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Friday 21st October 2016

Annual Health Check

14th May 2007

With NHS organisations gearing up for another round of self assessment over the next couple of months for the Healthcare Commission’s annual health check, we look at what it involves, and what changes are being made for this second year of assessment.

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What is the annual health check?

The annual health check has replaced the old Star Ratings system as the way of checking how well NHS acute, mental health and ambulance Trusts and PCTs are meeting a range of standards and targets. A separate process, also run by the Healthcare Commission, monitors the performance of independent sector providers.

What is being assessed?

The annual health check is a tougher test of performance than the star ratings were, covering a broader range of standards. The standards being tested against are as follows:

Getting the basics right:

  • Core standards, as published in the Department of Health’s Standards for Better Health (last updated April 2006), cover seven areas: safety, care environment and amenities, clinical and cost effectiveness, governance, patient focus, accessible and responsive care, and public health. Core standards include issues like having systems in place to minimise healthcare associated infections.
  • Existing national targets, as published in the Department of Health’s National Standards, Local Action, cover the government’s most important performance commitments around waiting times, cancelled operations etc, and are heavily weighted in the overall annual health check assessment.
  • Use of resources, on which the Healthcare Commission works with Monitor and the Audit Commission to assess standards of financial reporting, management, standing, internal control and value for money.

Making and sustaining progress:

  • New national targets, based on National Standards, Local Action these show how organisations are building on the basics and improving further, including targets such as halving MRSA rates by 2008 compared to 2004 levels; access to sexual health clinics, and sustaining improvements in patient experience year on year.
  • Service Reviews and national studies previously called improvement reviews and incorporating work done through the acute hospitals portfolio. A number of these are carried out nationally each year covering topics such as heart failure, diabetes and substance misuse.
  • Developmental standards, which build on the Core Standards and are also set out in the Department of Health’s Standards for Better Health. In 2006/07 developmental standards relating to three of the seven topics will form part of the annual health check, with all seven areas being covered over the next three years.

The Healthcare Commission plans to develop more standards around quality and effectiveness of commissioning in the coming years.

How is the annual health check carried out and scores awarded?

The results of each annual health check of the NHS are published in the October following the year end of the year being assessed. The first annual health check covered the year 2005/06 and was published last October.

The Healthcare Commission has pioneered a self assessment method for determining scores and ratings in the annual health check, rather than relying on annual visits by inspectors. Each organisation must complete their own assessment, and make a public declaration on whether they are meeting standards. The Healthcare Commission then selects 10% of organisations for follow up checks based on information they hold about those organisations that gives them reason to want to probe further. They select a further 10% at random for follow up cross-checking of their self assessment. For the 2006/07 check, the Healthcare Commission plans to make more extensive use of intelligence from other organisations as part of the assurance process for self assessment. This will include data collected from organisations such as the Commission for Social Care Inspection, and feedback from staff and patients.

The annual health check awards two overall ratings to each organisation – for quality of service and use of resources - on a four point scale from excellent to weak. For 2006/07,

• Overall rating for quality of service is determined by performance against all of the standards set out above, except those under use of resources and the outcomes of service reviews and national studies.

• Overall rating for use of resources is determined by performance against the use of resources standards.

• Outcomes of services reviews and national standards do not directly impact ratings, but are used for cross-checking as part of the assurance process underpinning self-assessment.

In the 2005/06 annual health check, of the 570 organisations rated

• 40% of organisations scored ‘excellent’ against quality of service, whilst only 15% scored ‘excellent’ for use of resources – mainly due to deficits and poor scorings against standards for financial management.

• Only two scored excellent on both ratings – compared to 28% of organisations who scored 3 stars in the previous year’s star ratings.

• 24 organisations were weak on both ratings – compared to 4% of got no stars in the last year of star ratings.

• The majority of organisations scored ‘fair’ on both ratings.

What is the future of the annual health check system?

The Healthcare Commission is due to merge with the Commission for Social Care Inspection and the Mental Health Act Commission to create a single regulator from 2008. Given that the self assessment based annual health check system is being held up as an example to other regulators, it is unlikely that it will be radically altered, even with these changes. What is more likely is that it will be broadened to encompass the new organisations and standards that the new Commission will be responsible for inspecting and regulating.

Latest news

  • The Healthcare Commission has recently consulted on its plans for the 2007/08 annual health check. The consultation closed on 20 April and its conclusions are awaited.

For more information on the annual health check go to:


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