Guidance and FAQs

Navigation

Q. How can I find information?

A. The performance ratings site has three main navigation aids:

• the left navigation menu - provides access to performance indicators, ratings and related information
• the right menu - provides links to key information such as help, what's new, find your trust and contact information
• search links are displayed at the top of the page

These aspects of the site will remain constant while the centre page will display information for whatever option has been selected. If you have tried these options but still can't find what you're looking for, please use the Contact us link to send your query to us.

Q. How can I tell where I am in the site?

A. The breadcrumb trail at the top of the page will show exactly where you are in the site at any time. The trail is updated each time an option is selected - for example:

Home > acute trusts > indicator listings for acute trusts

Each element of the trail is a link which can be selected to jump back to that point in the site.

Q. Do I have any control over how information is displayed?

A. The nature of the content on the performance ratings site is such that information needs to be displayed in (often very long) tables.

Where possible, table columns are displayed with up/down arrows, which means that the table can be sorted by that column, in ascending or descending order - for example, you might sort a list of results by trust name, or by rating.

If a table or table heading is not displayed with up/down arrows, its information cannot be sorted in this way.

Q. When I download files, what format will they be?

A. Throughout the performance ratings site you will find options to download information. Depending on the nature of this information, files will be in one of the following forms:

• Winzip
• Adobe Acrobat (PDF)
• Microsoft Excel

Each download available will have one of the icons above showing the type of file.

To open a Winzip file you will require a copy of the Winzip utility and to view PDF files you will require a copy of Adobe Acrobat reader. A trial version of Winzip can be downloaded free of charge from the Winzip website (http://www.winzip.com/download.htm), and Adobe Acrobat reader can be downloaded from the Adobe website (http://www.adobe.com/products/acrobat/readstep2.html), also free of charge.

Q. How can I print information from the performance ratings site?

A. Throughout the performance ratings website you will have the opportunity to print information using the print full report function. Typically, this link can be found at the top of pages.

When you select this print option, information currently displayed on the page will be printed in a 'printer friendly' way - i.e. without the surrounding web page assets.

Print links are placed in the most likely places that information will be required. If you wish to print a page where there is no link present, you can still use your own browser options to print the entire page - in this instance, the whole page will be printed as you see it on screen - i.e. including web page assets.

General information

Q. What information will I find on this website?

A. This website holds all Healthcare Commission performance ratings related information for 2004/2005. The information is divided into sectors and listed on the left side menu.

Overview

This provides general information affecting the sector and includes topics such as combined trusts and the impact of clinical governance reviews.

Indicators

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.

Ratings

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 are also available.

Q. How does the NHS performance ratings system work?

A. The NHS performance ratings system places NHS trusts in England into one of four categories:

• trusts with the highest levels of performance in the measured areas are awarded a rating of three stars
• trusts with mostly high levels of performance, but are not consistent across all measured areas, are awarded a rating of two stars
• trusts where there is some cause for concern regarding particular areas of measured performance are awarded a rating of one star
• trusts that have shown the poorest levels of measured performance receive a rating of zero stars.

The performance rating applies across the whole organisation, not to individual services.

Q. What is the role of clinical governance reviews in rating performance?

In February 2005, the Healthcare Commission made the decision to exclude the assessment scores from all clinical governance reviews (or the follow up of action plans, where more appropriate) from the performance ratings for all organisations in 2004/2005. This decision reflects feedback received from strategic health authorities and trusts. The Healthcare Commission continues to support the importance of clinical governance and this is reflected in the core standards assessment that will form part of the Healthcare Commission's annual health check in 2006 and beyond.

Q. What is a strategic health authority?

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 ensure 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 also ensure that national priorities are integrated into local plans.

Q. What if I don't know the name of my trust?

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 ratings home page and click the link provided in the blue box called having trouble finding your trust? This will launch a NHS website (in a new window) where you can enter the doctor's name to identify their trust.

Indicators

Q. What are indicators?

A. Indicators can be categorised within the following two groups:

• key targets
• balanced scorecard indicators

The performance ratings are calculated using key targets and a selection of performance indicators organised into the balanced scorecard.

Key targets

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.

Balanced scorecard

The balanced scorecard is populated with a broader set of performance indicators. These indicators are chosen to reflect the wider range of deliverables specified in the NHS Plan. The balanced scorecard indicators also include data from the patient and staff surveys, as well as clinical indicators.

Q. What do the symbols [DISC] and [SQUARE] mean?

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.

Q. It says 'data not returned' against an indicator for our trust. What does this mean?

A. This means that the trust failed to return data to the organisation that collected the data (for example 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 or of insufficient quality.

Q. What aspects of performance are covered by the indicators?

A. All trusts have been assessed on their performance during 2004/2005 against a limited number of key targets and a larger number and range of indicators (the balanced scorecard).

Key targets

Performance against key 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:

• a sizeable number of targets with some degree of underachievement
• a smaller number of targets against which there have been significant levels of underachievement
• a combination of both

Other indicators

The broader range of indicators make up a 'balanced scorecard' to refine the judgement on performance 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 other 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. The focus areas for primary care trusts are improving health, access to quality services, and service provision.

Q. How have the thresholds been set?

A. Thresholds are defined on the key targets and most 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 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.

Q. How do I view my trust's results for an indicator?

A. To view results for an indicator:

1. Click the Indicators link (on the left hand side) for the appropriate type of trust (acute, ambulance, mental health or primary care). A list of all indicators is displayed for the trust type. Note: If you wish to clarify the nature of an indicator, click its name to look at a more detailed description.

2. 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:

   • use the up and down arrows at the start of the list to sort results alphabetically, or by result, in ascending or descending order
   • click on the name of a trust to view its overall summary report

   Click the Indicators link (left side menu) again to return to the list of indicators

Q. What do the scores 1-5 mean for the 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.

Q. What are the England and median values and why do some indicators have England values and others have median values?

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 different 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 proportionately more high or low values in the distribution.

Q. How do I download a table of results for all trusts?

A. To download a table of results go to the More information link (at the bottom of the left side menu of the ratings home page). You will find a selection of Excel and zip files below the heading 'downloadable documents'.

These files include:

• trust summary download (matches the 2004 hard copy publication)
• trust balanced scorecard download (includes all trusts' performance for the indicators within the three focus areas)
• trust full download (provides the raw trust data that have been used to produced the balanced scorecard results)

Ratings

Q. My trust is a primary care trust (PCT) that also provides mental health services. Do we have two separate ratings or one overall?

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, which is why a trust can receive two different scores for an indicator with the same name.

Q. How do I view a summary of results for my trust's 2005 rating?

A. To view a summary of indicators for a trust's 2005 rating:

1. 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 the 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.

2. Click the Summary link against the trust that you wish to view. A list of indicators is displayed, broken down into four areas of performance (key targets, clinical focus, patient focus and capacity for acute, ambulance and mental health trusts: key targets, access to quality services, improving health and service provision for primary care trusts).

Q. How do I compare ratings across different trusts?

A. You can compare your rating with other trusts in a number of ways:

• Download a table of summary results for all trusts
• Download a table of balanced scorecard results for all trusts

Please select an option above for more detailed information.

Q. How do I view my trust's ratings for 2003/2004?

A. To view a trust's rating for the previous year (2003/2004), simply click on the 2003/2004 Performance Ratings tab at the top of the page. The 2003/2004 performance ratings site will open in a new window. You can use the left hand navigation menu to view results for trusts in the same way as for the 2005 ratings.

Alternatively, click on England ratings to see an overview of ratings for this year and links to previous year's results.

Trust reports

Q. What is a trust report?

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.

Q. How do I view my trust report?

A. To view a trust report:

1. 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 the 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.

2. Click the Trust report link for the required trust to view the trust report. To help navigate this information, a number of links to sections and sub sections are provided at the start of this page - select any of these to jump to that point in the report.

Q. How do I print my trust report?

A. To print a trust report:

1. 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 the 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.

2. Click the Trust report link for the required trust to view the trust report.
3. Click the Print full report link at the top of the page to open a standard print dialog box. Set print options as required and print the report.

Q. How do I download a table of results for all trusts?

A. To download a table of results go to the More information link (at the bottom of the left side menu of the ratings home page). You will find a selection of Excel and zip files below the heading 'downloadable documents'.

These files include:

• trust summary download (matches the 2005 hard copy publication)
• trust balanced scorecard download (includes all trust's performance to the indicators within the three focus areas)
• trust full download (provides the raw trust data which has not been refined to produced the balanced scorecard results)

England ratings

Q. How do I view an overall summary of results for 2004/2005?

A. To view a summary of ratings for 2004/2005, click the England ratings link (on the bottom left of the home page). Results are shown for:

• overall trusts - the number of trusts (all types) who received 0, 1, 2 and 3 stars
• acute trusts - the number of acute and specialist trusts who received 0, 1, 2 and 3 stars
• ambulance trusts - the number of ambulance trusts who received 0, 1, 2 and 3 stars
• mental health trusts - the number of mental health trusts who received 0, 1, 2 and 3 stars
• primary care trusts - the number of primary care trusts who received 0, 1, 2 and 3 stars

Q. How do I view an overall summary of results for previous years?

A. To view a summary of ratings for 2003/2004:

1. Click the England ratings link (on the left hand side) to display the overall summary of results page.

2. Scroll to the end of the page to find links for:

   • Overall summary of results for 2003/2004
   • Overall summary of results for 2002/2003
   • Overall summary of results for 2001/2002
   • Overall summary of results for 2000/2001
3. Click the required link to view results. Note that historic results are located on previous websites. Selecting one of these links will open the required site at the relevant page, in a new browser window. When you have finished with them, just close the window to exit.

Searching

Q. What search options are available?

A. The following search options are available on the performance ratings site:

• basic search - search by trust name (or part of a name)
• advanced search - search by name, rating, strategic health authority and/or trust type
• geographic search - find all trusts in a strategic health authority

Q. How do I perform a basic search?

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 in the county, or you might type the full name of a trust to return just that one entry. To do this:

1. Type the name of the trust (or as much of the name as you know) into the Search by trust name or part trust name field at the top of the page. Note: The search is not case sensitive - you can use upper and/or lower case

2. 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.

   Note: Confirmation of your search criteria and the number of matches displayed is shown at the top of the Results page.

Q. How do I perform an advanced search?

A. The Advanced search facility provides further options to refine your search criteria - you can choose to search by name, rating, strategic health authority, trust type or any combination of these. To do this:

1. Click the Advanced search link at the top of the page to display the Advanced search page
2. If you wish to specify a trust name, or part of a trust name, enter it into the Name of trust field. This field is not case sensitive
3. If you wish to return results for trusts that achieved a certain rating, select it from the Rating field. To return all matched trusts, irrespective of their rating, leave this set to All
4. If you wish to return trusts for a strategic health authority, click the check box for the required authority (or authorities). You can select as many authorities as required
5. If you wish to limit the search to trusts of a certain type (Acute, Ambulance, etc) select the required value from the Trust type field. To return all matches irrespective of type, leave this set to All

6. 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.

Q. How do I perform a geographic search?

A. The Geographic search facility enables the user to search for trusts within a strategic health authority. To do this:

1. Click the Geographic search link at the very top of the page to display a list of strategic health authorities and a strategic health authority map. From here you can:

   • Click the name of the strategic health authority that you wish to view
     
     or
      
   • Click an area on the map. Note: When the mouse pointer is positioned over an area of the map, the name of its strategic health authority is displayed

2. Having selected a strategic health authority from the list or from the map, a list of trusts within that authority is displayed. 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.

Methodology

Q. How can I view the methodology that was used for the performance ratings?

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.

Help

Q. What if I need more information?

A. Use the More information link (on the left hand side) to view further information, including:

• performance ratings publications
• all downloadable files (trust summary results, etc)
• useful links (for example, to download Winzip and Adobe Acrobat)
• contact information
• more detailed information concerning the background and/or construction of indicators

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.

Q. What if I have a query?

A. If you cannot find what you are looking for on the performance ratings site, or if you have any questions/feedback, please use the Contact us link on the right hand side of the page to send any questions or comments to the Health Commission.