried out in
     2005/2006 will also be published during 2006/2007.

   o Results from the HCC’s service reviews and national studies will feed
     into the assurance process for assessing performance in relation to
     standards. They will not feed directly into the overall rating for

 Developmental standards

   o Developmental standards outline improvements that the Government
     expects all trusts to aspire to in order to improve the quality of care and
     treatment provided. This is a new part of the annual health check.

   o In 2006/2007, the HCC will focus their assessment in three of the
     seven areas or domains set out in the Department of Health’s
     standards. These are safety, clinical and cost effectiveness, and public

   o Only the ‘public health’ developmental standards are applicable to the
     PCT this year. Performance against developmental standards will not
     feed into the overall annual rating in 2006/2007. However the HCC
     have indicated that they do expect it to form part of the rating from

   o Over the three-year cycle 2006/2007 to 2008/2009, the HCC expect to
     cover all seven domains within the developmental standards

Future Healthcare Commission development

During 2006/2007, the HCC will work with the Department of Health, the NHS,
the Commission for Social Care Inspection and other partners to determine
their approach for the future in commissioning arrangements that
organisations have in place.
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Recommendations for the Board

One of the primary concerns for the Board will be how it knows that there are
robust systems and processes in place to monitor all elements of Healthcare
Commission assessment and that areas of concern are escalated quickly. It
is anticipated that the new Integrated Governance structure for the PCT will
be the mechanism for doing this. It is proposed that the foundations of the
structure will be in place for the new financial year 2007/2008.
As this will not be fully embedded in time for this year’s declaration on the 1 st
May, it is recommended that the organisation maintain the following reporting
structure in the interim period:

      All Healthcare Commission processes including all elements of
       assessment should pass through the Clinical Governance & Risk
       Management Committee or Healthcare Commission Steering Group for
       initial discussion and areas of concern escalated to the Board
       accordingly. This will allow the organisation to take a holistic approach
       to the annual health check and be fully aware of all areas of

      From the beginning of the new financial year, it is proposed that the
       Integrated Governance Committee be the method for monitoring all
       elements of the ‘quality’ part of the HCC assessment, including core
       and developmental standards, national targets and service reviews.

      Each of the committees reporting through Integrated Governance
       Structures will have the relevant core/developmental standards and
       national targets linked to their Terms of Reference and will have five
       key responsibilities with regard to each of these:
          1. Raising at an early stage any concerns about compliance from
              relevant leads.
          2. Providing evidence/assurance of compliance with relevant
          3. Escalating any exceptions to the Integrated Governance/Audit
          4. Using the HCC’s cross-checking data to identify any areas of
              potential concern.
          5. Ensuring comprehensive action plans for gaps identified.

      The Integrated Governance Committee will review evidence from all
       commissioned and contracted services (including Provider services)
       and flag concerns up to the Audit Committee.

      The Audit Committee will continue its current functions including
       monitoring of all elements to do with the ‘use of resources’ part of the
       annual assessment. Additionally it will examine all the concerns raised
       by the Integrated Governance Committee. Where there are quality
       issues that may require financial support, the audit committee will
       agree how this can be allocated within budget. This will then be
       reported to the Board.
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Having the system set up this way would ensure integration right the way
through the organisation with ownership of every standard/target taken into
consideration at all levels.

To support this proposal, a robust system of monitoring will need to be put in
place. It is suggested that the PCT’s ‘Ariadne’ electronic monitoring system
be used. Information can be extrapolated from this database and presented
in a number of ways.

For each standard the PCT needs to provide evidence of compliance within its
own provider services and with contractor groups and commissioned services.
Systems have already been set up to ensure that evidence will be forthcoming
from all for these areas:
Provider Services -              via the ‘Team Tool’ results and action plans
                                 tracked on Ariadne.

Independent Contractors -         via contract reviews which have standards
                                  embedded in them and will also be reported
                                  on Ariadne

Commissioned Services -           by sharing their HCC cross-checking data
                                  with us so that any areas of concern that
                                  the HCC may have can be more closely
                                  monitored by Wandsworth PCT.

The table on the next page demonstrates how the PCT can report on
progress towards meeting core standards for all of the above groups.
Attach 9
           Appendix A
Attach 9

                                Glossary of terms

Ariadne                  This is a web-based application which permits the PCT to monitor
                         evidence for all of its functions. It is an electronic document
                         storage facility that helps management maintain evidence, keep it
                         up to date and set up robust accountability structures.

Commissioned Services St Georges NHS Trust, South West London St Georges Mental
                      Health Trust and Wandsworth Prison

Cross-checking data      Information that the Healthcare Commission used to assess the
                         likelihood of non-compliance with a standard based on other
                         sources of information that they have access to.

HCC                      Healthcare Commission, the national organisation charged with
                         running the annual health check and publishing and annual
                         performance rating.

Independent Contractors Dentists, GPs, Optometrists and Pharmacists

Team Tool                A yearly audit programme (one per month) that all teams within
                         the provider services are required to complete. These audits
                         have been based on core standards, Essence of Care
                         requirements and NHS Litigation Authority criterion as well as
                         other national requirements, to ensure staff are aware of the must
                         dos and have a logical way of checking these.

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