Acute trust overview

Key targets

• A&E emergency admission waits (12 hours)
• cancelled operations not admitted within 28 days
• financial management
• hospital cleanliness
• Improving Working Lives
• number of inpatients waiting longer than the standard
• number of outpatients waiting longer than the standard
• total time in A&E
• two week cancer waits

Performance against targets is assessed in terms of whether the target has been achieved, whether there has been some degree of underachievement or whether the target was significantly underachieved. Trust performance is considered to be of concern if there are:

• a sizeable number of targets with some degree of underachievement
• a smaller number of targets against which there has been significant levels of underachievement
• a combination of both

Indicators

The broader range of indicators make up a 'balanced scorecard' to refine the judgement on ratings. This balanced scorecard approach allows a broad range of areas to be measured within a single methodology. Trusts with high performance ratings therefore have to do well against a rounded set of indicators.

The indicators have been chosen to provide a balance across the clinical, patient, and capacity and capability focus areas outlined below:

Clinical focus

• clinical negligence
• death within 30 days of a heart bypass operation
• death within 30 days of selected surgical procedures
• emergency readmission to hospital following discharge
• emergency readmission to hospital following discharge for children
• emergency readmission to hospital following treatment for a fractured hip
• emergency readmission to hospital following treatment for a stroke
• infection control procedures
• Methicillin Resistant Staphylococcus aureus (MRSA) bacteraemia: improvement score
• thrombolysis treatment time

Patient focus

• A&E emergency admission waits (4 hours)
• better hospital food
• breast cancer treatment
• cancelled operations
• day case booking
• delayed transfers of care
• nine month heart operation waits
• outpatient / A&E survey – access & waiting
• outpatient / A&E survey – better information, more choice
• outpatient / A&E survey – building relationships
• outpatient / A&E survey – clean, comfortable, friendly place to be
• outpatient / A&E survey – safe, high quality, coordinated care
• paediatric outpatient did not attends rates
• patient complaints procedure
• privacy & dignity
• six month inpatient waits
• thirteen week outpatient waits
• total inpatient waits
• waiting time for rapid access chest pain clinic

Capacity and capability focus

• data quality
• staff opinion survey
• junior doctors' hours
• consultant appraisal
• sickness absence rate
• information governance
• fire, health & safety

Clinical governance reviews

As last year, information from CHI's reviews is used in determining poorly performing (zero star) and high performing (three star) NHS organisations.

Since beginning its work in 2000, CHI has published clinical governance review reports on most acute and specialist 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 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.

Specialist trusts

The ratings methodology for specialist trusts is similar to that for acute trusts. One of the key targets - two week cancer waits - and some individual indicators are only appropriate for some individual specialist trusts. For instance two week cancer waits are not appropriate for specialist trusts, such as Moorfields Eye Hospital, which do not provide most cancer services. Similarly accident and emergency waits do not apply to specialist hospitals without A&E services. A trust rating is allocated on the basis of those key targets and indicators that are appropriate to the specialist trust concerned.

The indicators for specialist trusts are selected, as appropriate to the functions of the individual trust, from the list detailed for acute trusts.

Combined trusts

Trusts that provide services in more than one sector have been given more than one star rating. For instance an acute trust that also provides mental health services will have a star rating in the acute list and a star rating in the mental health list.