Mental health trust overview
All mental health trusts have been assessed on their performance during 2002 / 2003 against a limited number of key targets and a larger number and range of indicators. Key targets are the most significant factors in determining overall performance ratings this year. The ratings methodology for NHS mental health trusts is similar to that for acute trusts. The exception is in the choice of key targets and indicators, some variations having been made to reflect the specialised range of services provided by mental health trusts.
- assertive outreach team implementation
- CMHT integration
- mental health minimum dataset implementation
- number of outpatients waiting longer than the standard
- Improving Working Lives
- hospital cleanliness
- financial management
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
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 negligence
- CPA systems implementation
- psychiatric readmissions (adult)
- psychiatric readmissions (older people)
- suicide rate
- transition of care between adult services and OPMH
- transition of care between CAMHS and adult services
- patients with copies of their own care plan
- patient complaints procedure
- better hospital food
- privacy & dignity
Capacity and capability focus
- missed outpatient appointments
- crisis resolution team implementation
- out of catchment area treatments (adults)
- out of catchment area treatments (older people)
- CAMHS service mapping
- data quality
- staff opinion survey
- junior doctors' hours
- consultant appraisal
- sickness absence rate
- information governance
- fire, health & safety
Clinical governance reviews
Information from CHI's reviews contributes to determining poorly performing (zero star) and high performing (three star) NHS organisations.
CHI has published clinical governance review reports on some mental health 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.
Learning disability trusts
The ratings methodology for trusts that provide services for people with learning disabilities is similar to that for mental health trusts. Learning disability trusts have been performance rated on the set of indicators applicable to mental health trusts, omitting those that do not apply to its services. A trust rating is allocated on the basis of those key targets and indicators that are appropriate to the learning disability trust concerned.
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.