Exclusive: Concern in NHS England over Hunt's CCG 'points' rating system

The health secretary’s proposals include using quality and performance indicators to create a “points” score for CCGs’ overall performance. The same approach would be used to rate CCGs’ performance on specific population categories, such as the “frail elderly” or people with mental health problems.

Mr Hunt has told NHS England the ratings should be used for its CCG assurance regime for 2015-16. They are also to be published on the public MyNHS website, which the health secretary has championed.

However, some staff in NHS England, along with CCG leaders, are opposed to and are questioning significant elements of the proposals, HSJ has learned.

CCG assurance is used by the national commissioning body to monitor and sometimes intervene in the groups. Its current guidance on assurance for 2015-16 was published in March and would see each CCG rated as “assured as outstanding”, “assured as good”, “limited assurance, requires improvement” or “not assured”. Groups with serious problems could also be put into “special measures”, as revealed by HSJ last year.

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However, the guidance did not give full details of the quality and performance measures – described as a “scorecard” – which would underpin the assurance regime. These details are expected to be published around the end of May, after the general election. In the past NHS England has decided each CCG’s assurance rating based on judgements about its leadership, capability and planning, as well as on quality and performance measures. It has not previously given CCGs points ratings, either for specific population groups or for overall performance.

Senior sources involved in the work said NHS England officials and CCGs had similar concerns about it. They have discussed these concerns with Department of Health officials and are continuing to informally consult on the proposals. Those involved in the work said it was thought that if Mr Hunt did not return as health secretary after the election, the proposed approach would not be adopted. If he does they will have to return to details of how to implement it.

One senior source said some of those involved at NHS England were worried about the scores “presenting an overly simple view of performance, just about adding up scores”. They would prefer performance on quality indicators to be “incorporated into a broad assessment” rather than published as separate points scores. The source also said there were technical and “definitional issues” with Mr Hunt’s proposals, such as which individuals represented the “frail elderly”.

A CCG source said some groups were concerned it was a “league table” approach to performance, with the potential for “perverse” and unfair judgements, such as a CCG with strong leaders and capability being rated poorly because they had a historically unhealthy population.

The sources did not want to be identified due to the sensitivity of the issue and the election campaign.

An NHS England spokesman said: “NHS England and the DH are in full agreement on the approach now being taken to CCG assurance following publication of the framework on 26 March. We hope to launch the first version of the scorecard later this spring.” 

The Conservative Party had not provided a comment at the time of publication.

However, Mr Hunt, speaking about his proposed CCG measures in February, said: “I think just as the new [Care Quality Commission] inspection regime has made a big step towards a learning culture… I hope that will happen in terms of the commissioning of care. I think some more scientific rigour in terms of assessing the quality of commissioning throughout the country is going to be a critical next step.”