The Department of Health is developing a new vision for delivering better care and value in health and social care.

The move is outlined in The Future Regulation of Health and Adult Social Care in England, seen by HSJ.

The report explains that the DoH is developing a new accountability framework to ensure organisations look to their local community for direction rather than to the DoH.

It says: 'A new accountability framework that supports reform will shift radically the focus of performance from central direction to locally driven improvement by building the framework around a clear set of outcomes across the whole range of health and social care and by supporting local integration... across health and social care services.'

Strategic objectives

It lists the three main features of this new approach.

  • First, the DoH will set out its 'vision and strategic objectives concerning delivering better health and well-being, better care and value for all'.
  • Second, the DoH is in talks with various stakeholders and the public to develop a set of 'no more than 40 ambitions and metrics derived from these strategic objectives'.
  • Third, primary care trusts will be issued with a public report card through which they will be benchmarked against their peers in each of the key outcomes, and against which PCTs (and local authorities where appropriate) are accountable to the public.

HSJ understands that the key outcomes will be derived from the '40 ambitions and metrics'.

League table danger

NHS Confederation PCT network chair David Stout said benchmarking was a positive thing as long as its interpretation did not result in a league table.

He said: 'Benchmarking can help your organisation compare itself to other places as it can be difficult to know how you are doing. But we have to be careful of the interpretation. We don't want it to look like a schools league table.'

He highlighted the fact that PCTs have provider and commissioner functions, which should not be compared against one another.

He added: 'There is a danger that people will take something that is complicated and leap to simplistic conclusions.'

Yearly checks

The Healthcare Commission's annual healthcheck ratings use a risk-based approach to assess PCTs and focuses on their provider rather than commissioner functions.

The document says the new performance framework for PCTs will enhance accountability to the public and Parliament and provide information to support local performance management.

It says: 'This assessment will be carried out by Ofcare [the new regulatory body for health and social care]. Responsibility for improvement action to be taken locally in response to performance assessments will be with PCTs, SHAs and local authorities.'

The document says a performance framework, focused on local priorities and based on outcomes, is being developed and will form the basis for assessing commissioners.

It adds that the secretary of state will have responsibility for developing the performance indicators and Ofcare will develop the overall assessment structure.

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