Meeting documents
Health Scrutiny Sub-Committee (DCC)
Monday 11 July 2005
Meeting: Health Scrutiny Sub-Committee (County Hall, Durham - Committee Room 2 - 11/07/2005 10:00:00 AM)
Item: A7 Health Care Commission - Assessment of Health Trusts
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11 July 2005
Health Care Commission - Assessment of Health Trusts
| Report of Head of Overview and Scrutiny |
Purpose of Report
1. To explain the accompanying report from the Primary Care Trusts in County Durham about the new assessment process for Health Trusts which will involve the Health Scrutiny Sub-Committee.
Background
2. The Health Care Commission promotes improvements in the quality of health care and public health in England. They are introducing a new approach to assessing and reporting on the performance of health care organisations.
3. This new system, or annual health check, measures performance by reference to the Government’s standards. The standards cover issues of concern to the public, patients and those who look after them.
4. Scrutiny Committees and Patient and Public Forums will be asked to comment about whether the Trust is meeting the core standards. The Commission recognises that, at this stage, Scrutiny Committees may not be in a position to make comprehensive judgements about the performance of Trusts. The opportunity is, however, to be given to Scrutiny Committees to comment based on their current knowledge of each Trust.
5. The attached briefing note gives more detail about the process and the standards. The Sub-Committee will be receiving a presentation about the briefing note.
Recommendation
6. You are recommended to consider this information.
| Contact: Ian Mackenzie Tel: 0191 383 3506 |
County Durham PCTs
Purpose
The PCTs Approach to Implementing Standards for Better Health
Briefing Note to Overview and Scrutiny Committee
1. This paper is intended to raise awareness of the PCTs approach to the implementation of Standards for Better Health and to request views from the County-wide Overview and Scrutiny Committee (OSC) about feedback on the draft and final declarations.
Standards for Better Health Summary
2. In July 2004 the Department of Health published Standards for better health within their publication, National Standards Local Action: Health and Social Care Standards and Planning Framework 2005/06 -2007/08. The standards comprise 24 core standards and 13 developmental standards. The standards are central to the planning and delivery of services to 2008.
3. The core standards describe an acceptable level of service that all patients and services users should expect from the NHS regardless of whether their care and treatment is provided by the public, private or voluntary sectors. They do not themselves set out any new expectations of the NHS and are based on a number of requirements that already exist. Meeting the core standards is not optional and it expected that organisations meet these from April 2005.
4. The developmental standards are intended to promote continuous improvement in the quality of services. It is expected that progress will continue to be made across the developmental standards as a result of the NHS Improvement Plan and extra investment up to 2008.
5. The core and developmental standards are organised across 7 domains:
- Safety
- Clinical and cost effectiveness
- Governance
- Patient focus
- Accessible and responsive care
- Care environment and amenities
- Public Health
Assessment Against the Standards
7. Standards for Better Health form part of the new assessment process introduced by the newly created Healthcare Commission. The Healthcare Commission has wide ranging responsibilities aimed at improving the quality of NHS services. This includes the statutory duty to assess the performance of healthcare organisations.
8. The assessment is known as the ‘annual health check’ which covers progress against the core and developmental standards and performance indicators and use of resources. The assessment process is subdivided into two parts. Part 1, getting the basics right looks at progress in meeting the core standards, existing targets and use of resources. Part 2, making and sustaining progress looks at progress against the developmental standards and new priorities to 2008. The assessment process in 2006/07 will include local targets developed by PCTs.
Declaration on meeting the Core Standards
9. As part of the assessment process, PCTs need to make a declaration to the Healthcare Commission on whether they are meeting the core standards. An action plan needs to be included in the declaration in instances where core standards have not been met. It is expected that only significant lapses in not meeting a core standard are included in the declaration. In this year only, a draft declaration is made to the Healthcare Commission in October 2005 and a final declaration is made in April 2006.
11. PCTs are required to seek comments on the draft declaration from key stakeholders including:
- Overview and Scrutiny Committee
- Strategic Health Authority
- Patient and Public Involvement Forums
13. The Healthcare Commission will undertake a process of checking the draft and final declaration to identify PCTs at risk of not meeting core standards. In checking the declaration, the Healthcare Commission will use existing information sources available to them, such as public health data. The Healthcare Commission will undertake further enquiries and possibly inspect those PCTs assessed at risk of not meeting a core standard. The Healthcare Commission will also undertake random spot checks of PCTs against core standards where there is insufficient information to determine if a core standard has been met.
14. At the end of the assessment process the Healthcare Commission will give PCTs a performance rating against meeting the core standards.
15. The Strategic Health Authority retains the responsibility for the performance management of any action required to be taken by a PCT to meet the core standards.
The PCTs Approach to meet Core Standards
16. Each PCT has developed arrangements to ensure the core standards are met and prepare to for the new Healthcare Commission assessment process. These preparations have been built on existing arrangements under the Department of Health’s policies for Clinical Governance, Corporate Governance and National Service Frameworks.
17. PCTs have undertaken baseline assessments against core and development standards to identify any gaps in meeting core standards and requirements to meet developmental standards that need to be incorporated into business planning.
18. Baseline assessments have included involvement of key stakeholders within their organisation, including primary care contractors, such as GP’s, Dentists, Pharmacists and Optometrists. A number of approaches to undertaking the baseline assessment have been used including workshops, seminars and presentations. Core and developmental standards have been allocated to named individuals with responsibility for ensuring that these are met and maintained.
19. The Strategic Health Authority (SHA) provided guidance to PCTs on approaches to the baseline assessment. Each PCT has submitted a copy its baseline assessment and action plan to address any gaps to the SHA for assessment. The SHA has provided detailed feedback to each PCT on its baseline assessment. The SHA continues to support PCTs in their preparations for meeting Standards for Better Health.
20. PCTs have developed a range of mechanisms to ensure reporting on progress in meeting the core and developmental standards, involving their Boards and Executive Committees. Links to the performance management system have also been made within PCTs.
Improvement Reviews
21. The Healthcare Commission will use improvement reviews to assess performance against meeting the developmental standards to look at progress made by PCTs in ensuring continuous improvement in health and the quality of care people receive. Improvement reviews will be phased in from this year following a number of pilots. Easington PCT, for example, took part in two Public Health Domain improvement review pilots. These pilots looked at Sexual Health Services and Tobacco Control. Subject to satisfactory evaluations, the Healthcare Commission will incorporate the following improvement reviews into the annual assessment for 2005/06:
- Public Health (tobacco control)
- Children’s hospital services (based on the National Service Framework)
- Substance misuse (with the National Treatment Agency)
- Adult community mental health (with the Commission for Social Care Inspection)
- MRSA/Hospital acquired infection/safety
- Heart Failure
Links with Existing Targets and New Priority Areas
23. The annual assessment will cover the assessment of performance against existing requirements, such as access targets, shorter waiting and response times and the new priority areas such as improving the health of the population. These requirements are detailed in the Department of Health publication National Standards Local Action: Health and Social Care Standards and Planning Framework 2005/06 -2007/08.
24. In 2005/06, PCTs will be required to introduce local targets to measure progress in making continuous improvements in services. The Department of Health’s programme on better metrics will provide an approach for PCTs. Better metrics aims to assist PCTs to develop more clinically focused indicators with involvement of healthcare professionals at local level. Some PCTs are developing local indicators, using the better metrics approach during 2005/06 in preparation for the next annual assessment in 2006/07.
Engagement with Overview and Scrutiny Committee
25. Standards for Better Health provides a number of opportunities for the OSC to become involved in the Healthcare Commission’s new assessment framework. PCTs are required to seek comments from the OSC on their draft and final declarations for meeting the core standards in 2005/06. This will be an annual requirement and will enable the OSC to consider the work it has undertaken over the year and how this informs the Committee about a PCTs declaration against the core standards.
26. There are 24 core standards and some may be more relevant to the role and remit of the OSC than others. Discussion with the Commission suggests that the OSC might, in particular, wish to comment on the following core standards.
C13 - Health care organisations have systems in place to ensure that:
a) staff treat patients, their relatives and carers with dignity and respect;
b) appropriate consent is obtained when required for all contacts with patients and for the use of any patient confidential information; and
c) staff treat patient information confidentially, except where authorised by legislation to the contrary.
C 14 - Health care organisations have systems in place to ensure that patients, their relatives and carers:
a) have suitable and accessible information about, and clear access to, procedures to register formal complaints and feedback on the quality of services;
b) are not discriminated against when complaints are made; and
c) are assured that organisations act appropriately on any concerns and, where appropriate, make changes to ensure improvements in service delivery.
C 15 - Where food is provided, health care organisations have systems in place to ensure that:
a) patients are provided with a choice and that it is prepared safely and provides a balanced diet; and
b) patients’ individual nutritional, personal and clinical dietary requirements are met, including any necessary help with feeding and access to food 24 hours a day.
C 16 - Health care organisations make information available to patients and the public on their services, provide patients with suitable and accessible information on the care and treatment they receive and, where appropriate, inform patients on what to expect during treatment, care and after-care.
C17 - The views of patients, their carers and others are sought and taken into account in designing, planning, delivering and improving health care services
C22 - Health care organisations promote, protect and demonstrably improve the health of the community served, and narrow health inequalities by:
a) co-operating with each other and with Local Authorities and other organisations;
b) ensuring that the local Director of Public Health’s Annual Report informs their policies and practices; and
c) making an appropriate and effective contribution to local partnership arrangements including Local Strategic Partnerships and Crime and Disorder Reduction Partnerships.
C23 - Health care organisations have systematic and managed disease prevention and health promotion programmes which meet the requirements of the National Service Frameworks and national plans with particular regard to reducing obesity through action on nutrition and exercise, smoking, substance misuse and sexually transmitted infections.
C24 - Health care organisations protect the public by having a planned, prepared and, where possible, practiced response to incidents and emergency situations which could affect the provision of normal services.
27. There is no obligation on the OSC to provide comments but PCTs are required to ask and this process enables the OSC to become involved in Standards for Better Health and the assessment of PCTs.
28. The County-wide OSC needs to give some thought with regard to the two-tier system of local government in relation to comments on the declaration. It is assumed that the relevant District Council members of the OSC will be a focus for comments on their respective PCT.
29. There needs to be agreement about the process for obtaining comments which will need to be at two points during 2005/06 in October and April. It is hoped that this could be discussed on 11 July.
Recommendation
30. The OSC is requested to receive the report and to agree mechanisms for feedback to the 5 PCTs on the draft and final declaration.
Report Prepared by:
Helen Byrne
Deputy Chief Executive, Easington PCT
Andrew Young Chief Executive
Durham and Chester-le-street PCT
23 June 2005
Attachments