NHS regulators have developed plans to assess and rate how well acute trusts use their resources, which is likely to include factors such as staff sickness and turnover rates, and rostering efficiency.
The Care Quality Commission and NHS Improvement have unveiled plans for their future approach to checking trusts on their “effective use of resources” and “effective leadership and governance”.
“There is evidence engaged staff, working in well-led organisations are more productive”
At present, the proposals only relate to checks on the efficient use of resources by non-specialist acute trusts, because they are generally perceived to have better productivity data at present.
The two bodies, which have today launched a joint consultation on the plans, said the effective use of resources was “fundamental to enable trusts to deliver and sustain high quality services”.
The move stems from Lord Carter’s productivity review, published in February, which identified “considerable efficiency opportunities for acute hospitals” in areas like workforce, informatics and procurement.
The document – Consultation on use of resources and well-led assessments – said that, under the proposals, NHS Improvement would assess annually how trusts were using the resources available to them and identify further efficiency opportunities, which would then “inform” a rating by the CQC.
The document stated: “One area where this link is perhaps most often articulated is the optimal use of staff time and expertise. This might mean, for instance, fully engaging staff in operational delivery of the trust’s strategic objectives, minimising sickness and turnover rates, and making best use of job planning and e-rostering.
“There is evidence that engaged staff, working in well-led organisations, are more productive,” it noted.
“We want to simplify our assessments, but also strengthen them”
The methodology for NHS Improvement’s assessment of resource use is currently being developed and will be finalised following testing in 2017, said the consultation document.
However, the consultation said the assessment framework will have four overarching themes, including how effectively a trust managed its financial resources, maximised patient benefit, used its workforce to maximise patient benefit, and maximised its operational productivity.
Meanwhile, it said NHS Improvement was working through a shortlist of metrics that were likely to form a core part of the “use of resources” annual assessment.
The shortlist currently includes workforce factors such as agency spend – performance against the trust’s individual agency spending cap – vacancy and staff turnover rates, and sickness absence. Other proposed indicators cover finance, clinical services and operational function.
A series of “prompts” or sub-questions for NHS Improvement to get more detailed understanding will also be used during the interview stage of the assessment, said the consultation.
As well as questions on agency staff and turnover, they include enquiries about pay levels and skill mix, which could potentially indicate encouragement to introduce the new nursing associate role.
For example, one proposed sub-question asks trusts whether “beneficial alternative or non-traditional staffing models of care delivery [are] being investigated”. On workforce, suggested prompts in the consultation include:
- How is the trust tackling excessive pay bill growth, where relevant?
- How well is the trust reducing its reliance on agency staff?
- Are there significant gaps in current staff rotas? What is the trust doing to address these?
- Is the trust making effective use of e-rostering or similar systems, for nurses, midwives, healthcare assistants and other clinicians? How many weeks in advance are the trust’s rosters signed off?
- Is there an appropriate skill mix for the work being undertaken? Are beneficial alternative or non-traditional staffing models of care delivery being investigated?
- Is the trust an outlier in terms of sickness absence and/or staff turnover?
Trusts will be given a rating for their use of resources at overall organisation level using the CQC’s ratings system of outstanding, good, requires improvement or inadequate.
In addition, the two regulators have developed a new draft version of the framework that is currently used by the CQC to assess and rate trusts on how well-led they are.
Regulator appoints nurses to advise on mental health
They highlighted that strong and effective leadership and governance was a “key component in addressing the challenges facing the sector”.
Both noted they had “seen what a difference a positive culture, open and transparent leadership” could make.
As a result, they said they had updated the existing well-led assessment framework to set out a “single vision of what good leadership looks like”.
The proposed changes to the content includes “more detail on themes such as compassionate, inclusive leadership, system leadership, and financial and resource governance”.
It would be “building on the strengths of the previous version, and streamlining and updating it to cover system governance and leadership, leadership behaviours, culture, and finance and resource governance”, they said in the consultation document.
The new joint structure of the well-led framework will apply to acute, mental health, community and ambulance trusts.
The CQC has also launched a separate consultation setting out proposals for a new approach to its inspections, which are likely to result in fewer visits to health and social care providers.
Under plans for its “next phase” – set out yesterday in Shaping the Future: CQC’s strategy for 2016-21 – the commission said it wanted to deliver a “more targeted, responsive and collaborative approach to regulation”.
This, it should, would mean a “move towards smaller and more targeted inspections” for NHS trusts, while still focusing on “what matters most to patients – whether services are safe, caring, effective, responsive to their needs and well-led”.
“These inspections will be based on inspection findings and ratings, as well as wider intelligence about the quality of care gathered through improved monitoring activity,” said the regulator.
CQC chief executive David Behan said: “This consultation is about evolving our existing approach using what we have learnt from our comprehensive inspections to help drive further improvement in the quality and safety of care, while adapting to changes in the way services are being provided.
“Our proposals for NHS trusts are designed to enable us to be more responsive to risk and improvement, while at the same time being more efficient and effective,” he said. “By working more closely with partner organisations, we will reduce duplication and unnecessary burden for providers.”
He added: “We want to simplify our assessments, but also strengthen them using what we have learned over the last three years to make sure they continue to highlight best practice, identify concerns and where necessary, to take appropriate action whilst supporting inadequate providers to improve their quality and safety in the interests of people who use their services.”
The two consultations are open for eight weeks and will close on 14 February 2017.
A further consultation focusing on the CQC’s regulation of adult social care and primary medical care will take place next year.