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Bromley PCT
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 the reports of acute, mental health and ambulance trusts in their area, and are likely to discuss the findings with their partners in the local health community. The CHI performance ratings web pages contain reports on every health trust in England, of each type. Acute, mental health and ambulance 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 to 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 primary care trusts) of the indicators against which they were to be assessed. Detailed indicator descriptions (constructions) were published in May.

This is also the first year for which primary care trusts have been awarded star ratings. Star ratings for primary care trusts, and the indicators which contribute to them, have been the subject of extensive consultation with the service, and patients and their representatives. 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 primary care trusts highlights four areas of performance that are of interest to patients and the public, and relate to their core functions:
  • key targets, the most significant areas of performance in the NHS Plan
  • access to quality services
  • improving health
  • service provision
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
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
Access to quality services
Improving health
Service provision

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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 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


CHI assessment
CHI Clinical Governance Review reports for primary care and ambulance trusts have not been used in calculating this year's star ratings.

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.
Access to quality services
Overall, this trust is in the lowest band of performance in this focus area.

Performance falls in the highest band for the following indicators.
  • Twelve month heart operation waits
  • Access to NHS Dentistry
Performance falls in the lowest band for the following indicators.
  • Level of 24 hour access to specialist mental health services
  • PCT Survey - Access and waiting
Improving health
Overall, this trust is in the top band of performance in this focus area.

Performance falls in the highest band for the following indicators.
  • Death rates from circulatory diseases, ages under 75 (change in rate)
  • Diabetes services baseline assessment
  • CHD Audit
  • Suicide audit
Performance falls in the lowest band for the following indicators.

    Service provision
    Overall, this trust is in the top band of performance in this focus area.

    Performance falls in the highest band for the following indicators.
    • Prescribing rates for drugs acting on benzodiazepine receptors
    • GP 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
      IndicatorCurrent trust figurePerformance levelThreshold to achieveThreshold to significantly underachieve
      Access to a GP87.5% or betterLess than 70%
      0
      Access to a Primary Care Professional87.5% or betterLess than 70%
      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
      Single Telephone Access - Implementation PlansYesNo
      0
      Four-week smoking quitters45% or betterLess than 30%
      0
      Improving Working Lives10
      0
      Financial ManagementIn financial balanceDeficit greater than 1% of turnover or greater than £1 million, or unplanned financial aid.
      0


      Focus areas

      Access to quality services
      IndicatorCurrent national figureCurrent trust figurePerformance level
      Emergency readmission to hospital following treatment for a fractured hip8.73% (Eng)
      0
      Substance Misuse - Percentage of GP practices in a shared care scheme27.9% (Eng)
      0
      Sexual health - Access to services for early unintended pregnancy 50.5% (Eng)
      0
      Level of 24 hour access to specialist mental health services2 (Med)
      0
      A&E Emergency admission waits (12 hours)0 (Med)
      0
      Twelve month heart operation waits0 (Med)
      0
      Delayed transfers of care4.1% (Med)
      0
      Access to NHS Dentistrycategorical data
      0
      PCT Survey - Access and waiting71.870 (Med)
      0
      PCT Survey - Better information, more choice74.748 (Med)
      0
      PCT Survey - Building closer relationships89.268 (Med)
      0
      PCT Survey - Clean, comfortable, friendly place to be82.024 (Med)
      0
      PCT Survey - Safe, high quality, coordinated care79.453 (Med)
      0
      Prescribing of atypical antipsychotics49.0% (Eng)
      0


      Improving health
      IndicatorCurrent national figureCurrent trust figurePerformance level
      Death rates from circulatory diseases, ages under 75 (change in rate)a (Eng)
      0
      Death rates from accidents, all ages (change in rate)c (Eng)
      0
      Death rates from cancer, ages under 75 (change in rate)c (Eng)
      0
      Breast Cancer Screening75.9% (Eng)
      0
      Cervical Screening81.6% (Eng)
      0
      Flu Vaccinations68.5% (Eng)
      0
      Teenage pregnancy - Conceptions below age 18 (change in rate)a (Eng)
      0
      Diabetes services baseline assessmentcategorical data
      0
      CHD Audit82.7% (Eng)
      0
      Suicide auditcategorical data
      0


      Service provision
      IndicatorCurrent national figureCurrent trust figurePerformance level
      Emergency admissions (change in rate)a (Eng)
      0
      Emergency admission to hospital for children with lower respiratory tract (LRT) infections (change in rate)e (Eng)
      0
      Primary Care Management - Acute conditions (change in rate)a (Eng)
      0
      Primary Care Management - Chronic conditions (change in rate)a (Eng)
      0
      Community equipment96.0% (Med)
      0
      Patient complaints procedure66.7% (Med)
      0
      Prescribing rates of antibacterial drugs1.062 (Eng)
      0
      Prescribing rates for drugs acting on benzodiazepine receptors8.785 (Eng)
      0
      Staff opinion survey3.368 (Med)
      0
      GP Appraisal100.0% (Med)
      0
      Sickness absence rate4.1% (Med)
      0
      Fire, Health and Safety5.54 (Med)
      0
      Generic prescribing77.65% (Eng)
      0

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      Annex 2

      Click here for the ratings methodology

      Tables of Thresholds - Trusts

      Access to quality servicesSignificantly above averageAbove averageAverageBelow averageSignificantly below average
      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: 8.44% to 9.04%No 95% confidence interval overlap: Higher valuesNo 99% confidence interval overlap: Higher values
      Substance Misuse - Percentage of GP practices in a shared care schemeGreater than or equal to 78.3%Greater than or equal to 37.5% and less than 78.3%Greater than or equal to 6.0% and less than 37.5%Greater than or equal to 0.0% and less than 6.0%-
      Sexual health - Access to services for early unintended pregnancy Greater than or equal to 68.1%Greater than or equal to 58.4% and less than 68.1%Greater than or equal to 44.1% and less than 58.4%Greater than or equal to 34.2% and less than 44.1%Less than 34.2%
      Level of 24 hour access to specialist mental health servicesGreater than or equal to 54Greater than or equal to 1 and less than 4-0
      A&E Emergency admission waits (12 hours)0-Less than or equal to 3 and greater than 0Less than or equal to 35 and greater than 3Greater than 35
      Twelve month heart operation waits0---1 or more
      Delayed transfers of careLess than or equal to 1.5%Less than or equal to 3.0% and greater than 1.5%Less than or equal to 6.1% and greater than 3.0%Less than or equal to 9.1% and greater than 6.1%Greater than 9.1%
      Access to NHS DentistryYes---No
      PCT Survey - Access and waitingGreater than or equal to 75.657Greater than or equal to 73.206 and less than 75.657Greater than or equal to 69.967 and less than 73.206Greater than or equal to 67.367 and less than 69.967Less than 67.367
      PCT Survey - Better information, more choiceGreater than or equal to 77.833Greater than or equal to 76.114 and less than 77.833Greater than or equal to 73.315 and less than 76.114Greater than or equal to 70.419 and less than 73.315Less than 70.419
      PCT Survey - Building closer relationshipsGreater than or equal to 91.546Greater than or equal to 90.092 and less than 91.546Greater than or equal to 87.955 and less than 90.092Greater than or equal to 85.834 and less than 87.955Less than 85.834
      PCT Survey - Clean, comfortable, friendly place to beGreater than or equal to 84.695Greater than or equal to 83.243 and less than 84.695Greater than or equal to 80.630 and less than 83.243Greater than or equal to 78.255 and less than 80.630Less than 78.255
      PCT Survey - Safe, high quality, coordinated careGreater than or equal to 81.304Greater than or equal to 80.205 and less than 81.304Greater than or equal to 78.479 and less than 80.205Greater than or equal to 76.648 and less than 78.479Less than 76.648
      Prescribing of atypical antipsychoticsGreater than or equal to 60.0%Greater than or equal to 54.6% and less than 60.0%Greater than or equal to 43.5% and less than 54.6%Greater than or equal to 35.9% and less than 43.5%Less than 35.9%


      Improving healthSignificantly above averageAbove averageAverageBelow averageSignificantly below average
      Death rates from circulatory diseases, ages under 75 (change in rate)The probability of this level of improvement happening by chance is less than 1% but more than 1%The probability of this level of improvement happening by chance is less than 5%The level of improvement or deterioration is not statistically significantThe probability of this level of deterioration happening by chance is less than 5% but more than 1%The probability of this level of deterioration happening by chance is less than 1%
      Death rates from accidents, all ages (change in rate)The probability of this level of improvement happening by chance is less than 1% but more than 1%The probability of this level of improvement happening by chance is less than 5%The level of improvement or deterioration is not statistically significantThe probability of this level of deterioration happening by chance is less than 5% but more than 1%The probability of this level of deterioration happening by chance is less than 1%
      Death rates from cancer, ages under 75 (change in rate)The probability of this level of improvement happening by chance is less than 1% but more than 1%The probability of this level of improvement happening by chance is less than 5%The level of improvement or deterioration is not statistically significantThe probability of this level of deterioration happening by chance is less than 5% but more than 1%The probability of this level of deterioration happening by chance is less than 1%
      Breast Cancer ScreeningGreater than or equal to 83.2%Greater than or equal to 80.7% and less than 83.2%Greater than or equal to 74.6% and less than 80.7%Greater than or equal to 64.7% and less than 74.6%Less than 64.7%
      Cervical ScreeningGreater than or equal to 86.4%Greater than or equal to 84.6% and less than 86.4%Greater than or equal to 81.3% and less than 84.6%Greater than or equal to 77.7% and less than 81.3%Less than 77.7%
      Flu VaccinationsGreater than or equal to 72.7%Greater than or equal to 71.0% and less than 72.7%Greater than or equal to 67.8% and less than 71.0%Greater than or equal to 63.4% and less than 67.8%Less than 63.4%
      Teenage pregnancy - Conceptions below age 18 (change in rate)The probability of this level of improvement happening by chance is less than 1% but more than 1%The probability of this level of improvement happening by chance is less than 5%The level of improvement or deterioration is not statistically significantThe probability of this level of deterioration happening by chance is less than 5% but more than 1%The probability of this level of deterioration happening by chance is less than 1%
      Diabetes services baseline assessmentYes---No
      CHD AuditEqual to 100.0%-Greater than or equal to 92.0% and less than 100.0%Greater than or equal to 40.2% and less than 92.0%Less than 40.2%
      Suicide auditYes---No


      Service provisionSignificantly above averageAbove averageAverageBelow averageSignificantly below average
      Emergency admissions (change in rate)The probability of this level of improvement happening by chance is less than 1% but more than 1%The probability of this level of improvement happening by chance is less than 5%The level of improvement or deterioration is not statistically significantThe probability of this level of deterioration happening by chance is less than 5% but more than 1%The probability of this level of deterioration happening by chance is less than 1%
      Emergency admission to hospital for children with lower respiratory tract (LRT) infections (change in rate)The probability of this level of improvement happening by chance is less than 1% but more than 1%The probability of this level of improvement happening by chance is less than 5%The level of improvement or deterioration is not statistically significantThe probability of this level of deterioration happening by chance is less than 5% but more than 1%The probability of this level of deterioration happening by chance is less than 1%
      Primary Care Management - Acute conditions (change in rate)The probability of this level of improvement happening by chance is less than 1% but more than 1%The probability of this level of improvement happening by chance is less than 5%The level of improvement or deterioration is not statistically significantThe probability of this level of deterioration happening by chance is less than 5% but more than 1%The probability of this level of deterioration happening by chance is less than 1%
      Primary Care Management - Chronic conditions (change in rate)The probability of this level of improvement happening by chance is less than 1% but more than 1%The probability of this level of improvement happening by chance is less than 5%The level of improvement or deterioration is not statistically significantThe probability of this level of deterioration happening by chance is less than 5% but more than 1%The probability of this level of deterioration happening by chance is less than 1%
      Community equipmentEqual to 100.0%Greater than or equal to 98.6% and less than 100.0%Greater than or equal to 90.9% and less than 98.6%Greater than or equal to 79.6% and less than 90.9%Less than 79.6%
      Patient complaints procedureGreater than or equal to 93.8%Greater than or equal to 77.7% and less than 93.8%Greater than or equal to 54.2% and less than 77.7%Greater than or equal to 33.3% and less than 54.2%Less than 33.3%
      Prescribing rates of antibacterial drugsLess than or equal to 0.895Less than or equal to 0.997 and greater than 0.895Less than or equal to 1.132 and greater than 0.997Less than or equal to 1.245 and greater than 1.132Greater than 1.245
      Prescribing rates for drugs acting on benzodiazepine receptorsLess than or equal to 5.708Less than or equal to 7.211 and greater than 5.708Less than or equal to 10.080 and greater than 7.211Less than or equal to 12.516 and greater than 10.080Greater than 12.516
      Staff opinion surveyGreater than or equal to 3.58Greater than or equal to 3.46 and less than 3.58Greater than or equal to 3.29 and less than 3.46Greater than or equal to 3.17 and less than 3.29Less than 3.17
      GP AppraisalEqual to 100.00%-Greater than or equal to 42.6% and less than 100.0%Greater than or equal to 6.0% and less than 42.6%Less than 6.0%
      Sickness absence rateLess than or equal to 2.5%Less than or equal to 3.4% and greater than 2.5%Less than or equal to 4.7% and greater than 3.4%Less than or equal to 5.8% and greater than 4.7%Greater than 5.8%
      Fire, Health and SafetyEqual to 0.00Less than or equal to 0.07 and greater than 0.00Less than or equal to 17.57 and greater than 0.07Less than or equal to 44.15 and greater than 17.57Greater than 44.15
      Generic prescribingGreater than or equal to 80.41%Greater than or equal to 79.07% and less than 80.41%Greater than or equal to 76.38% and less than 79.07%Greater than or equal to 74.17% and less than 76.38%Less than 74.17%

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