1. New Health Service Annual Health Check Adam R. Brown - Team Leader West Yorkshire and North East Yorkshire and North Lincolnshire August 2005 N

2. 2 Our statutory roles Assessment of the provision of health care, including public health, in the NHS & independent sectors Annual ratings for NHS trusts Regulation and annual inspection of independent healthcare Consideration of complaints which NHS trusts have not resolved Investigations into serious service failures Coordination of healthcare inspection by others

3. 3 10 local areas across 4 regions

4. 4 North Head of region: Kate Lobley Area: North East Area manager: Jo Dent SHAs: County Durham and Tees Valley and Northumberland,Tyne and Wear Area: North West Area manager: Mike Rose SHAs: Cheshire and Merseyside, Greater Manchester and Cumbria and Lancashire Area: Yorkshire and Humberside Area manager: Jo Dent SHAs: North and East Yorkshire and Northern Lincolnshire, South Yorkshire and West Yorkshire

5. 5 Working locally Roles: provide information, advice and assistance in support of the annual health check support sharing of learning and best practice work with local healthcare organisations, and patients’ and community groups carry out inspections in NHS and independent healthcare Four regions with the majority of our operations staff working locally

6. 6 Working locally Roles: coordinate our work with other regulators develop local knowledge of both the independent and NHS healthcare providers understand local needs and concerns for both patients and the public context setting for annual health checks and other evaluations provide a local interface for providers and patient representative groups

7. 7 Principles of new approach Measuring what matters Richer picture of performance Standards and targets Reduce unnecessary burden self assessment intelligent use of information partnership with other regulators - Concordat targeted inspection Fair judgements, reported clearly to each of our audiences

8. 8 Standards for better health safety clinical and cost effectiveness governance patient focused accessible and responsive care care environment and amenities public health Core standards – must do now Developmental standards - aspirational

9. 9 Our assessments 2005/2006 Annual review and performance rating Core standards Getting the basics right Developmental standards Making & sustaining progress Meeting new national targets Improvement reviews Meeting existing targets Use of resources Meeting core standards

10. 10 Assessing trusts on core standards April 2005: Guidance published Criteria for assessing core standards: 24 standards, broken into 80 ‘elements’, or component parts key pieces of national guidance or legislation relevant to each ‘element’ information we will use to check each ‘element’ in the declaration Core standards Getting the basics right

11. 11 Assessing trusts on core standards October 2005: Draft declaration Trust boards make a statement outlining: if they are meeting core standards any significant lapse with action plan any standard where compliance is not clear We will require trusts to invite comments from: patient and public involvement forums overview and scrutiny committees strategic health authorities Core standards Getting the basics right

12. 12 Assessing trusts on core standards October/November 2005: Cross checking the draft declaration Check draft declarations against: comments from third parties wide range of available information intelligence from our complaints and investigations work NHS staff and patients’ surveys other regulators’ findings Checking process identifies trusts most at risk of not meeting core standards Core standards Getting the basics right

13. 13 Assessing trusts on core standards November 2005-April 2006: Selective follow-up Two groups of trust: risk-based group where checks have raised concern for some standards random spot checks Significant concerns may lead to a formal investigation Core standards Getting the basics right

14. 14 Assessing trusts on core standards April 2006: Final declaration states how far the trust has met the core standards in the past year includes new comments from same third parties is made in public will form the basis for our assessment Core standards Getting the basics right

15. 15 Assessing trusts on core standards April - September 2006: Cross checking and selective inspection same cross checking process as before selective inspections of trusts at risk of not meeting standards plus random spot checks, visiting a total of 20% of trusts we judge how well each trust is meeting core standards and may amend the declaration Core standards Getting the basics right September 2006: Scoring on 4 point scale

16. 16 Core standards assessment Timeline Oct. – Nov. 2005 April – June 2005 Nov. 2005 – Apr. 2006 October 2005 Selective follow-up Cross checking draft declarations Guidance published Draft declarations Annual performance rating published September 2006 April – Sept 2006 Final declarations, cross checking and selective inspection

17. 17 Assessing trusts on core standards Primary care trusts Standards apply to all PCT activities including: services provided directly services provided by independent contractors services commissioned from other providers PCTs should: use commissioning process to promote compliance take appropriate action when standards not being met In 2005/2006 PCTs will be assessed on the process of commissioning, not on services commissioned from others

18. 18 Other components of getting the basics right Core standards Getting the basics right Existing targetsUse of resources The 20 targets to which NHS is already committed Financial performance and how well money is spent Methods familiar from the current ratings Using results from the Audit Commission & Monitor These assessments will be reported separately in our annual review. Other regulatory findings will be used for: checking trusts’ declarations as ‘trump cards’, taken as evidence of meeting a standard commentary on ‘dashboard’

19. 19 Making & sustaining progress Improvement reviews In depth review to identify and measure the steps trusts can take to progress towards meeting developmental targets. Focusing on: an aspect of the patient’s pathway… a service e.g. adult community mental health a population group, e.g. children a condition e.g. heart failure a domain of the developmental standards… - e.g. safety/hospital acquired infection/MRSA Developmental standards Making & sustaining progress

20. 20 Improvement reviews : main steps Development: identify best practice and factors critical to performance Collecting data: gather data, where possible using data which is already available Assessing performance: assess performance of all relevant organisations Planning improvement: target visits on trusts where there is greatest potential for improvement Monitoring improvement: we will monitor data to track improvement Developmental standards Making & sustaining progress

21. 21 Improvement reviews Programme for 2005/06 Reviews that will contribute directly to performance ratings Heart failure YY Children's hospital services (national service framework) Y Adult community mental health services - with Commission for Social Care Inspection YY Substance misuse - with National Treatment Agency YY Public health - tobacco control Y Safety – hospital acquired infection/MRSA YY Admissions to hospitals (acute hospital portfolio) YY Diagnostic services (acute hospital portfolio) YYY Management of medicines (acute hospital portfolio) YYY Acute Primary care Mental health Ambulance Specialist Developmental standards Making & sustaining progress

22. 22 Improvement reviews Programme for 2005/06 Reviews that may feed indirectly into ratings Public health - sexual health Y Older people's services - with Commission for Social Care Inspection and the Audit Commission YYYY Joint area reviews (children's services) - Ofsted-led YYYY Chronic obstructive pulmonary disease YY Equality, diversity and human rights YYYYY Acute Primary care Mental health Ambulance Specialist Developmental standards Making & sustaining progress

23. 23 Annual performance rating will be based on a four point scale will include separate ratings for components Core standards Existing targets Overall rating Use of resources New national targets Improvement reviews Fully met Almost met Partly met Not met Excellent Good Fair Weak

24. 24 Dashboard Illustration

25. 25 Assessing independent healthcare Targeted inspection Revised self assessments tailored to different types of establishment hospitals and mental health establishments single specialty services private doctors services which do not require a clinical qualification shorter forms, with more focused questions mapped to Standards for Better Health inspections focused on particular standards

26. 26 Future developments We are developing: criteria for feeding other findings into ratings how to measure best practice in developmental standards assessment of leadership and capacity assessment of local targets ways to access the views of disadvantaged communities...and we will be consulting on our strategy for regulation of independent healthcare.

27. 27 FOR MORE INFORMATION For copies of available guidance and documents on the new health check please contact: e-mail: feedback@healthcarecommission.org.uk call our helpdesk on 0845 601 3012 All these materials are available at: www.healthcarecommission.org.uk