The Care Quality Commission is responsible for assessing and reporting on the performance of all NHS organisations in England against measures and priorities set by government.

It assesses: A. core standards, including safety and cleanliness, safeguarding children, infection control, dignity and respect, and privacy and confidentiality. B. existing commitments, including indicators concerned with waiting times for inpatient and outpatient treatment, and ambulance response times. And C. national priorities, including indicators concerned with patient reported experience of services, infection rates, waiting times for cancer treatment, and a range of public health measures.

All 392 NHS trusts make a public declaration against the 44 parts of the 24 core standards, and the CQC uses a total of 86 performance indicators across the different types of trust to assess the existing commitments and national priorities.

Trusts receive a rating involving an overall quality score; and a score for financial management. It applies a four-point scale of ‘excellent’, ‘good’, ‘fair’, or ‘weak’.

Mixed bag of ratings in 2008/2009

Overall, it is a mixed picture of performance this year.

CQC said the NHS is performing well against a rigorous assessment on quality, with more trusts rated ‘excellent’ or ‘good’. The national compliance rate for core standards is the highest it has ever been, at 96.3% this year.

It also commended the significant improvement in ratings for financial management, positive news as we enter a period of restraint on public spending. The assessment shows big improvements for patients with more people seen in A&E within four hours, more receiving treatment within 18 weeks of referral, more screened for Chlamydia and big reductions in MRSA and Clostridium Difficile cases.

Thirty-seven trusts were rated double-excellent, including The Royal Marsden NHS Foundation Trust, which was double-excellent for the fourth year running. Barking, Havering and Redbridge University Hospitals NHS Trust was the only trust rated double-weak, down from six trusts last year.

But CQC raised concerns about the 20 trusts rated ‘weak’ this year on quality and a further 27 that have not been higher than ‘fair’ for quality and financial management in the last four years.

CQC ascribes ratings to trusts based on their performance across a range of priority areas identified by the government.
For quality, CQC rated 15% of trusts ‘excellent’, 47% ‘good’, 32% ‘fair’ and 5% ‘weak’. Last year, ratings were 26%, 35%, 34% and 6% respectively. On financial management, 26% were rated ‘excellent’, 45% ‘good’, 26% ‘fair’ and 3% ‘weak’. Last year, ratings were 24%, 37%, 34% and 5% respectively.

Primary care trusts earned better results overall, with more than half rated ‘excellent’ or ‘good’ for the first time.

Challenges for acute trusts

But there was a decrease in ratings awarded to acute hospital trusts, with fewer trusts rated ‘excellent’ and more ‘fair’.

CQC said a number of factors were behind the acute trust ratings: more trusts declared they did not meet all core standards; increased scrutiny on child safeguarding and healthcare-associated infection; a significant number did not meet new indicators on quality of basic maternity data and participation in heart disease audits, vital to monitor quality of care; a significant number did not meet required performance on specialist stroke care; and a greater proportion of operations were cancelled at the last minute for non-clinical reasons.

CQC also pointed out that this year it has produced the most comprehensive and rigorous assessment ever of the performance of mental health and ambulance trusts.

Positive improvements for patients

1. More than 98% of the 19 million patients attending A&E waited less than four hours.

2. Between January and March this year, three million patients waited 18 weeks or less from referral to treatment.

3. 16% of people aged 15 to 24 were screened for Chlamydia, up from 5% the previous year.

4. There were 19,400 fewer cases of Clostridium Difficile and 1,500 fewer cases of MRSA in 2008/09 compared to 2007/08 - a reduction of a third for both.

5. Ambulances responded within eight minutes to more than 1.4 million life-threatening calls.

Areas for future improvement 

1. There was a drop in compliance with the core standard on child safeguarding down from 96.4% last year to 90.7% this year.

2. While MRSA and C. Diff rates are decreasing, acute trusts still need to do more on infection control. This year 48 acute trusts did not meet at least one of the three relevant standards, compared to 44 last year.

3. 37% of acute trusts meet the required level of performance on specialist stroke care.

4. New measures highlight considerable variation in quality of basic maternity and mental health data that is vital for monitoring quality of care.

5. The proportion of cancelled operations rose for the second year in a row to almost 1%. This equates to 63,000 operations cancelled at the last minute for non-clinical reasons. However, of these cancellations, more were rearranged for a new date within 28 days of the original operation.

Future direction of the Annual Health Check

Next year, CQC will further develop regulation to become more focussed on patients and outcomes. All trusts will need to register with the regulator to legally function.

CQC said compliance with core standards is a good indication of whether a trust is ready for registration. Overall compliance with standards has increased from 95% to 96%. However, only about half of trusts fully met all core standards and compliance declined in the acute sector with 59% fully met this year compared to 69% last year.

Cynthia Bower, CQC chief executive, said: “The NHS has performed well on quality, which is good news in the face of a rigorous assessment. But it is clear that some trusts are struggling and that some issues are proving tough nuts to crack.

“My biggest concern is those trusts that are ‘weak’ and persistently ‘weak’ or ‘fair’. They must do better for their patients.

“I want to ring the alarm bell in the boardrooms of these organisations. Next year, all trusts must register with us to legally function. It is clear that many have significant work to do and a short time in which to do it.”

Details of the performance ratings for individual trusts are available on the CQC website.