The aim of self assessment is to draw attention to problems but after this first round of reporting, will the new system help or hinder NHS trusts?
The publication last week of the public declarations of performance by NHS trusts fed the media maelstrom about the quality of services provided by the NHS. Trusts had to comply with 44 core standards set by the Department of Health and inspected or assessed by the Healthcare Commission. The declarations revealed that 60 per cent of all trusts have failed to meet all 44 standards.
So what does this actually mean? First of all, we need to remind ourselves of the purpose behind the declarations which will feed into the Healthcare Commission's annual health check, due to be published later this year. The purpose of the annual health check, which replaced the previous star ratings for trusts, is to ensure the quality and safety of NHS services.
The Healthcare Commission inspects NHS trusts so they can inform the public about the quality of health services in their area. The Commission also inspects the NHS in order to improve health services, where necessary, and to ensure consistency and safety for all who use and work in the NHS. The standards and the health check are not ends in themselves but a means to an end - to achieve high quality services for patients.
Second, we need to remind ourselves that this is the first time the Healthcare Commission has used a system of self-assessment in the lead-up to the health check.
This means that we have a new system with which it is not helpful, or fair, to compare performance from previous years. We also have a system that is designed to alleviate unnecessary burden placed on trusts, by reducing inspections to a minimum based on risk identified through the self-declaration. This is an important step forward..
We should also bear in mind that given that this is a new approach, it will undoubtedly cause a few teething problems in the first year. But as trusts get used to the new methodology and the standards, compliance will be improved as will consistency and confidence in the system. The new approach adopted by the Healthcare Commission will also provide better, and more, information on the performance of trusts that any previous system, including star ratings. In a new world driven by patient choice, this information is invaluable.
Third, whilst it is right to be concerned about the two thirds of trusts who have not declared compliance in all the standards, we should remind ourselves that over 75 per cent of all trusts have declared compliance in at least 90 per cent of the standards which is a great deal more reassuring. After all, would you not rather be treated in a trust where they recognise their shortcomings and are doing something about it, than in a trust where they have denied they have a problem in the first place? The new approach is designed to inspire and incentivise honesty and transparency, so that trusts can take firm action where there is a problem and not cover it up.
In conclusion, given the relatively low number of trusts who have declared overall compliance, perhaps the question is not whether this indicates failure, but whether the core standards themselves are set at an appropriate level. And what in fact we are looking at is not the basics, but aspirational levels of development that trusts should strive to in the medium and long term. If this is the case, we should be moving towards fewer national targets and standards and more targets being set locally - as this is where the knowledge and expertise is concentrated that is needed to drive forward improvements.
The issue then becomes about strong leadership, strong commissioning, involvement of patients and the public in the design of services, open and transparent governance and, of course, financial well-being. But all regulation should hope to deliver in this new world is national performance assessment that helps drive forward this improvement agenda, but also inspires local ownership and action.
There will always be challenges within the NHS. But how they are dealt with, and what the information really tells us is a real challenge, because the public perception of the state of health of the NHS still does not match the experience of patients.
Maria Nyberg
Policy Manager
NHS Confederation
Health Management Journal - September 2006
