Performance ratings for NHS trusts in England, covering the year ending March 2003 are the first to be produced and published by CHI, the Commission for Health Improvement. This year is also the first in which primary care trusts and mental health trusts have received full star ratings.
CHI is the independent regulator of NHS performance. The Government is responsible for setting priorities, which in turn determine the indicators relating to key targets. Other indicators have this year been designed by CHI and the Department of Health to reflect a wide range of performance issues, following consultation with the service and other stakeholders.
For the first time, the confirmed lists of indicators, and the technical specifications (or constructions) used to calculate them, were published in advance. Indicator lists for acute and ambulance trusts were published in December 2002, and for primary care and mental health trusts in March 2003. CHI is committed to extending this transparency by publishing indicator lists even earlier for the 2003 / 2004 year.
The ratings and indicators provide people working in the NHS and the public with accessible and easy to understand information about the performance of local health services.
In addition to this website, two publications summarising this year’s star ratings and indicator scores for each trust are also available. This same information can be downloaded free of charge from the more information section of the website or alternatively, the publications can be purchased from The Stationery Office (0870 600 55 22).
Combined trusts, those that provide services in mental health as well as acute or primary care, are star rated in both sectors (acute and mental health, or primary care and mental health). Each star rating is listed in the appropriate section.
Summary reports are available for each type of NHS trust. Each one explains to local people and those responsible for leading and managing the trust how the trust has fared in the ratings. The ratings tables allow trusts to compare their performance against others, so they can share good practice, and address weaknesses.
Developments in the NHS performance ratings
Over time CHI aims to develop performance indicators and ratings to enhance their accuracy as a reflection of the patient experience. The method used this year to determine ratings is based on last year’s approach, although there have been some changes to individual indicators and some modifications to the methodology for calculating the star ratings.
The ratings incorporate key targets which cover Government priority areas, as well as a broader set of important indicators. This year, CHI has improved the transparency of the ratings methodology by publishing in advance the indicator lists. CHI aims to bring this forward for the forthcoming year, to give trusts more notice of the indicators against which they will be assessed.
Star ratings for acute, specialist and mental health trusts also take into consideration CHI’s clinical governance reviews. In future years this will be extended to include ambulance and primary care trusts. In some cases, where a CHI clinical governance review is older, an assessment has been made of progress by the trust against the action plan agreed after the review. This updated assessment has been used in calculation of the star rating.
How does the NHS performance ratings system work?
The NHS performance ratings system places NHS trusts in England into one of four categories:
- trusts with the highest levels of performance are awarded a performance rating of three stars
- trusts that are performing well overall, but have not quite reached the same consistently high standards, are awarded a performance rating of two stars
- trusts where there is some cause for concern regarding particular areas of performance are awarded a performance rating of one star
- trusts that have shown the poorest levels of performance against the indicators or little progress in implementing clinical governance are awarded a performance rating of zero stars
Where a trust has a low rating based on poor performance on a number of key targets and indicators, this does not necessarily mean that a hospital is unsafe, does not contain some very good clinical services or that the staff are not working hard in often difficult circumstances. It does mean that performance must be improved in a number of key areas.
A zero star trust is one which either fails against the key targets or is considered to have poor clinical governance.
A three star trust is one that does well on the indicators and, if a review has been undertaken, is considered to have good clinical governance.
Role of the clinical governance reviews in rating performance
As last year, information from CHI's reviews is used in determining poorly performing (zero star) and high performing leading (three star) NHS organisations.
Since beginning its work in 2000, CHI has published clinical governance review reports on most acute and specialist trusts, most ambulance trusts and some mental health and primary care trusts. A CHI clinical governance review assesses the trust across seven components of performance:
- risk management
- clinical audit
- research and education
- patient involvement
- information management
- staff involvement
- education, training and development
Each component is scored from I to IV.
After each review, the trust prepares an action plan to address areas for improvement identified by the CHI report. It is agreed with CHI, and published. For some trusts whose CHI clinical governance reviews are older (published before September 2002), CHI, with the support of strategic health authorities, has assessed progress against this action plan. Any significant improvements have been taken into consideration in calculating the star rating.
For this year, clinical governance scores have not been incorporated into star ratings for ambulance trusts, who have only recently adopted clinical governance principles or for primary care trusts, in recognition of their immaturity as organisations. CHI does intend to reflect clinical governance assessments in next year's star ratings.