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Leeds Mental Health Teaching 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.

Strategic health authorities, acute and primary care trusts will also have access to this report, and are likely to discuss the findings with partners in the local health community. The CHI performance ratings web pages contain reports on every health trust in England, of each type. Mental health 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, including star ratings and performance indicators which contribute them.

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 March 2003 for mental health trusts) of the indicators against which 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 mental health trusts highlights four areas of performance that are of interest to patients (or service users) 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, this Trust has received a performance rating of 2 stars

Ratings should be interpreted as follows:

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

CHI assessment
This trust has not received a clinical governance review (CGR) report from CHI.

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

Key targets
The trust achieved -1 out of 7 key targets.

The trust under achieved -1 out of 7 key targets.

The trust significantly under achieved -1 out of 7 key targets.

Clinical 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.

Clinical negligence
CPA systems implementation
Psychiatric readmissions (older people)

Performance falls in the lowest band for the following indicators.

Psychiatric readmissions (adults of working age)

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.

Transition of care between adult Services and OPMH
Patients with copies of their own Care Plan
Better hospital food
Privacy and dignity

Performance falls in the lowest band for the following indicators.

Transition of care between CAMHS and adult Services

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.

Crisis Resolution Team implementation
Junior doctor's hours
Consultant appraisal

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
Indicator	Current trust figure	Performance level	Threshold to achieve	Threshold to significantly underachieve
Assertive Outreach Team implementation			2 or more	0


CMHT integration			60% or more	Less than 50%


Mental Health Minimum Dataset implementation			2 or more	0


Number of outpatients waiting longer than the standard			5 breaches or less	Greater than 50 breaches


Improving Working Lives			1	0


Hospital cleanliness			47 or better	Less than 22


Financial management			In financial balance	Deficit greater than 1% of turnover or greater than £1 million, or unplanned financial aid.

Focus areas

Clinical focus
Indicator	Current national figure	Current trust figure	Performance level
Clinical negligence	1 (Med)


CPA systems implementation	categorical data


Psychiatric readmissions (adults of working age)	9.41 (Eng)


Psychiatric readmissions (older people)	6.15 (Eng)


Suicide rate	0.21% (Med)

Patient focus
Indicator	Current national figure	Current trust figure	Performance level
Transition of care between adult Services and OPMH	categorical data


Transition of care between CAMHS and adult Services	categorical data


Patients with copies of their own Care Plan	96.1% (Med)


Patients complaints procedure	59.5% (Med)


Better hospital food	categorical data


Privacy and dignity	categorical data

Capacity & capability focus
Indicator	Current national figure	Current trust figure	Performance level
Missed outpatient appointments	19.3% (Med)


Crisis Resolution Team implementation	1 (Med)


Out of catchment area treatments (adults)	7.1% (Med)


Out of catchment area treatments (older people)	1.5% (Med)


CAMHS service mapping	3 (Med)


Data quality	0.90 (Med)


Staff opinion survey	3.236 (Med)


Junior doctor's hours	100% (Med)


Consultant appraisal	96.4% (Med)


Sickness absence rate	5.1% (Med)


Information governance	23 (Med)


Fire, health & safety	5.57 (Med)

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Annex 2

Click here for the ratings methodology

Tables of Thresholds - Trusts

Clinical focus	Significantly above average	Above average	Average	Below average	Significantly below average
Clinical negligence	1 or 2	-	0	-	-
CPA systems implementation	Yes	-	-	-	No
Psychiatric readmissions (adults of working age)	No 99% confidence interval overlap: Lower values	No 95% confidence interval overlap: Lower values	Overlapping 95 % confidence intervals, England: 9.20% to 9.62%	No 95% confidence interval overlap: Higher values	No 99% confidence interval overlap: Higher values
Psychiatric readmissions (older people)	No 99% confidence interval overlap: Lower values	No 95% confidence interval overlap: Lower values	Overlapping 95 % confidence intervals, England: 5.90% to 6.41%	No 95% confidence interval overlap: Higher values	No 99% confidence interval overlap: Higher values
Suicide rate	Less than or equal to 0.09%	Less than or equal to 0.14% and greater than 0.09%	Less than or equal to 0.25% and greater than 0.14%	Less than or equal to 0.32% and greater than 0.25%	Greater than 0.32%

Patient focus	Significantly above average	Above average	Average	Below average	Significantly below average
Transition of care between adult Services and OPMH	Yes	-	-	-	No
Transition of care between CAMHS and adult Services	Yes	-	-	-	No
Patients with copies of their own Care Plan	100.0%	-	Greater than or equal to 84.2% and less than 100.0%	Greater than or equal to 33.4% and less than 84.2%	Less than 33.4%
Patients complaints procedure	Greater than or equal to 79.4%	Greater than or equal to 70.0% and less than 79.4%	Greater than or equal to 51.9% and less than 70.0%	Greater than or equal to 35.2% and less than 51.9%	Less than 35.2%
Better hospital food	green	-	amber	-	red
Privacy and dignity	green	-	amber	-	red

Capacity and capability	Significantly above average	Above average	Average	Below average	Significantly below average
Missed outpatient appointments	Less than or equal to 12.2%	Less than or equal to 15.4% and greater than 12.2%	Less than or equal to 22.6% and greater than 15.4%	Less than or equal to 28.2% and greater than 22.6%	Greater than 28.2%
Crisis Resolution Team implementation	2	1	0	-	-
Out of catchment area treatments (adults)	Less than or equal to 2.4%	Less than or equal to 4.0% and greater than 2.4%	Less than or equal to 10.9% and greater than 4.0%	Less than or equal to 17.0% and greater than 10.9%	Greater than 17.0%
Out of catchment area treatments (older people)	Less than or equal to 0.40%	Less than or equal to 1.00% and greater than 0.40%	Less than or equal to 2.83% and greater than 1.00%	Less than or equal to 7.78% and greater than 2.83%	Greater than 7.78%
CAMHS service mapping	3	-	2	1	-
Data quality	Greater than or equal to 0.97	Greater than or equal to 0.94 and less than 0.97	Greater than or equal to 0.85 and less than 0.94	Greater than or equal to 0.76 and less than 0.85	Less than 0.76
Staff opinion survey	Greater than or equal to 3.466	Greater than or equal to 3.311 and less than 3.466	Greater than or equal to 3.151 and less than 3.311	Greater than or equal to 2.984 and less than 3.151	Less than 2.984
Junior doctor's hours	100.0%	-	Greater than or equal to 85.7% and less than 100.0%	Greater than or equal to 69.4% and less than 85.7%	Less than 69.4%
Consultant appraisal	100%	-	Greater than or equal to 80.0% and less than 100.0%	Greater than or equal to 42.0% and less than 80.0%	Less than 42.0%
Sickness absence rate	Less than or equal to 3.7%	Less than or equal to 4.4% and greater than 3.7%	Less than or equal to 5.7% and greater than 4.4%	Less than or equal to 6.1% and greater than 5.7%	Greater than 6.1%
Information governance	Greater than or equal to 30	Greater than or equal to 26 and less than 30	Greater than or equal to 21 and less than 26	Greater than or equal to 17 and less than 21	Less than 17
Fire, health & safety	0	Less than or equal to 1.48 and greater than 0.00	Less than or equal to 14.98 and greater than 1.48	Less than or equal to 46.90 and greater than 14.98	Greater than 46.90

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Leeds Mental Health Teaching NHS Trust NHS performance ratings (July 2003): trust detail report

Annex 1

Annex 2

Leeds Mental Health Teaching NHS Trust
NHS performance ratings (July 2003): trust detail report