Accounting for the NHS – The Annual Health Check 2007/08

The third Annual Health Check from the Healthcare Commission has now been published. Alan Jones provides a round-up of the most significant results. Have you accounted for these in your local plans?

The Healthcare Commission as an independent body has gone and is now part of the Care Quality Commission, officially live in April 2009. For its swansong, it published the latest results of the Annual Health Check for England’s 319 NHS Trusts. As companies re-invent account management for the NHS and dive deeper into customer-centric working and enhanced customer focus to achieve deep customer insight, these results provide one with a fabulously rich vein of NHS gold for local account management purposes.

What is the Annual Health Check?

Over the last 10 years or so, the NHS in England has been subject to very close scrutiny over its performance. Once upon a time we had star ratings, but these were ditched as being too narrowly focused. Then Standards for Better Health, published in 2004, went to the other end of the performance management spectrum with a vast array of 24 core standards (with 44 components) and 33 national targets. One such standard, just for interest, is the implementation of NICE technology appraisals. All NHS Trusts are asked to make self declarations as to whether they are achieving all of this (or not), the Healthcare Commission makes some spot checks and then, voila, each Trust gets a rating on a fourpoint scale ranging from excellent to weak on both quality of services and use of resources (financial management). But these are only the headline stories and so much more information is available to you.

How did the NHS do in 2007/08?

The Commission found that overall NHS Trusts had improved over previous years. In terms of quality, the Commission judged 100 NHS Trusts (26%) to be excellent, 139 (36%) good, 132 (34%) fair and 20 (5%) weak. For their use of resources, this year 94 Trusts (24%) were excellent, 145 (37%) were good, 132 (34%) were fair and 20 (5%) were weak. Overall, 42 Trusts were excellent on both measures (mostly NHS Foundation Trusts), compared with two in the first annual health check in 2005-6, while the number scoring weak on both measures has fallen from 25 to six.

One hundred and sixty-nine Acute and Specialist Trusts were the most dramatically improved, whilst PCTs’ performance disappointed overall, with only 33% rated excellent or good on quality of services, although this year Salford PCT became the first ever double-excellent PCT. Brent, Great Yarmouth & Waveney and North Yorkshire & York PCTs were all rated ‘double-weak’. And just to give you a flavour of some of the individual standards being measured: a core standard with one of the highest rates of compliance was C22b (99.3%), about requiring organisations to use annual public health reports to inform policies and practices. Knowledge of what is in these reports is also critically important for you in terms of PCT account management.

Regionally, NHS North East performed the best and NHS London the worst. In fact, London SHA was the only area of the country where performance for quality of services had declined and, for the first time, there seems to be a gap opening up with the rest of England – not surprising really since London’s small PCTs were ‘unreconfigured’ in the last re-organisation and remain weak.

Action to address these issues will likely focus on encouraging PCTs to work together to commission services and future reconfiguration of London PCTs is not out of the question. So those working the London Health Economy need to note that already a London Clinical & Business Support Agency is being formed, responsible for sharing the skills and knowledge that will enable London’s 31 PCTs to become world class commissioners – a possible new Regional Influencing Centre?

So why is all this important to me?

Well, if you are an account manager, it would make sense to know how your organisational accounts are performing and what they are being measured on. The individual Trust Annual Health Check results are vitally important to know and need to be added to any ‘sophistication indices’ you might be using. We have seen that there are 42 organisations at the top of this excellence tree (including one PCT) and six organisations at the bottom (including 3 PCTs). Now, let’s say you are calling on these organisations, surely this kind of knowledge might change the very nature of your account management strategy for a particular organisation? For instance, as far as joint working approaches to those at the top of the tree were concerned, your approach might be centred more around their innovativeness and their moving even further forward in terms of delivering improved outcomes for their patients. With those at the bottom, your approach might be more measured and possibly about helping them out of the deep black hole they are in! And a thorough analysis of the detailed results would also be needed. For instance, they might not be implementing NICE guidance and you might be able to be of some assistance here. It will be very useful for local Acute Trust, Mental Health Trust and PCT account managers to know the individual detailed results of their accounts and these can all be found on the Healthcare Commission’s website. Please see www.healthcarecommission.org.uk.

Alan Jones is an independent policy analyst and adviser. He comments widely on the implications of NHS reform and is a much sought after presenter, chair and facilitator. He can be contacted at alan.jones28@virgin.net.

Other questions are: Why have NHS Foundation Trusts done so well? What is it about this future NHS hospital model that is so different to the non- Foundation Trust? And why are PCTs doing so poorly? Also, how will this relate to PCTs moving towards becoming ‘world class commissioners’? This is particularly relevant as from this autumn, PCTs will be assessed against a whole range of new competencies. The results will eventually be made public and here too will be another rich vein of information for local account management. Finally, the Audit Commission too is an excellent source of local information, and those who want to dig more deeply into the finance side can see their recent Health Briefing Auditors Local Evaluation 2007/8 at www.audit-commission.gov.uk, where, in Appendix 2, you will find each NHS Trust’s scores in terms of financial management and value for money. For instance, Bromley PCT scores very highly here and Ashton, Leigh and Wigan PCT are mentioned in despatches for their approach to tackling health inequalities.

Deep customer intelligence has to be the way forward for account management and the ‘truth’ is indeed out there…