PERFORMANCE MEASURES 472 'prompts': a light touch?

Published: 02/12/2004, Volume II4, No. 5934 Page 7

Managers are concerned that the Healthcare Commission's new inspection system could impose major new burdens on trusts.

Far from the light touch regime they were promised, some chief executives fear the slew of 472 detailed 'prompts' for action on the 24 core standards could usher in a new age of targets by another name.

One senior source in inspection said: 'Chief executives are worried that there are a lot of words in the document saying that this is going to be a light touch, but if you count up all the intervention prompts it feels quite heavy.' The source continued: 'The commission says there will be more of a self-assessment system, but they are bringing in spot checks [to police compliance]. But he said this was not genuine self-assessment: the penalties will be so severe for foundation trusts and three-star trusts that they will not want to fail on anything during a spot check.

'So they will end up having to gather swathes of information to pass the standards. It will be a pretty intensive regime.' NHS Confederation policy manager Gary Fereday said managers were concerned that the prompts could become targets in all but name. 'Often it is not clear the difference between what is a requirement of our members, what is being recommended and what is just an observation about what could be done to improve services, ' he said.

'The language the commission uses is often a bit vague.

'We need to be clearer about what the commission is asking our members and what is in their power to require NHS managers to do.' But South Yorkshire strategic health authority chief executive Mike Farrar said the greater range of indicators meant that trusts would not have to skew their performance to meet centrally driven targets.

'It would be virtually impossible to have a system that measured every single facet of an organisation, so people will be freer to focus on the key issues in their trusts, ' he said.

NHS Alliance chair Dr Michael Dixon said it looked as if the new regime would not be as sensitive as star-ratings, where tiny variations could see trusts moving up and down entire stars.

He said he would have preferred there not to have been an aggregate score - but that ministers and the public wanted a single rating. 'One of the problems of star-ratings is that it mixed up the ratings of different departments, some good, some bad, ' he said. 'It produced a general score that did not mean anything for anyone looking for a good service.' Milton Keynes primary care trust chief executive Barbara Kennedy said she was not concerned that the local targets element was being delayed for a year. 'There is not enough money to do what we are supposed to be doing now, ' she said.

'The 18-week target is very challenging, and we have to get our head round practice-based commissioning, and new pharmacy and dental contracts. It makes sense to wait a year before taking on anything else.' She added: 'I think it will be more sensitive than the current system which is a bit of a blunt instrument. There seems to be increased transparency.

'I think the public needs some simple way of understanding how we have been doing. But there is no easy way of recognising complexity and informing the public at the same time.' Health Foundation chief executive Stephen Thornton, who is also a Healthcare Commission commissioner, said the commission had tried to reduce the burden on organisations at the same time as government increased the breadth of its standards: 'What has been brought out is a way to assess the performance of NHS organisations which is least burdensome in the circumstances - and the circumstances are a much wider range of standards than was the case under the old starratings system.'

Health check ratings: proposed timeline

Spring 2005: the Healthcare Commission will issue guidance on how to meet core standards and how it will assess performance against existing and new targets. The commission will also announce which improvement reviews will count against the 2005-06 ratings, and which NHS organisations will be affected.

September 2005: trusts will need to declare their ability to meet core standards. Those that cannot will have until the end of the month to deliver an action plan.

From December 2005: 'spot checks' on those trusts whose information causes the commission to doubt its compliance with core standards.

July 2006: publication of the new ratings.