New NHS star ratings by Healthcare Commission
The Healthcare Commission has just published the annual star ratings of performance for NHS trusts in England. Star ratings show that the NHS improving against tougher targets but that a third of acute trusts fail on financial performance.
Overall the ratings show an improvement in the performance of the NHS against tougher waiting time targets for outpatient appointments and operations, as well as lower death rates for cancer and heart disease.
But almost a quarter of all trusts, including a third of acute trusts, failed to achieve financial balance for the year.
The ratings, which cover the financial year 2004/2005, assess performance in meeting targets that have become progressively tougher each year.
Areas covered include waiting times for hospital treatment, access to GPs and response times of ambulances, as well as management of finances and handling of patients and staff.
The results show:
Distribution of performance ratings in each sector of the NHS (%)
3 Star (last year) 2 Star 1 Star 0 Star
Acute & Specialist 42% (44%) 31% (34%) 22% (17%) 5% (6%)
Ambulance 42% (32%) 19% (35%) 29% (19%) 10% (13%)
PCT 19% (15%) 52% (60%) 27% (21%) 2% (5%)
Mental Health 25% (18%) 54% (46%) 14% (28%) 6% (8%)
Overall 28% (25%) 44% (49%) 24% (21%) 4% (6%)
Net Change +3% - 5% +3% -2%
Actual number of trusts with each performance rating
3 Star(last year) 2 Star 1 Star 0 Star
Total
Acute & Specialist 73 (76) 53 (58) 38 (29) 9 (10) 173
Ambulance 13 (10) 6 (11) 9 (6) 3 (4) 31
PCT 58 (45) 157 (181) 81 (63) 7 (14) 303
Mental Health 21 (15) 45 (38) 12 (23) 5 (7) 83
Overall 165 (146) 261 (288) 140 (121) 24 (35) 590
Net Change +19 -27 +19 -11
The results show a rise in the overall number of trusts with the maximum three stars, up 19 from 146 to 165. There was also a fall in the number of trusts with zero stars, down 11 from 35 to 24.
But for the first time in four years there was a drop in the number of acute hospital trusts with three stars. This reflects difficulties in meeting the indicator relating to financial performance and the tougher targets for waiting times in accident and emergency.
Thirteen more primary care trusts (PCTs) achieved three stars compared with last year. But still only 19% of PCTs earned the three star status, which compares with 42% for acute and ambulance trusts.
In London, where PCTs serve complex populations and historically have performed less well, four PCTs jumped from zero stars to two, including Tower Hamlets Primary Care Trust. This contributed to a considerable rise in the number of two star PCTs, although London still has no three star PCTs.
Among ambulance trusts, there was a 10% rise in the number of three-star organisations (three more). But 12 out of 31 ambulance trusts have zero or one star.
The number of two and three star mental health trusts increased but still only a quarter have three stars. The Commission has worked closely with mental health trusts to improve the quality of data on performance but the challenge remains to measure what really matters to patients and staff in the most meaningful way.
Almost a quarter of all trusts (138 out of 590) failed the key target on financial management (to break even by year end), resulting in a total overspend of almost £500 million. Twenty four per cent (72 out of 303) of PCTs failed to achieve financial balance, with one in three (59 out of 173) acute trusts also failing on this key target.
On performance in meeting key targets, the ratings show:
· 87% of acute and specialist trusts achieved the nine month waiting time target for inpatient care
· 94% of acute and specialist trusts achieved the 17-week waiting time target for outpatient appointments after referral by a GP
· 81% of PCTs achieved their own targets of helping people to quit smoking for at least four weeks
· 97% of PCTs offered patients a routine appointment to see a GP within two working days.
For the first nine months of the year all trusts met the national A&E target, which required 90% of patients to wait less than four hours. But the government increased the target to 100% for the last three months of the year. Sixty-two out of 159 acute trusts with A&E departments failed to meet the higher standard (set at 98% to allow for patients who could not be moved for clinical reasons).
This year the Commission assessed performance in relation to MRSA including rates of infection, levels of improvement, and use of alcohol gel for washing hands. Twenty-eight trusts achieved above average performance scores while 21 achieved below average scores. The number of MRSA bacteraemia cases in hospital fell from 7,684 in 2003/2004 to 7,215 in 2004/2005.
The ratings show a drop in death rates from cancer, stroke and heart disease. In England, there has been a fall in the number of deaths from cancer in people aged under 75 - from around 67,000 in 1999 to under 63,500 in 2003. Over the same time period, there has been a fall in deaths from circulatory diseases, such as stroke and heart disease, in people aged under 75 - from around 64,000 to just over 52,000.
Anna Walker, Chief Executive of the Healthcare Commission, said: “The NHS is improving against tougher targets. The overall improvement in performance this year should not be underestimated. Today the targets are a lot tougher, but despite this many trusts are rising to the challenge.
“Four years ago the target for patients waiting to have an operation was 18 months, but today it is nine months. There are more top performers and fewer trusts with no stars at all.
“The fly in the ointment is financial performance. Quality of care is inextricably linked to good financial management. Temporary instability must not lead to a permanent problem. If it does, patients will lose out because the standards of care will suffer.
“There are also still unacceptably wide variations in performance and more one and zero star trusts than there should be. More has to be done to bring the poor performing organisations up to the standards of the best.”
This is the final year that the Commission will rate performance using the current star ratings system. Next year the inspectorate will rate trusts by reference to its new annual health check, which aims to give a more comprehensive picture of NHS performance.
http://ratings2005.healthcarecommission.org.uk/more_information.asp
Overall the ratings show an improvement in the performance of the NHS against tougher waiting time targets for outpatient appointments and operations, as well as lower death rates for cancer and heart disease.
But almost a quarter of all trusts, including a third of acute trusts, failed to achieve financial balance for the year.
The ratings, which cover the financial year 2004/2005, assess performance in meeting targets that have become progressively tougher each year.
Areas covered include waiting times for hospital treatment, access to GPs and response times of ambulances, as well as management of finances and handling of patients and staff.
The results show:
Distribution of performance ratings in each sector of the NHS (%)
3 Star (last year) 2 Star 1 Star 0 Star
Acute & Specialist 42% (44%) 31% (34%) 22% (17%) 5% (6%)
Ambulance 42% (32%) 19% (35%) 29% (19%) 10% (13%)
PCT 19% (15%) 52% (60%) 27% (21%) 2% (5%)
Mental Health 25% (18%) 54% (46%) 14% (28%) 6% (8%)
Overall 28% (25%) 44% (49%) 24% (21%) 4% (6%)
Net Change +3% - 5% +3% -2%
Actual number of trusts with each performance rating
3 Star(last year) 2 Star 1 Star 0 Star
Total
Acute & Specialist 73 (76) 53 (58) 38 (29) 9 (10) 173
Ambulance 13 (10) 6 (11) 9 (6) 3 (4) 31
PCT 58 (45) 157 (181) 81 (63) 7 (14) 303
Mental Health 21 (15) 45 (38) 12 (23) 5 (7) 83
Overall 165 (146) 261 (288) 140 (121) 24 (35) 590
Net Change +19 -27 +19 -11
The results show a rise in the overall number of trusts with the maximum three stars, up 19 from 146 to 165. There was also a fall in the number of trusts with zero stars, down 11 from 35 to 24.
But for the first time in four years there was a drop in the number of acute hospital trusts with three stars. This reflects difficulties in meeting the indicator relating to financial performance and the tougher targets for waiting times in accident and emergency.
Thirteen more primary care trusts (PCTs) achieved three stars compared with last year. But still only 19% of PCTs earned the three star status, which compares with 42% for acute and ambulance trusts.
In London, where PCTs serve complex populations and historically have performed less well, four PCTs jumped from zero stars to two, including Tower Hamlets Primary Care Trust. This contributed to a considerable rise in the number of two star PCTs, although London still has no three star PCTs.
Among ambulance trusts, there was a 10% rise in the number of three-star organisations (three more). But 12 out of 31 ambulance trusts have zero or one star.
The number of two and three star mental health trusts increased but still only a quarter have three stars. The Commission has worked closely with mental health trusts to improve the quality of data on performance but the challenge remains to measure what really matters to patients and staff in the most meaningful way.
Almost a quarter of all trusts (138 out of 590) failed the key target on financial management (to break even by year end), resulting in a total overspend of almost £500 million. Twenty four per cent (72 out of 303) of PCTs failed to achieve financial balance, with one in three (59 out of 173) acute trusts also failing on this key target.
On performance in meeting key targets, the ratings show:
· 87% of acute and specialist trusts achieved the nine month waiting time target for inpatient care
· 94% of acute and specialist trusts achieved the 17-week waiting time target for outpatient appointments after referral by a GP
· 81% of PCTs achieved their own targets of helping people to quit smoking for at least four weeks
· 97% of PCTs offered patients a routine appointment to see a GP within two working days.
For the first nine months of the year all trusts met the national A&E target, which required 90% of patients to wait less than four hours. But the government increased the target to 100% for the last three months of the year. Sixty-two out of 159 acute trusts with A&E departments failed to meet the higher standard (set at 98% to allow for patients who could not be moved for clinical reasons).
This year the Commission assessed performance in relation to MRSA including rates of infection, levels of improvement, and use of alcohol gel for washing hands. Twenty-eight trusts achieved above average performance scores while 21 achieved below average scores. The number of MRSA bacteraemia cases in hospital fell from 7,684 in 2003/2004 to 7,215 in 2004/2005.
The ratings show a drop in death rates from cancer, stroke and heart disease. In England, there has been a fall in the number of deaths from cancer in people aged under 75 - from around 67,000 in 1999 to under 63,500 in 2003. Over the same time period, there has been a fall in deaths from circulatory diseases, such as stroke and heart disease, in people aged under 75 - from around 64,000 to just over 52,000.
Anna Walker, Chief Executive of the Healthcare Commission, said: “The NHS is improving against tougher targets. The overall improvement in performance this year should not be underestimated. Today the targets are a lot tougher, but despite this many trusts are rising to the challenge.
“Four years ago the target for patients waiting to have an operation was 18 months, but today it is nine months. There are more top performers and fewer trusts with no stars at all.
“The fly in the ointment is financial performance. Quality of care is inextricably linked to good financial management. Temporary instability must not lead to a permanent problem. If it does, patients will lose out because the standards of care will suffer.
“There are also still unacceptably wide variations in performance and more one and zero star trusts than there should be. More has to be done to bring the poor performing organisations up to the standards of the best.”
This is the final year that the Commission will rate performance using the current star ratings system. Next year the inspectorate will rate trusts by reference to its new annual health check, which aims to give a more comprehensive picture of NHS performance.
http://ratings2005.healthcarecommission.org.uk/more_information.asp
posted by Dr Search- Principal Consultant at the Search Clinic at
10:41 AM
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