NHS RATINGS 81 per cent of chief executives polled fear hidden significance of 'prompts'

Published: 17/02/2005, Volume II5, No. 5943 Page 6

Trust chief executives fear that the Healthcare Commission's 472 'prompts' - designed to help them map their progress against the core standards - will become another set of must-do targets.

In what commission chief executive Anna Walker described as a 'very, very significant misunderstanding', a massive 81 per cent of respondents to HSJ's chief executives survey said they thought the prompts would become another set of proxy targets for the NHS.

And NHS Confederation policy manager Gary Fereday said the commission had an 'awful lot more work to do' to reassure its members that this was not the case.

'A lot of our membership are saying that the problem with the prompts - whatever way they look at it - is that they are going to become a list of things you are going to have to do, or you are going to have to second guess the Healthcare Commission as to what the 'mustdos' are and the ones that do not apply to your trust.

'There is a real communications issue around the prompts and when the final document comes out we will be hoping there will be much greater clarity as to what they represent.' Sheffield Teaching Hospitals foundation trust chief executive Andrew Cash warned that the new system may not be 'fit for the purpose' for which it was intended because it will leave organisations with little time to focus on local targets.

Mr Cash, who is chair of the confederation's foundation trusts network, added: 'There is a general feeling that the burden of 472 prompts will turn into data requirements and be over burdensome. The real issue for me is the danger that we are going to squeeze out the ability to create local targets.' Network director Sue Slipman said the concerns were mirrored across all acute trusts. 'The system is designed to be one That is self-analytical. But when you have that number of prompts, if they become information requests, everyone would need vast departments to get that information organised and that would be a huge burden of regulation that would cost a fortune.' University Hospitals of Leicester trust chief executive Dr Peter Reading said: 'We are working through the 472 prompts - some are extremely helpful, some are of less value. There is the risk that they could become proxy targets, and no doubt the Healthcare Commission is aware of that.' However Milton Keynes primary care trust chief executive Barbara Kennedy said the prompts were 'really helpful'.

'We accept they are not meant to be targets in themselves but a useful means of self- assessment. However the comprehensive nature of the prompts means it will be a challenge for organisations to assess themselves against all that criteria.' Ms Walker said the prompts were there as 'guidance only' to help trusts check core standards were being met.

She added: 'My own personal view is that the NHS has been used to receiving very detailed guidance of things they should and shouldn't do and they have tended to see this in the same category.

Whereas what we are saying is this is a major shift because we are asking the trust board to make a selfassessment as to whether they meet the standards. It is a really radical departure.'