A. This website holds all Healthcare Commission performance ratings related information for 2003/2004. The information is divided into sectors and listed on the left side menu.
This provides general information affecting the sector and includes topics such as combined trusts and the impact of clinical governance reviews.
Specific information regarding the performance indicators (including key targets and other broader measures of performance) are available in this section. You can see the list of indicators and their technical details, which include such information as the data source / period, rationale, construction and thresholds. Trusts' performance can also be compared by indicator performance in this section.
In this section you can see how a trust has been performance rated. A summary report showing how the trust has performed with respect to the performance indicators and a detailed trust report is also available.
A. The NHS performance ratings system places NHS trusts in England into one of four categories:
The performance rating applies across the whole organisation, not to individual services.
A. Information from clinical governance reviews is used in determining poorly performing (zero star) and high performing (three star) NHS organisations. A clinical governance review assesses the trust in relation to seven components of performance:
Each component is scored from I to IV.
After each review, an action plan to address these areas for improvement identified by the report is prepared by the trust, agreed with the Healthcare Commission (or previously CHI), and published. For trusts whose clinical governance reviews are older (published before July 2003), the Healthcare Commission, with the support of strategic health authorities, has assessed progress by reference to this action plan to ensure that any significant improvements have been taken into consideration in calculating the star rating.
For this year, scores in clinical governance reviews have not been incorporated into star ratings for acute and specialist trusts, since the majority of the reviews are now several years old. They do apply to all other types of trusts where the review was substantially completed before the end of March 2004.
A zero star trust is one that either fails against the key targets or is considered to have poor clinical governance.
A three star trust is one that scores highly on the indicators and, if a review has been undertaken, is considered to have good clinical governance.
A. Trusts that have demonstrated significant strengths, many strengths, strengths or significant areas of weakness in applicable reviews have been given symbols to denote their performance.
Trusts that received a review some time ago, a pilot review or have not yet had a review have received a not applicable (n/a).
A. There are 28 strategic health authorities in England, each with responsibility for their own geographic area.
Strategic health authorities develop strategies for the local health services and ensuring high-quality performance by performance managing those in their area. They manage the NHS locally and are a key link between the Department of Health and the NHS. They will also ensure that national priorities are integrated into local plans.
A. If you want to view the results for a trust but you aren't sure of the name, you can identify it in several ways.
If you think you know the name but are not certain -
Go to the home page and click the link 'geographic search' near the top of the page. You will then see a map of England divided into regions. Click the region you want to see and you will be given a list of all trusts in the area.
If you know the name of a doctor -
Go to the home page and click the link provided in the blue box called having trouble finding your trust? This will launch an NHS website (in a new window) where you can enter the doctor's name to identify their trust.
A. Indicators can be categorised within the following two groups:
The performance ratings are calculated using key targets and a selection of performance indicators organised into the balanced scorecard.
The key targets reflect the minimum standards that all organisations are expected to achieve and map onto the Planning & Priorities Framework (PPF) priorities for that year.
The balanced scorecard is populated with a wider set of performance indicators. These indicators are chosen to reflect the wider range of deliverables specified in the NHS Plan. The wider set of performance indicators also includes data from the patient surveys, staff surveys as well as the clinical indicators.
A. The symbol [SQUARE] is used to indicate 'Data not available' - the indicator was applicable to this trust BUT data were not available through no fault of the trust (the trust has not been penalised in the performance ratings for the lack of data for this indicator).
The symbol [DISC] is used to indicate 'Data not returned' - the indicator was applicable to this trust but data were NOT returned for this trust or invalid data were provided (the trust was penalised in the performance ratings for the lack of data for this indicator).
'Data not applicable' is denoted by n/a. The indicator was not applicable to this trust and the trust has not been penalised in the performance ratings for the lack of data for this indicator.
A. This means that either the trust failed to return data to the organisation that collected the data (eg the Department of Health), or failed to return data by the deadline set by the organisation that collected the data, or submitted data that was invalid.
A. All trusts have been assessed on their performance during 2003 / 04 against a limited number of key targets and a larger number and range of indicators. Performance against targets is assessed in terms of whether the target has been achieved, whether there has been some degree of underachievement or whether the target was significantly underachieved. Trust performance is considered to be of concern if there are:
The broader range of indicators make up a 'balanced scorecard' to refine the judgement on ratings. This balanced scorecard approach allows a broad range of areas to be measured within a single methodology. To achieve a high overall rating, trusts must achieve good scores in a rounded set of indicators.
The indicators have been grouped into clinical, capacity and capability, and patient focus areas for all acute, ambulance and mental health trusts. The ratings methodology for NHS primary care trusts is similar to that for acute trusts, but balanced score card indicators are grouped under unique headings to reflect the responsibilities of these organisations in public health improvement, and as providers of primary care and commissioners of primary and secondary care services. These focus areas are access to quality services, improving health and service provision.
A. Thresholds are defined on the key targets and some balanced scorecard indicators and are used to create three levels of performance. In general, this approach to determining levels of performance has been used where there is a clear policy target that trusts should be expected to achieve. (The exception was the child protection indicators where the decision was based on the nature of the indicator). The threshold used to define the highest level of performance was always defined in relation to the published target. The threshold to define the lowest level of performance was based on what would be generally regarded as poor performance against the target.
A. To view results for an indicator:
Click on the Results link for the indicator that you wish to see. A list of trusts will be displayed with their results for the indicator. From here you can:
click the Indicators link (left side menu) again to return to the list of indicators
A. A score of 1 is used to identify performance for an indicator which is poor, 5 identifies good performance. Scores of 2 - 4 should be considered on a scale relative to the identified performance boundaries.
A. The England value gives the mean value for the country. It is generally not the average of all the trust figures because this does not take into account the difference numbers of people cared for by different trusts.
The median value is related to the distribution of values across the trusts. If these are ranked in order, from the highest to the lowest, the median is the middle value. If the distribution of values is symmetric, the median is equal to the mean value. However, in some cases, there can be more high or low values. The median is a more robust measure of the average than the mean in these circumstances.
A. To download a table of results for an indicator go to the More information link (on the bottom left side menu of the home page). You will find a selection of excel and zip files below the heading 'downloadable documents'.
These files include:
A. Primary care trusts (PCTs) that also provides mental health services will receive two ratings. Each rating will be on the set of indicators which apply to the services being delivered.
Thresholds can be different depending on the sector they are being applied to, this is why a trust can receive two different scores for an indicator with the same name (eg financial management)
A. To view a summary of indicators for a trust's 2004 rating:
Click the Ratings link (on the left-hand side) for the appropriate type of trust (acute, ambulance, mental health or primary care). A list of all trusts (for the type selected) is displayed with their rating.
Note: If required, you can use up and down arrows at the start of the list to sort results alphabetically, or by result, in ascending or descending order. Alternatively, you may wish to use search options to locate the required trust.
A. You can compare your rating with other trusts in a number of ways:
Please select an option above for more detailed information.
A. To print a summary of indicators for a trust's 2004 rating:
Click the Ratings link (on the left-hand side) for the appropriate type of trust (acute, ambulance, mental health or primary care). A list of all trusts (for the type selected) is displayed with their rating.
Note: If required, you can use up and down arrows at the start of the list to sort results alphabetically, or by result, in ascending or descending order. Alternatively, you may wish to use search options to locate the required trust.
A. To view a trust's rating for the previous year (2002/2003), simply click on the 2002/2003 Performance Ratings tab at the top of the page. The previous version of the performance ratings site will open in a new window. You can use the left-hand navigation to view results for trusts in the same way as for the 2004 ratings.
Alternatively, click on England ratings to see an overview of ratings for this year and links to previous year's results.
A. A trust report summarises the trust's performance and explains how indicators were used to determine its rating. The report highlights areas in which the trust has achieved high standards of performance, together with any areas where improvements need to be made.
These reports are a helpful tool for trusts to identify areas which need immediate improvement and areas in which they are excelling.
To help users compare their ratings with other trusts, the report also provides access to cluster information and benchmark graphs.
A. To view a trust report:
Click the Ratings link (on the left-hand side) for the appropriate type of trust (acute, ambulance, mental health or primary care). A list of all trusts (for the type selected) is displayed with their rating.
Note: If required, you can use up and down arrows at the start of the list to sort results alphabetically, or by result, in ascending or descending order. Alternatively, you may wish to use search options to locate the required trust.
A. To print a trust report:
Click the Ratings link (on the left-hand side) for the appropriate type of trust (Acute, Ambulance, Mental Health or Primary Care). A list of all trusts (for the type selected) is displayed with their rating.
Note: If required, you can use up and down arrows at the start of the list to sort results alphabetically, or by result, in ascending or descending order. Alternatively, you may wish to use search options to locate the required trust.
A. To download a table of results for an indicator go to the More information link (on the bottom left side of the home page). You will find a selection of excel and zip files below the heading 'downloadable documents'.
These files include:
A. To view a summary of ratings for 2003/2004, click the England ratings link (on the bottom left of the home page). Results are shown for:
A. To view a summary of ratings for 2003/2004:
Scroll to the end of the page to find links for:
A. For the purposes of comparison and analysis, trusts have been grouped into clusters on the benchmark graphs. (Note: the ratings were not derived using these clusters.) The clusters for all trust types except for PCTs have been provided by the Department of Health. The PCT clusters are based on the classification of PCTS published by the Office for National Statistics. The PCT clusters correspond to 14 of the supergroups/ groups/ subgroups within the ONS classification and have names that are broadly consistent with those used by the ONS.
A. To find which cluster a trust belongs to:
Click the Ratings link (on the left-hand side) for the appropriate type of trust (Acute, Ambulance, Mental Health or Primary Care). A list of all trusts (for the type selected) is displayed with their rating.
Note: If required, you can use up and down arrows at the start of the list to sort results alphabetically, or by result, in ascending or descending order. Alternatively, you may wish to use search options to locate the required trust.
Select the Cluster information link at the top of the page to view:
A. To view results for all trusts in a specific cluster:
Click the Find button to perform the search. All trusts found will be listed on a Results page (in alphabetical order), together with their rating. From here you can:
Click the Summary link for a trust to view its results summary page.
Click the Trust report link for a trust to view its detailed report.
Note: Confirmation of your search criteria and the number of matches displayed is shown at the top of the Results page.
For further information about search functionality please refer to our Searching section.
A. To help understand performance rating information and aid comparison across trusts, benchmark graphs can be viewed. Namely:
A. Not all indicators using in the 2004 ratings are suitable for benchmarking purposes. For example, some indicators are measured on scales with a few values (e.g. 0, 1, 2) and so are not suitable for graphing. Also, it was necessary to keep the benchmark section of the trust report to a manageable size. Consequently, graphs were included only for those indicators that were judged to be most interest and informative.
A. To view benchmark graphs for your trust:
Click the Ratings link (on the left-hand side) for the appropriate type of trust (acute, ambulance, mental health or primary care). A list of all trusts (for the type selected) is displayed with their rating.
Note: If required, you can use up and down arrows at the start of the list to sort results alphabetically, or by result, in ascending or descending order. Alternatively, you may wish to use search options to locate the required trust.
A. Each trust will have three benchmark performance graphs - one for each focus area:
Note: PCT focus areas are: access to quality service, improving health and service provision.
These graphs are in the form of a bar chart, showing all trusts in the same cluster, with your trust (i.e. the trust that was selected to access the report) highlighted for identification.
A. Each trust will have between 4 and 8 supplementary benchmark graphs, dependent on which cluster the trust belongs to. These graphs will be made up of:
This graph shows all trusts in ascending order, represented by a plus symbol for each. A single, vertical bar will be displayed to indicate your trust (i.e. the trust that was selected to access the report).
Two horizontal lines are also displayed, one marks the upper threshold and the other marks the lower threshold. If no threshold is held for an indicator, these lines will not be shown.
A. For balanced scorecard indicators, the performance of a trust is shown against trusts within its peer group. In these graphs, the indicator values of the trusts are shown as bars. Horizontal lines show the thresholds of the middle performance level (the band that scored 3).
A. The benchmark graph pages have been designed for screens set to resolution 1024 x 768 pixels. If you are using a different screen resolution you may need to use horizontal and/or vertical scroll bars to view all information shown in the charts.
A. The following search options are available on the performance ratings site:
A. The basic search facility can be used to search for a trust (or trusts) by name. For example, you might choose to enter the word 'Hampshire' to list all trusts with Hampshire in its name, or you might type the full name of a trust to return just that one entry. To do this:
Click the Find button to perform the search. All trusts found will be listed on a Results page (in alphabetical order), together with their rating. From here you can:
Note: Confirmation of your search criteria and the number of matches displayed is shown at the top of the Results page.
A. The Advanced search facility provides further options to refine to refine your search criteria - you can choose to search by name, rating, geographic area (strategic health authority), trust type or any combination of these. To do this:
Click the Find button to perform the search. All trusts found will be listed on a Results page (in alphabetical order), together with their rating. From here you can:
Note: Confirmation of your search criteria and the number of matches displayed is shown at the top of the Results page.
A. The Cluster search facility enables the user to search for trusts of a given type, within a specified cluster. If required, you can refine the search on the basis of rating. To do this:
Note: Confirmation of your search criteria and the number of matches displayed is shown at the top of the Results page.
A. The Geographic search facility enables the user to search for trusts within a strategic health authority's area. To do this:
Click the Geographic search link at the very top of the page to display a list of strategic health authorities and a geographic map. From here you can:
click the name of the strategic health authority that you wish to view
or
Having selected a strategic health authority from the list or from the map, a list of trusts within that area is displayed. From here you can:
A. To view the detailed methodology that was used for this year's performance ratings, click the Methodology link, which is displayed in the Ratings assistance section on the top right-hand side of the home page.
This is divided into sectors (acute, ambulance, mental health and primary care) and each has their own downloadable file.
The Finsbury rules are the rules for incorporating The Healthcare Commission's clinical governance review (CGR) assessment levels into star ratings. They are:
A. For assistance with site functionality (navigation, searching, etc) click the Help link which is displayed on the right-hand side under Ratings assistance, or use Help links that are displayed with specific functions.
A. Use the More information link (on the left-hand side) to view further information, including:
If you have a query that is not addressed in this FAQ or the site Help pages, or if you have any general comments, please use the Contact Us link on the right-hand side of the page.