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County Durham and Darlington Acute Hospitals NHS Trust
NHS performance ratings (July 2003): trust detail report

Performance rating: 2 stars

Introduction
Using this report
Benchmarking performance
The performance indicators
The role of CHI in publishing performance ratings
Contents
Introduction
The Commission for Health Improvement (CHI) has produced and published 2002 / 2003 performance indicators and ratings for every NHS trust in England. This report summarises the trust performance against a set of published indicators and explains how the indicators were used to allocate the trust?s performance rating. It highlights areas in which the trust has achieved high standards of performance, as well as identifying areas where performance has not been so good.

This report summarises this trust?s performance relative to national performance during 2002 / 2003. The NHS performance ratings system places performance into one of four categories ranging from three stars, performance at the highest level, to a rating of zero stars, reflecting poorest levels of performance. The star rating applies across the whole organisation, not to individual services. In using the report to investigate aspects of local performance, you may want to refer also to other relevant local performance assessments provided by CHI, NHS Modernisation Agency, or contained within audit letters.
Using this report
This report is intended for use by the trust board, staff and others in the local health community. It will help the trust understand the rationale behind the performance rating it has received. It will support the trust in identifying areas of strong performance, the lessons of which others in the health community and beyond will want to share and understand. The trust will be able to use the information in the report to identify areas of poorer performance so that it can investigate and take action to bring about improvements.

Primary care trusts will also have access to this report, and are likely to discuss the findings with their partners in the local health community. The CHI performance ratings web pages also contain reports on all primary care trusts in England. Acute trusts may wish to consider the reports of local primary care trusts to identify any specific contributions they can make to improve overall performance in the local health economy.

Primary care trusts (PCTs) issue a patient prospectus to every household within the PCT area, which should incorporate performance information for local health providers. This will include star ratings and indicators for local acute trusts.

Strategic health authorities will consider summary reports for all their constituent trusts and use these results to inform strategic planning and performance development initiatives. The performance ratings and indicators for different types of NHS trusts provide an opportunity to identify and plan ways of addressing issues which cross organisational boundaries, and those internal to a particular organisation.

The star rating and performance indicators are dependent on the quality and accuracy of data used to calculate them. Trusts must ensure that adequate systems are in place to capture and record performance data accurately, so that the conclusions this report draws about local performance strengths and weaknesses are soundly based.
Benchmarking performance
The two principle reasons for measuring NHS performance are to ensure accountability to the public and Parliament for the quality of service delivered in return for ever increasing levels of investment; and to enable NHS clinicians and managers to undertake meaningful benchmarking ? comparing their performance results and methods against those of their peers ? so that they can identify scope for improvement and share knowledge of best practice.

The indicators currently being published do not necessarily reveal exactly why a trust has done well, or in some cases not so well, in certain areas of performance. But they do highlight certain areas so that, following benchmarking and other local investigations, trusts can share examples of best practice that are seen to be effective, and change any instances of poor practice that are unacceptable.
The role of CHI in publishing performance ratings
The 2002 / 2003 performance ratings are the first to be published by CHI, the independent regulator of NHS performance. The Government retains responsibility for setting priorities and key targets in the ratings, but CHI has taken over responsibility for the development of the methodology of ratings, and collation.

For the first time, trusts received notification (in December 2002 for acute trusts) of the indicators against they were to be assessed. Detailed indicator descriptions (constructions) were published in May.

CHI intends to indicate to the NHS as soon as possible how their performance will be assessed for 2003 / 2004.
The performance indicators
The NHS performance assessment framework was first published in 1999 to provide a system for assessing NHS performance in a rounded way. Since then it has been developed so that, whilst continuing as a balanced scorecard, it better reflects the NHS Plan as it applies to the different NHS organisations.

The framework for acute trusts highlights four areas of performance that are of interest to patients and the public, and where clinical governance reports have been published by CHI, progress in implementing clinical governance:
  • key targets, the most significant areas of performance in the NHS Plan
  • clinical focus
  • patient focus
  • capacity and capability focus
Contents
The main body of this report summarises the trust's performance against the indicators in each of these four areas. For each area the report shows:
  • how the trust's performance compares to the national average
  • which indicators the trust has performed well on
  • which, if any, indicators the trust has performed poorly on
Where available this report also summarises CHI?s assessment of the trust?s progress in implementing clinical governance.

The main body of the text is supported by two annexes. Annex 1 gives a summary of the trust's performance on the indicators in each area, showing how performance compares against the national average. Annex 2 explains the methodology used to allocate the trust rating.
Summary of performance on key targets and areas of the balanced scorecard
CHI assessment
Key targets
Clinical focus
Patient focus
Capacity & capability focus

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Summary of performance on key targets and areas of the balanced scorecard
Overall, your Trust has received a performance rating of 2 stars

Ratings should be interpreted as follows:

Star Rating
3 stars Trust has the highest levels of performance
2 stars Trust is performing well overall, but has not quite reached the same consistently high standards
1 star Trust is showing some cause for concern regarding particular key targets
Zero stars Trust has shown the poorest level of performance against key targets or in implementation of clinical governance


CHI assessment
This trust has received a clinical governance review (CGR) report from CHI in Jul 02.
Progress against this trust's action plan following the CHI CGR report has been assessed.
This trust was found to have some strengths.

CHI reports can be found at http://www.chi.gov.uk/eng/report/index.shtml

Key targets
The trust achieved -1 out of 9 key targets.

The trust under achieved -1 out of 9 key targets.

The trust significantly under achieved -1 out of 9 key targets.
Clinical focus
Overall, this trust is in the middle band of performance in this focus area.

Performance falls in the highest band for the following indicators.
    Performance falls in the lowest band for the following indicators.
    • Emergency readmission to hospital following discharge
    • Emergency readmission to hospital following discharge for children
    Patient focus
    Overall, this trust is in the top band of performance in this focus area.

    Performance falls in the highest band for the following indicators.
    • A&E emergency admission waits (4 hours)
    Performance falls in the lowest band for the following indicators.

      Capacity & capability focus
      Overall, this trust is in the top band of performance in this focus area.

      Performance falls in the highest band for the following indicators.
        Performance falls in the lowest band for the following indicators.

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          Annex 1

          Summary of trust performance indicator values
          These tables identify the thresholds used in calculating performance against individual indicators. Where appropriate, a national figure is provided against which the trust figure can be compared. The national figure presented is either a national average rate or the median. The median is derived as the mid-value of the organisations' indicator values. For further details on how the indicators were constructed, click on the indicators link under the appropriate trust type in the left menu bar or on the indicator name below.

          Key targets
          IndicatorCurrent trust figurePerformance levelThreshold to achieveThreshold to significantly underachieve
          A&E emergency admission waits (12 hours)9 breaches or lessGreater than 50 breaches
          0
          Cancelled operations not admitted within 28 days0.5% or lessGreater than 1.0%
          0
          Financial managementIn financial balanceDeficit greater than 1% of turnover or greater than £1 million, or unplanned financial aid.
          0
          Hospital cleanliness50 or betterLess than 25
          0
          Improving Working Lives10
          0
          Number of inpatients waiting longer than the standard2 breaches or lessGreater than 10 breaches
          0
          Number of outpatients waiting longer than the standard5 breaches or lessGreater than 50 breaches
          0
          Total time in A&E90% or betterLess than 85%
          0
          Two week cancer waits95% or betterLess than 85%
          0


          Focus areas

          Clinical focus
          IndicatorCurrent national figureCurrent trust figurePerformance level
          Clinical Negligence1 (Med)
          0
          Deaths within 30 days of a heart bypass operation2216.74 (Eng)
          0
          Deaths within 30 days of selected surgical procedures5025.46 (Eng)
          0
          Emergency readmission to hospital following discharge5.53% (Eng)
          0
          Emergency readmission to hospital following discharge for children4.91% (Eng)
          0
          Emergency readmission to hospital following treatment for a fractured hip8.62% (Eng)
          0
          Emergency readmission to hospital following treatment for a stroke7.76% (Eng)
          0
          Infection control procedures83 (Med)
          0
          Methicillin Resistant Staphylococcus Aureus (MRSA) bacteraemia improvement score-
          0
          Thrombolysis treatment time68.2% (Med)
          0


          Patient focus
          IndicatorCurrent national figureCurrent trust figurePerformance level
          A&E emergency admission waits (4 hours)92.6% (Med)
          0
          Better hospital foodcategorical data
          0
          Breast cancer treatment99% (Med)
          0
          Cancelled operations1.03% (Med)
          0
          Day case booking81.1% (Med)
          0
          Delayed transfers of care4.0% (Med)
          0
          Nine month heart operation waits97% (Med)
          0
          Outpatient A&E survey - access & waiting0.130 (Med)
          0
          Outpatient A&E survey - better information, more choice0.129 (Med)
          0
          Outpatient A&E survey - building relationships0.093 (Med)
          0
          Outpatient A&E survey - clean, comfortable, friendly place to be0.160 (Med)
          0
          Outpatient A&E survey - safe, high quality, co-ordinated care0.098 (Med)
          0
          Paediatric outpatient did not attend rates12.0% (Med)
          0
          Patient complaints procedure65.5% (Med)
          0
          Privacy & dignitycategorical data
          0
          Six month inpatient waits82% (Med)
          0
          Thirteen week outpatient waits76% (Med)
          0
          Total inpatient waits3.7% (Med)
          0
          Waiting times for Rapid Access Chest Pain Clinic94.8% (Med)
          0


          Capacity & capability focus
          IndicatorCurrent national figureCurrent trust figurePerformance level
          Consultant appraisal96.0% (Med)
          0
          Data quality0.95 (Med)
          0
          Fire, Health & Safety9.24 (Med)
          0
          Information Governance59 (Med)
          0
          Junior doctors' hours80.5% (Med)
          0
          Sickness absence rate4.5% (Med)
          0
          Staff opinion survey3.2 (Med)
          0

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          Annex 2

          Click here for the ratings methodology

          Tables of Thresholds - Trusts

          Clinical focusSignificantly above averageAbove averageAverageBelow averageSignificantly below average
          Clinical Negligence2 or 31-0-
          Deaths within 30 days of a heart bypass operationNo 99% confidence interval overlap: Lower valuesNo 95% confidence interval overlap: Lower valuesOverlapping 95% confidence intervals, England: 2102.16 to 2335.93No 95% confidence interval overlap: Higher valuesNo 99% confidence interval overlap: Higher values
          Deaths within 30 days of selected surgical proceduresNo 99% confidence interval overlap: Lower valuesNo 95% confidence interval overlap: Lower valuesOverlapping 95 % confidence intervals, England: 4949.41 to 5102.39No 95% confidence interval overlap: Higher valuesNo 99% confidence interval overlap: Higher values
          Emergency readmission to hospital following dischargeNo 99% confidence interval overlap: Lower valuesNo 95% confidence interval overlap: Lower valuesOverlapping 95% confidence intervals, England: 5.51% to 5.55%No 95% confidence interval overlap: Higher valuesNo 99% confidence interval overlap: Higher values
          Emergency readmission to hospital following discharge for childrenNo 99% confidence interval overlap: Lower valuesNo 95% confidence interval overlap: Lower valuesOverlapping 95% confidence intervals, England: 4.85% to 4.96%No 95% confidence interval overlap: Higher valuesNo 99% confidence interval overlap: Higher values
          Emergency readmission to hospital following treatment for a fractured hipNo 99% confidence interval overlap: Lower valuesNo 95% confidence interval overlap: Lower valuesOverlapping 95% confidence intervals, England: 8.33% to 8.92%No 95% confidence interval overlap: Higher valuesNo 99% confidence interval overlap: Higher values
          Emergency readmission to hospital following treatment for a strokeNo 99% confidence interval overlap: Lower valuesNo 95% confidence interval overlap: Lower valuesOverlapping 95% confidence intervals, England: 7.49% to 8.05%No 95% confidence interval overlap: Higher valuesNo 99% confidence interval overlap: Higher values
          Infection control proceduresGreater than or equal to 95Greater than or equal to 89 and less than 95Greater than or equal to 77 and less than 89Greater than or equal to 68 and less than 77Less than 68
          Methicillin Resistant Staphylococcus Aureus (MRSA) bacteraemia improvement scoreSignificant improvement at 5% level (value >= 1.96)Significant improvement at 10 % level (value >= 1.64 and < 1.96)No significant improvement or deterioration (value < +1.64 and > - 1.64)Significant deterioration at 10 % level (value <= -1.64 and > - 1.96)Significant deterioration at 5 % level (value <= -1.96)
          Thrombolysis treatment timeGreater than or equal to 85.5%Greater than or equal to 75.2% and less than 85.5%Greater than or equal to 59.0% and less than 75.2%Greater than or equal to 38.6% and less than 59.0%Less than 38.6%


          Patient focusSignificantly above averageAbove averageAverageBelow averageSignificantly below average
          A&E emergency admission waits (4 hours)Greater than or equal to 99.5%Greater than or equal to 97.5% and less than 99.5%Greater than or equal to 86.3% and less than 97.5%Greater than or equal to 72.3% and less than 86.3%Less than 72.3%
          Better hospital foodgreen-amber-red
          Breast cancer treatmentequal to 100%-Greater than or equal to 96% and less than 100%Greater than or equal to 91% and less than 96%Less than 91%
          Cancelled operationsLess than or equal to 0.42%Less than or equal to 0.75% and greater than 0.42%Less than or equal to 1.39% and greater than 0.75%Less than or equal to 2.29% and greater than 1.39%Greater than 2.29%
          Day case bookingGreater than or equal to 92.8%Greater than or equal to 85.5% and less than 92.8%Greater than or equal to 74.1% and less than 85.5%Greater than or equal to 44.9% and less than 74.1%Less than 44.9%
          Delayed transfers of careLess than or equal to 1.0%Less than or equal to 2.7% and greater than 1.0%Less than or equal to 5.7% and greater than 2.7%Less than or equal to 8.5% and greater than 5.7%Greater than 8.5%
          Nine month heart operation waitsGreater than or equal to 99%Greater than or equal to 97% and less than 99%Greater than or equal to 95% and less than 98%Greater than or equal to 92% and less than 95%Less than 92%
          Outpatient A&E survey - access & waitingGreater than or equal to 1.213Greater than or equal to 0.502 and less than 1.213Greater than or equal to -0.472 and less than 0.502Greater than or equal to -1.082 and less than -0.472Less than -1.082
          Outpatient A&E survey - better information, more choiceGreater than or equal to 1.055Greater than or equal to 0.517 and less than 1.055Greater than or equal to -0.394 and less than 0.517Greater than or equal to -1.044 and less than -0.394Less than -1.044
          Outpatient A&E survey - building relationshipsGreater than or equal to 1.050Greater than or equal to 0.643 and less than 1.050Greater than or equal to -0.433 and less than 0.643Greater than or equal to -1.125 and less than -0.433Less than -1.125
          Outpatient A&E survey - clean, comfortable, friendly place to beGreater than or equal to 1.107Greater than or equal to 0.559 and less than 1.107Greater than or equal to -0.295 and less than 0.559Greater than or equal to -1.268 and less than -0.295Less than -1.268
          Outpatient A&E survey - safe, high quality, co-ordinated careGreater than or equal to 1.129Greater than or equal to 0.642 and less than 1.129Greater than or equal to -0.344 and less than 0.642Greater than or equal to -1.091 and less than -0.344Less than -1.091
          Paediatric outpatient did not attend ratesLess than or equal to 7.1%Less than or equal to 10.1% and greater than 7.1%Less than or equal to 13.5% and greater than 10.1%Less than or equal to 18.3% and greater than 13.5%Greater than 18.3%
          Patient complaints procedureGreater than or equal to 88.1%Greater than or equal to 76.0% and less than 88.1%Greater than or equal to 56.2% and less than 76.0%Greater than or equal to 40.8% and less than 56.2%Less than 40.8%
          Privacy & dignitygreen-amber-red
          Six month inpatient waitsGreater than or equal to 94%Greater than or equal to 87% and less than 94%Greater than or equal to 78% and less than 87%Greater than or equal to 74% and less than 78%Less than 74%
          Thirteen week outpatient waitsGreater than or equal to 88%Greater than or equal to 81% and less than 88%Greater than or equal to 73% and less than 81%Greater than or equal to 67% and less than 73%Less than 67%
          Total inpatient waitsGreater than or equal to 14.8%Greater than or equal to 8.3% and less than 14.8%Greater than or equal to 0.6% and less than 8.3%Greater than or equal to -9.0% and less than 0.6%Less than -9.0%
          Waiting times for Rapid Access Chest Pain ClinicEqual to 100.0%Greater than or equal to 98.9% and less than 100.0%Greater than or equal to 82.6% and less than 98.9%Greater than or equal to 36.4% and less than 82.6%Less than 36.4%


          Capacity and capabilitySignificantly above averageAbove averageAverageBelow averageSignificantly below average
          Consultant appraisalEqual to 100.0%-Greater than or equal to 90.0% and less than 100.0%Greater than or equal to 60.0% and less than 90.0%Less than 60.0%
          Data qualityGreater than or equal to 0.98Greater than or equal to 0.96 and less than 0.98Greater than or equal to 0.93 and less than 0.96Greater than or equal to 0.91and less than 0.93Less than 0.91
          Fire, Health & SafetyEqual to 0.00Less than or equal to 3.51 and greater than 0.00Less than or equal to 22.05 and greater than 3.51Less than or equal to 70.25 and greater than 22.05Greater than 70.25
          Information GovernanceGreater than or equal to 67Greater than or equal to 64 and less than 67Greater than or equal to 40 and less than 64Greater than or equal to 32 and less than 40Less than 32
          Junior doctors' hoursGreater than or equal to 97.2%Greater than or equal to 87.8% and less than 97.2%Greater than or equal to 69.2% and less than 87.8%Greater than or equal to 57.4% and less than 69.2%Less than 57.4%
          Sickness absence rateLess than or equal to 3.5%Less than or equal to 4.1% and greater than 3.5%Less than or equal to 4.8% and greater than 4.1%Less than or equal to 5.4% and greater than 4.8%Greater than 5.4%
          Staff opinion surveyGreater than or equal to 3.44Greater than or equal to 3.31 and less than 3.44Greater than or equal to 3.15 and less than 3.31Greater than or equal to 3.01 and less than 3.15Less than 3.01

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