The NHS Performance Regime
The DoH’s report published in early June aims to set out a “systematic and transparent approach to managing performance across the NHS”. It has three goals: identifying underperformance; supporting recovery; and managing failure. The tone is tough: we’ll bring in external reinforcements if you’re struggling; but if you’re failing you’ll be outsourced, taken over or shut down. There is also opportunity here for the best PCTs and trusts to takeover underperforming peers. We hope the regime has teeth. Here are our take-aways.
Besides the DoH, there are five entities involved in delivering the performance strategy. Most of them are active in their roles today i.e. PCTs, SHAs and Monitor, but some are relatively new i.e. the CQC (Care Quality Commission) and IMAS (Interim Management And Support). Their influence on providers and each other is shown in the chart and discussed below:
Responsibilities and metrics in the NHS performance regime
SHAs
SHAs can have a direct influence on state-owned hospital trusts and in the performance of PCTs. Their responsibilities include:
- Performance assessment. Financial metrics for trusts and PCTs will be based on the framework used by Monitor for foundation trusts. Service performance will be based on a combination of vital signs indicators and new clinical indicators (TBD). Finally, there will be an assessment of the boards’ capability
- Supporting recovery. Through IMAS, see below
- Managing failure. The options for failing trusts could include: closure/ asset disposal; outsourcing of individual services or management; acquisition by another NHS organisation. The options for failing PCTs could include: replacement of the board; outsourcing some or all of the functions; takeover by another PCT
IMAS(Interim Management And Support)
This is a new turnaround unit to support organisational recovery, aligned to the PCT/ SHA. We’re guessing this is a combination of trouble-shooting experts and interim management
PCTs
Through its role in commissioning and contracting with NHS and independent providers, PCTs have a major role to play in balancing the needs of the community, provider capacity and quality of delivery.
System management. There are three parts to this aimed at delivering world class commissioning:
- Understand provider economics (scale, finances, performance) and dynamics
- Make changes to provider capacity through forecasting, modelling risk and the impact of structural changes
- Make investment/ disinvestment decisions which lead to a mix of providers that achieve a trade-off between cost and quality
Measurement through a performance dashboard. Interestingly, this will contain clinical outcome data as well as operational standards (e.g. waiting times) and user experience (e.g. patient satisfaction and patient-reported outcomes)
CQC (Care Quality Commission)
A new regulatory body for health and adult social care, its responsibilities include:
- Registration requirements for NHS and independent organisations providing care
- Periodic assessment of NHS trusts
- Publish comparative information about commissioners and providers
Monitor
Authorising body for foundation trusts (as now). Compliance and tracking against financial, governance and services risk.
The full report, Developing the NHS Performance Regime, can be found here.
