01 April 2005
A new health regulatory framework aims to eliminate targets that could compromise clinical care
The 'radical' new inspection regime for NHS trusts launched this week will help end the distortion of clinical priorities caused by excessive use of performance targets, Anna Walker has told Public Finance.
The Healthcare Commission's chief executive said the new regulatory framework, unveiled on March 31 and replacing the star ratings system, would usher in a more rounded inspection regime.
Trusts would be rated on their ability to 'get the basics right', such as cleanliness and customer focus, and there would be less emphasis on performance against specific benchmarks.
'At the moment there is not much measurement of things that matter clinically,' said Walker, who is expected to become permanent secretary at the Department of Trade and Industry after the election. 'But with the new system we're not just looking at narrow targets, we're bringing out the distortions inherent in the system.'
In recent weeks, there have been claims that clinical staff have been prevented from closing MRSA-infected wards because managers were worried about not meeting treatment targets.
Commission chair Sir Ian Kennedy told PF that where the new inspection regime produced evidence that specific targets were compromising clinical care, the watchdog would make representations to the government.
'One of our duties is to report to Parliament annually on the state of health care. That report would be an opportunity to comment if standards themselves needed to be adjusted or if new targets were leading to distortion in provision of care.'
Under the new streamlined system, inspections will occur only where the commission believes there are grounds for concern, and their scope will depend on the scale of the perceived problem.
Instead, each trust will produce a self-assessment, which must include the views of patients' forums and other partners, measuring performance against five criteria. Trusts will be expected to publish their first draft assessments by October.
The criteria are: core standards, such as safety; existing targets set by the Department of Health; use of resources; the new national targets in the DoH's Public Service Agreement; and improvement reviews, scrutinising progress on a specific issue.
The Healthcare Commission will validate these assessments using a wide range of 'surveillance' data that is already collated by itself, the DoH and other regulators such as the Audit Commission. Around 20% of trusts will receive a site visit or unannounced spot check.
The commission will score trusts on each individual criterion and for overall performance using a four-point scale, likely to be poor, fair, good and excellent.
In cases where the watchdog decides intervention is necessary, it will have much greater discretion to decide what form that should take.
'This much more flexible approach allows for different responses, from a phone call to a chief executive to discuss an area of concern through to a full-scale investigation,' Kennedy said. 'Previously, the regulator only had the possibility of ordering an investigation, which set the threshold for intervention rather high.'
The reforms have been given broad backing from health care professionals. Nigel Edwards, director of policy at the NHS Confederation, said: 'We hope that the new assessment system will reduce the heavy burden of regulation under the existing system of star ratings.'
British Medical Association chair James Johnson said: 'We have sought to ensure that any new health care checking system is practical, meaningful for patients, and supports doctors' work in delivering the best possible patient care. The commission's new system has addressed many of our concerns.'
PFapr2005
