• Financial efficiency rating will be included in overall acute trust CQC rating next year
  • This is despite concerns from some that it will “dilute” quality ratings

Acute trusts’ overall Care Quality Commission ratings will take into account their financial efficiency from next year, despite concerns, NHS Improvement has said.

A response to a consultation on how to rate use of resources and leadership, published yesterday, said that regulators “anticipate” the “use of resources” assessment will contribute to overall CQC rating from 2018.

It states: “From 2018, we anticipate that all use of resources assessments will result in formal CQC ratings, which together with the rating from CQC’s core service level and well led inspections will yield an overall trust rating.”

It also states: “Effective use of resources is fundamental to enabling health providers to deliver and sustain high quality services. As the quality regulator, it is important that CQC reflects this.”

The decision was made despite concerns from consultation respondents that aggregating the use of resources rating with the CQC’s existing quality judgements would “dilute” the overall rating. The document cites concerns about it “making it less meaningful to patients and concern that it could mask poor performance”.

The consultation was carried out jointly by the CQC and NHS Improvement, and the response published on NHSI’s website.

It said “some respondents” believed the assessment “could lead to financial gains being pursued at the expense of the quality of care”.

Only 52 per cent of respondents agreed with the overall approach to the use of resources rating, although 65 per cent “agreed that the ratings should be combined over time”. The report said respondents overall supported combining the ratings.

The use of resources rating will look at how a trust performs against financial and operational productivity metrics including staffing costs and retention rates, length of stay and readmission rates, estate and procurement costs and distance from financial plan.

Assessments will start from autumn for non-specialist acute trusts. The assessments will be carried out by the NHS Improvement and will result in a rating of outstanding, good, requires improvement or inadequate which will then be passed to the CQC.

Initially, the resources rating will be published separately from the overall rating. In late autumn this year, NHS Improvement and CQC will then consult on how to combine the overall quality rating with a use of resources rating.

Justifying the decision, the consultation report said: “Combining the ratings will give us a more complete picture to ensure that our health services can continue to deliver high quality, including safe, care in a sustainable way.”

It continued: “Our overall approaches will therefore remain focused on quality; the addition of the use of resources assessment is about filling a gap to ensure we are overseeing trusts in a more rounded way”.

When it launched the consultation in December last year, neither NHSI nor the CQC had committed to incorporating use of resources in a single rating.

For trusts other than general acutes, no timetable has been specified for when use of resources assessments will begin. NHS Improvement’s report said the “availability and quality of productivity metrics” are not yet good enough to allow their efficiency to be assessed.

The use of resources assessment will become part of NHSI’s own single oversight framework assessment.

The document also reveals the CQC and NHSI are due to sign a new memorandum of understanding to “set out the principles and details of our working relationships”. It will include “operational protocols” to ensure roles and work are “clear and duplication is minimised”. It also confirms that the CQC and NHSI will use the same framework to judge leadership in future.