Existing national targets

Introduction

Assessment of performance against the existing national targets is one component of the ‘Quality’ element of the Healthcare Commission’s 2005/2006 annual health check and covers the targets published by the Department of Health in National Standards, Local Action: Health and Social Care Standards and Planning Framework 2005/2006 – 2007/2008. The existing national targets assess whether levels of service set through the 2003-2006 planning round are being maintained and are considered to be the basics of what organisations should be doing. Accordingly, the existing national targets carry a heavy weight in the derivation of the overall ‘Quality’ score.

We will assess performance in relation to the existing national targets outlined in National Standards, Local Action using the indicators detailed under the relevant links on the left hand side of this webpage. For each target, we will assess the performance of organisations that provide services. Where appropriate, primary care trusts (PCTs) will also be assessed on the services they commission from providers.

The links on the left hand side of this webpage refer to:

• the names of the indicators which we will use to assess ambulance, acute and specialist, mental health and primary care trusts, including details of why the indicator is included, the data source and the period of time assessed by the indicator.

Queries

We welcome feedback on, or queries about, the indicators. It would be helpful if issues were raised as soon as possible rather than waiting until we are close to publishing performance ratings in 2006. Please direct any queries to the mailbox:

performance.indicators@healthcarecommission.org.uk

Key Issues

Core Standards

Some of the existing national targets overlap with elements of core standards. Where this is the case, we will assess performance under the existing national targets strand of our assessment.

Our approach to targets

The existing national targets assess whether levels of service set through the 2003-2006 planning round are being maintained and are considered to be the basics of what organisations should be doing.

We will continue to use our experience of assessing performance relating to targets to contribute to improving the understanding of the impact of targets and addressing any unintended effects.

Combined trusts

Combined trusts (those healthcare organisations which provide functions of more than one type, for example, primary care trusts which also provide mental health services) should refer to the indicator lists for all relevant trust types. Their assessment will be based on all of the indicators for each function they deliver.

Learning disability trusts

There are currently no existing national targets that relate to learning disability trusts, so learning disability trusts will not be assessed under this component of the annual health check.

How do we assess performance relating to existing national targets?

The process for assessing performance relating to the existing national targets consists of

• publication of technical specifications for the indicators (constructions)
• data collection from data collectors (as described below)
• data validation by data collectors
• data ratification by the Healthcare Commission
• Healthcare Commission consideration of extenuating circumstances applications
• scoring
• publication of the score as part of the annual health check

Further guidance will be issued on the process as indicated below .

This section outlines key activities and highlights important issues healthcare organisations should take into account in preparing for our assessment

Data collection

The Healthcare Commission is committed to reducing the burden of inspection and data collection on healthcare organisations. Where possible, we use data from existing, mandatory data collections to support our assessment of performance relating to the existing national targets. We therefore commission data from a range of data collectors - for example, the Department of Health, the new NHS Information Centre, the Royal College of Physicians - as indicated in the data source section of the indicators published on this web site. As in previous years, we will apply to the Review of Central Returns (ROCR) for permission for special data collections.

Data quality and timeliness

Healthcare organisations are responsible for supplying accurate, good quality data. Complete data must be supplied by the deadlines set by data collectors

Organisations can be penalised for poor quality data or if complete data are not returned by published deadlines.

Data collectors are responsible for data validation and healthcare organisations should ensure that they take up the opportunities provided for validation, as the Healthcare Commission will only allow changes to data in exceptional circumstances.

Ratification

The ratification process will take place in early summer 2006, commencing May 17th 2006, as relevant datasets become available to the Healthcare Commission. The Healthcare Commission will provide trusts and SHAs with detailed guidance and their unique passwords in advance of the commencement of the ratification process. The process is similar to that used for the ratification of star ratings data in previous years.

Ratification provides organisations with an opportunity to see the data that will be used to construct their performance rating for each indicator in this strand of the annual health check. The object of the exercise is not to provide an opportunity to change data but to enable organisations to check that the Healthcare Commission is using the data they supplied to the data collector.

Extenuating circumstances

The Healthcare Commission seeks to apply its assessments fairly and consistently across all organisations, using criteria and methods that have been developed following consultation with a wide range of stakeholders. Occasionally, due to the impact of an extenuating circumstance, it may be inappropriate and unfair to assess an organisation using a specific aspect of the published criteria and methods. In such cases, an organisation may make a request for the Healthcare Commission to take this into account before undertaking their scoring.

The protocol for extenuating circumstances will be released to trusts and SHAs in May 2006 and will also be available for download from within the ratification website. Trusts must be able to demonstrate that they fully meet the criteria contained within the protocol before the Healthcare Commission will consider any request.

Scoring

The scores for each existing national target are aggregated into one overall score, which then contributes to the overall ‘Quality’ element of the annual health check. Existing national targets are scored on the following four-grade scale:

• fully met
• almost met
• partly met
• not met

Each trust is assessed by a set of performance indicators, specifically designed to measure the existing national targets that apply to it. Scoring of the individual performance indicators underlying each target will use a three point scale reflecting the level of achievement.

Not all existing national targets apply to all trusts. The number of applicable existing national targets varies by health care organisation type and may vary between trusts of the same organisation type. Trusts will only be assessed against the targets and indicators that are applicable to them within their relevant set(s) of indicators.

Please click here for further details on the scoring methodology for existing national targets. This document was updated on May 11th 2006, to include a worked example (the rules have not been amended since the original publication). The document includes the following information:

• outline of the existing national targets scoring methodology
• key principles of scoring existing national targets
• allocation table for acute & specialist trusts
• allocation table for primary care trusts (PCTs)
• allocation table for ambulance trusts
• allocation table for mental health trusts
• allocation table for PCTs that also provide mental health services
• allocation table for combined trusts, which provide acute, ambulance, and mental health services

As the annual health check is a new system, the Healthcare Commission reserves the right to modify its scoring methods in light of experience. Any changes made would be transparent and intended to promote fairness in the results of the assessment. Rule changes would either apply across all health care organisation types, or might be specific to a particular health care organisation type.

If you have any comments or queries regarding scoring of the existing national targets, please e-mail us at:

performance.indicators@healthcarecommission.org.uk

Thresholds and targets

On May 11th 2006 we are pleased to be able to publish some of the high-level thresholds for the existing national targets. We are confident that these thresholds are robust and take into account any data issues, and for this reason, we are happy to publish them early. We hope that this will help performance leads in their role of assessing the performance of their organisation and in assuring their trust board. It should also help trusts to focus on which indicators they may wish to query during ratification. More will follow within the next two months, with the remainder being published in October 2006.

 

Further guidance

We will publish the following guidance in May 2006:

• handling general data queries
• handling extenuating circumstances
• the ratification process