• 
  
  Acute and specialist trust indicators
• Ambulance trust indicators
• Learning disability trust indicators
• Mental health trust indicators
• Primary care trust indicators

Latest indicator thresholds (XLS, 161KB, opens in new window)
Scoring methodology (PDF, 102KB, opens in new window)
FAQ document (PDF, 71KB, opens in new window)
Ratification and extenuating circumstances protocol (PDF, 55KB, opens in new window)

Introduction

Existing commitments and national priorities are used to assess whether levels of service set through the 2008-2011 planning round are being maintained. Assessment of performance against the existing commitments and national priorities are components of the Care Quality Commission's periodic review in 2009/10 for primary care trusts (PCTs), acute and specialist trusts, and ambulance trusts. Mental health trusts and learning disability trusts will be assessed against one national priorities component.

Trust classifications

Please see below for the full list of trust classifications that will be used for the 2009/10 indicator based assessments:

• Acute and specialist trust
• Ambulance trust
• Learning disability trust
• Mental health trust
• Mental health trust that provides learning disability services (and will therefore be assessed against both the applicable learning disability and the applicable mental health national priority indicators)
• Primary care trust
• Primary care trust that provides inpatient mental health services (and will therefore receive a provider indicator based assessment against the applicable mental health national priority indicators)
• Primary care trust that provides both learning disability and inpatient mental health services (and will therefore receive a provider indicator based assessment against both the applicable learning disability and the applicable mental health national priority indicators).

Primary care trusts that only provide learning disibility services will be assessed against the applicable indicators from the learning disability indicator set. However, they will not receive an overall score against these indicators.

Two trusts do not fall into any of the above classifications - Isle of Wight NHS PCT will be assessed against all applicable indicators from across the five trust types; South Downs Health NHS Trust will not receive an indicator based assessment in 2009/10.

Data collection deadlines

For data collected by the Department of Health via Unify 2, a comprehensive list of submission deadlines is available to users of the Unify portal.

HES Data

HES data for the relevant indicators will be sourced from Secondary Uses Service (SUS).

We intend to use HES data relating to April to December 2009. The HES data used for the 2009/10 periodic review will now be sourced no earlier than the month 10 HES extract, which includes data submitted to SUS by the December post-reconciliation inclusion date of 23 February 2010. This is a change from the previously stated earlier month 9 provider submission date of 22 January 2010.

CQC is currently considering sourcing data from month 11 HES extract, which includes data submitted to SUS with the inclusion date of 23 March 2010.  Please note that CQC still reserves the right to source data from any month but no earlier than the month 10 HES extract.

Details of the Secondary Uses Service 2009/10 PbR Inclusion dates and deadlines (opens in new window)

Removal of general rounding principle

Prior to the 2008/09 annual health check, a general rounding principle had been applied to the thresholds used to assess performance on indicators. For example, a trust would be deemed to have achieved a 98% target if its performance was 97.5% or above.

Just as in 2008/09, in 2009/10, again in common with Monitor, we are not intending to apply this principle in general. For example, a trust would have to reach performance at or above 98% to achieve the four-hour total time in A&E target.

The A&E target is a particularly meaningful example, as the numbers involved are very large and the 0.5% rounding historically applied could equate to a considerable number of patients spending more than four hours in A&E.

Exceptions will however be considered on an individual indicator basis, taking into account issues such as low activity or thresholds that have little or no tolerance, such as those set at 99-100%.

Performance against plan indicators

In 2009/10, we will continue to assess performance against plan indicators as actual performance against planned performance.

2009-2011 Vital Signs plans (or in a small number of cases, 2008 Local Delivery plans) agreed between PCTs and SHAs, and signed off by SHAs, will be the data source used for 2009/10 Vital Signs Tier 1 and 2 indicators, where appropriate and indicated in the construction.

Person-identifiable information

Trusts are reminded not to send person-identifiable information (this includes NHS Numbers and staff names) at any point, for instance as part of ratification enquiries, extenuating circumstance requests, or requests for review of the periodic review. Sending such information could breach the Data Protection Act 1998 and the standards required for patient confidentiality and records management for NHS and independent sector organisations. Such information will not be used by the Care Quality Commission, but will be destroyed or returned to the sender. Deadlines (where applicable) will not be extended to facilitate the resubmission of information. Information that identifies members of staff can only be accepted if it is confirmed that the identities are either already in the public domain or the staff have no objection to being identified in this way.

Our approach

We will continue to use our experience of assessing performance to contribute to improving the understanding of indicators and addressing any unintended effects.

In the light of our experience of using some of the indicators in previous assessments, we reserve the right to make amendments where necessary to this published list at a later date. Any such amendments will be highlighted in the publication schedule towards the top of this page and significant changes will be notified to trusts directly.

Our process

The process for assessing performance relating to existing commitments and national priorities consists of:

• publication of indicators
• data collection
• data ratification
• consideration of extenuating circumstances applications
• scoring
• consideration of representations
• publication of the score as part of the periodic review

This section outlines key activities and highlights important issues that healthcare organisations should take into account in preparing for our assessment.

Data collection

The Care Quality Commission is committed to reducing the burden of inspection and data collection on healthcare organisations. Where possible, we use data from existing, mandatory data collections to support our assessment of performance. We therefore commission data from a range of data collectors - for example, the Department of Health, the Health and Social Care Information Centre, or the Royal Colleges - as indicated in the data source section of the indicators published on this website.

Where data are not available from other such collections, we have gained approval from the Review of Central Returns Steering Committee - ROCR to collect the data directly from NHS organisations (ref: ROCR-Lite/OR/0195/FT6/003MAND). This process is called our "Special data collection", and will commence in April 2010.

Any trust which does not return data as per the published data source and period will receive a score of "Data failure" for that indicator. This score is equivalent to failing the indicator.

Data quality and timeliness

It is the responsibility of NHS trusts to supply accurate, comprehensive, good quality data within data collection deadlines for standard and special data collections.  The Care Quality Commission would expect trusts to undertake any check necessary to ensure that the data supplied is of sufficient quality for the purposes of assessment, including any data supplied on the trust's behalf by a delegated third party. 
 
The Care Quality Commission may apply quality checks to the data, at any time following the deadlines for data collection, to ensure that it is accurate, comprehensive and of good quality data.  Such checks may include, but will not be limited to, data quality measures outlined within the constructions for the existing commitment and new national priorities.  Organisations can be penalised for poor quality data or if complete data are not returned by published deadlines.

Ratification

The data ratification process will take place as relevant datasets become available to the Care Quality Commission, currently planned to commence in mid-June 2010. The Care Quality Commission will provide trusts and SHAs with detailed guidance and their unique passwords in advance of the ratification process.

Ratification provides organisations with an opportunity to see the data that will be used to construct their score for each applicable indicator. The exercise offers no opportunity to correct previously submitted data or to supply data that were not supplied within published data collection deadlines, unless actual performance or ability to submit data were adversely affected by an extenuating circumstance outside of the control of the organisation. The ratification process does enable organisations to check that the Care Quality Commission is using the data as they were supplied to the data collector, to ensure that data have not been subject to transcription error during transfer.

Extenuating circumstances

Where trusts believe that their performance has been adversely affected by unforeseen or emergency circumstances outside of the organisation's control and where the organisation could not reasonably be expected to have contingency in place to mitigate or remove this effect, they may request that this is taken into consideration. Additionally, where trusts believe that their ability to submit accurate, comprehensive data within data collection deadlines was compromised due to unforeseen or emergency circumstances outside of the organisation's control, they may also request that this is taken into consideration.

Trusts should be aware that the extenuating circumstances process offers the last opportunity to submit evidence demonstrating why it would be unfair to assess the trust using the data, as provided to us by the data collection agencies. The Care Quality Commission will not request further information or evidence that is not provided as part of a trust's submission, rather it is the trust's responsibility to ensure their submission is clearly set out and supported by evidence. Trusts should not place reliance on the provision of evidence from any third party but should ensure they collate and submit this themselves.

In March, we published our ratification and extenuating circumstances protocol, which is available at the top of this page.

Additional information for commissioners

Please click the following link for access to our commissioner assessment guide.

http://www.cqc.org.uk/guidanceforprofessionals/nhstrusts/annualassessmen...