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Annual Health Check 200708 ratings

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					 Meeting of the                                                         Date: November 2008
 Commissioning Board                                                    Agenda Item No.: 13


Annual Health Check 2007/08 ratings
Purpose of report:
To provide an update to the Board on the performance of the three North of Tyne PCOs
against the Healthcare Commission ratings during 2007/08.


Executive Summary:
This report focuses upon the ratings awarded by the Healthcare Commission’s
performance assessment process during 2007/08.
The first section of the report focuses upon the role of the Healthcare commission within
the assessment process along with the structure of the assessment process

The second section presents the ratings along with an interpretation of the results.

There is also a summary of the lessons learnt along with the current actions being taken
to improve the PCOs performance against the ratings for 2008/09.

Recommendation:
The Commissioning Board is asked to note the content of this report and revised
approach to performance management.




Lead director: Mark Adams, Director of Planning, Contracts & Performance

Other leads: David Lea, Head of Performance
             Joan Charlton Performance Manager




Working on behalf of Newcastle and North Tyneside Primary Care Trusts and Northumberland Care Trust
Supporting Information
  • Service implications:
  The PCOs are required to support the accountable officers in the delivery of the
  actions to achieve both national and local targets to meet the performance standards
  and targets outlined in this report.

  • Financial implications:
  None directly identified within this report although the delivery and achievement of
  the performance standards will have a financial implication.

  • Key risks:
     Improving upon the performance of the three PCOs to achieve a better
     performance rating for 2008/09.

  • Equality and diversity considerations:
  None identified

  • Community engagement/communications requirements:
  The promotion of the organisation’s requirement to improve performance and
  continue to commission and provide quality services across the North of Tyne

  • Link to corporate objectives:
  The content of the report contributes to the following corporate objectives:
  2. To commission a range of services of the right quality to provide timely access to
  appropriate treatment for those who are ill.

  7. To become an organisation that makes the best possible use of public resources.




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1. Introduction to the Annual Health Check 2007/08
The Healthcare Commission is responsible for assessing and reporting on the
performance of both NHS and independent healthcare organisations.

This is the third year of assessment for NHS organisations. The focus was on whether
requirements, in areas such as safety, access and clinical effectiveness, were being met
on behalf of patients across the NHS.

The assessment looked at a wide range of areas, including those that are of high
importance to patients and the public.

The core standards assessment includes standards concerned with safety and
cleanliness, safeguarding children, infection control, dignity and respect, and privacy
and confidentiality.

The existing national targets assessment includes indicators concerned with waiting
times for cancer treatment, inpatient and outpatient treatment, and ambulance response
times

The new national targets assessment includes indicators concerned with patient
reported experience of services, MRSA rates, access to reproductive and sexual health
services, and reductions in deaths from cancer.

2. Core Standards
The core standards cover seven key areas of health and healthcare, including safety,
patient focus, clinical effectiveness and cost effectiveness.
The scores for each core standard are aggregated into one overall score, which then
contributes to the overall quality of services element of the annual health check. The
core standards component of the 2007/2008 annual health check was scored on the
following four-grade scale:
• Fully met
• Almost met
• Partly met
• Not met
The score is based on a calculation that reflects the proportion of core standards for
which there is compliance.
3. Existing National Targets
Healthcare organisations should be able to demonstrate each year that they are meeting
these targets.

Each target is measured against one or more indicators, which capture, for example,
how a particular aspect of a service is provided. Where there is more than one indicator
for a particular target, the indicators are weighted equally.



                                             3
The scores for each existing national target are aggregated into one overall score, which
then contributes to the overall quality of services part of the annual health check
performance rating. The existing national targets component of the 2007/2008 annual
health check was scored on the following four-grade scale:
• Fully met
• Almost met
• Partly met
• Not met

4. New National Targets
The new national targets are goals for the entire NHS, which aim to improve the health
of the population in England.

Each Primary Care organisation was given a score for each of the new national targets.
The target is measured against one or more indicators, which capture, for example, how
a particular aspect of a service is provided. Where there is more than one indicator for a
particular target, the indicators are weighted equally.

The scores for each new national target are aggregated into one overall score, which
then contributes to the overall quality of services part of the annual health check
performance rating. The new national targets component of the 2007/2008 annual
health check was scored on the following four-grade scale:
• Excellent
• Good
• Fair
• Weak

5. NHS North of Tyne overall performance
The overall performance rating is made up of two parts: 'use of resources', which looks
at how effectively a trust manages its financial resources; and 'quality of services', which
is an aggregated score of performance against national standards and targets. The
tables below summarise the last two years of the annual health check for organisations
in NHS North of Tyne.



                                     2007/08                        2006/07
                        Quality of       Use of        Quality of       Use of
                        Services         Resources     Services         Resources

Newcastle PCT                Fair            Fair          Good             Fair

North Tyneside PCT          Good             Fair          Good             Fair
Northumberland
Care Trust                   Fair            Fair           Fair           Weak




                                             4
Components of quality of services


                               2007/08                            2006/07
                   Core        Existing    New       Core         Existing     New
                   Standard    Targets     Targets   Standard     Targets      Targets
Newcastle PCT       Almost     Fully Met    Weak      Fully Met    Fully Met    Good
                      Met
North Tyneside      Almost      Almost      Good      Fully Met   Fully Met     Good
PCT                   Met        Met
Northumberland      Almost     Fully Met     Fair     Fully Met   Fully Met     Weak
Care Trust            Met

6. Interpretation of results
Newcastle Primary Care Trust
Newcastle provided an adequate quality of service to patients but failed to maintain the
good standard of performance it achieved the previous year.

Core Standards – Almost Met
   • compliant with 41 standards
   • not compliant with 2 standard
         o C04c – decontamination
         o C24 - emergency preparedness

Existing National Targets – Fully Met
   • 14 indicators achieved
   • 3 indicators not achieved
          o PCT facilities in place to support choice
          o Access to a primary care professional within 24 hours and to a primary
              care doctor within 48 hours.
          o Practice-based registers

New National Targets – Weak
  • 9 indicators achieved
  • 4 indicators not achieved
         o Under-18 conception rate
         o Mortality heart disease and stroke
         o Long term conditions
         o 18 weeks from GP referral to hospital treatment

Focus on services
   • Urgent and emergency care – Best Performing
   • Substance misuse service review 2006/2007 – Good




                                            5
North Tyneside Primary Care Trust
North Tyneside continued to provide a good quality of service to patients. It has
continued to manage its finances adequately for the last three years.

Core Standards – Almost Met
   • Compliant with 40 standards
   • Not compliant with 3 standard
         o C18 - equity, choice
         o C20a - safe, secure environment
         o C24 - emergency preparedness

Existing National Targets – Almost Met
   • 13 indicators achieved
   • 4 indicators not achieved
          o Diabetic retinopathy
          o PCT facilities in place to support choice
          o Access to a primary care professional within 24 hours and to a primary
              care doctor within 48 hours
          o Practice-based registers

New National Targets – Good
  • 10 indicators achieved
  • 3 indicators not Achieved
         o Under-18 conception rate
         o Mortality form heart disease and stroke
         o Long term conditions

Focus on services
   • Urgent and emergency care – Best Performing
   • Substance misuse service review 2006/2007 – Good

Northumberland Care Trust
Northumberland Care Trust continued to provide an adequate quality of service to
patients. It has managed its finances adequately and has made improvements on its
weak standard of the last two years.

Core Standards - Almost Met
   • 40 compliant
   • 3 not compliant
         o C04b - safe use of medical devices
         o C04c – decontamination
         o C24 - emergency preparedness




                                            6
Existing National Targets – Fully Met
   • 14 indicators achieved
   • 3 indicators not achieved
          o Diabetic retinopathy
          o PCT facilities in place to support choice
          o Access to a primary care professional within 24 hours and to a primary
              care doctor within 48 hours

New National Targets – Fair
  • 7 indicators achieved
  • 6 indicators not achieved
         o Older people being supported to live in their own
         o Drug users in drug treatment
         o Adult smoking rates
         o Under-18 conception
         o Suicide and undetermined injury
         o Mortality from heart disease and stroke

Focus on services
   • Urgent and emergency care – Best Performing
   • Substance misuse service review 2006/2007 – Excellent

7. Lessons learnt from the HCC ratings.

Action plans are now in place for all the current indicators that will influence the 2008/09
ratings that are under-performing and traffic lighted as red or amber in the performance
scorecard.

Performance clinics are in place to proactively improve the performance on the at risk
targets. Heads of Service and the Performance team meet regularly to discuss issues in
relation to the areas which are underperforming against the indicators.

A dedicated resource is available to assess and implement the guidance associated with
the Healthcare commission performance ratings.

The PEC Chair and a Performance lead are conducting a sensitivity analysis on last
year’s rating to assess how further improvements can be made on performance to
achieve a higher banding for this year’s ratings

Greater engagement with GPs and other service providers is planned to ensure that
they are fully aware of the impact that they can make on the PCOs’ performance against
the current indicators.

The scorecard and performance reports are being restructured to ensure that the
shortfalls in performance can more easily be identified.



                                             7
8. Recommendation

The Board is asked to note the content of this report and revised approach to
performance management.


Joan Charlton       Performance Manager
David Lea           Head of Performance

November 2008




                                     Appendices

Appendix One shows the Performance team’s forecast assessment of the likely
outcome of the results of the 2007/08 ratings based upon previous guidance available at
the time based upon the March 2008 outturn information.

Appendix Two shows the ratings as interpreted by the Healthcare Commission for
2007/08.




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