Published: 17/02/2005, Volume II5, No. 5943 Page 5
NHS chief executives fear the Healthcare Commission's new ratings system will be beset by bureaucracy and ineffective scrutiny, and that trusts will be unfairly named and shamed.
Although the majority of respondents to HSJ's survey praised the proposals, 81 per cent of chief executives feared that the system of prompts - designed as guidelines to help organisations to self-assess - will ultimately become 472 new proxy targets for the NHS.
Chief executives also questioned how effectively non-executive directors, patient forums and local authority scrutiny and overview committees would be able to discharge the role given to them under the new ratings system to ensure that standards were met.
And 79 per cent of chief executives said they did not understand what would happen to organisations that failed to meet the new standards.
Meanwhile, chief executives of foundation trusts were concerned about the high burden of scrutiny, expressing concerns that the commission's work will duplicate that of foundations regulator Monitor.
Overall, the majority of the 75 chief executives who responded to the survey preferred the new system to the star-ratings it will replace.
Fifty-seven per cent said the system was 'better' or 'significantly better' than star-ratings while 71 per cent felt the new system would produce a 'broader, fairer and more accurate assessment of performance'.
But respondents raised a host of concerns about the detail of the proposals, on which consultation closes on Monday.
One respondent summed up the fears of many chief executives: 'If you spend all the time weighing the pig, when do you take it to market?' Another welcomed the direction of travel but said the system was 'being rushed through'.
Others expressed fears of inconsistency in the way ratings would be applied, and of a significant increase in local bureaucracy.
One respondent called for 'urgent clarification' about the weightings of standards and the 'position of the bar' for performance grades.
Another said that judgements about the quality of leadership should only be made by 'very senior' and experienced personnel.
Concerns were also raised about the way the territories of regulatory bodies overlapped, an area described by one chief executive as 'a disaster waiting to happen'.
Several of the anonymous commentators praised the principles of the new system, but called for 'political maturity' in the way the standards are handled by both the commission and government.
The most succinct comment about the proposals for a new system provided the commission with a stark warning: 'The words 'frying pan' and 'fire' come to mind.' Of the 75 chief executives, 94 per cent questioned the commission's independence from government.
Commission chief executive Anna Walker said it would be measuring progress against government standards, but chief executives were 'simply wrong' if they thought it would be influenced by government.
Ms Walker welcomed HSJ's survey, saying it would 'have a real impact on the way we carry out our systems of assessment'. She highlighted the fact that 33 per cent of respondents felt the commission's proposals were 'too vague'.
'When we put out our final proposals we need to be more precise in certain areas - particularly on process.'
What the commission proposes There are 24 core standards. Trusts will have to declare publicly they are hitting these in September and this will then be corroborated by local partners. Only half of the chief executives polled were confident they would be able to achieve this.
The consultation sets out 472 prompts which boards should consider in deciding if they are meeting the standards.
Trusts will consequently be given one of five performance grades: very good, good, satisfactory, unsatisfactory or serious concerns.
Additional local targets will also be introduced, along with 13 developmental standards, but they will not be taken into account until the second year of the new ratings.
www. healthcare commission. org. uk