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Annual performance ratings 2005/2006

Summary of results for Dartford, Gravesham and Swanley Primary Care Trust
This report summarises the results of the Healthcare Commissions annual performance rating for 2005/2006 for Dartford, Gravesham and Swanley Primary Care Trust. Executive and non-executive members of the board and others involved in the management of healthcare services for Dartford, Gravesham and Swanley Primary Care Trust may want to use this summary as a starting point for exploring the strengths and weaknesses of the organisation's performance in our annual health check. Other groups, including overview and scrutiny committees and patient and public involvement forums, may also find the summary useful for monitoring the way local healthcare services are planned and run. The Healthcare Commissions annual health check scores organisations in the NHS on many aspects of their performance, including how well they manage their finances (use of resources) and the quality of the services they provide (quality of services). These scores are based on a range of information gathered throughout the year. This includes information about whether organisations in the NHS are meeting the targets and standards set by the Government.

More detailed information about the results for Dartford, Gravesham and Swanley Primary Care Trust is available on the Healthcare Commissions website at www.healthcarecommission.org.uk.

Overall rating
In 2005/2006, the trust was rated: Weak for use of resources Fair for quality of services This means that the organisation scored weak for use of resources because it failed to meet its financial targets within the year. It is stronger in other aspects of our assessment of use of resources. Our assessment of quality of services highlighted some areas for improvement.

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Detailed results for Dartford, Gravesham and Swanley Primary Care Trust
Use of resources
The score for use of resources is based on how well an organisation in the NHS manages its finances. This could include how it plans and reports on its financial performance, how it monitors the money it spends, and how it makes sure that the services it offers to patients represent good value for money. Dartford, Gravesham and Swanley Primary Care Trust was scored weak for use of resources. This organisation did not meet its financial targets for 2005/2006 and it is because of this reason alone that they automatically received a score of weak for use of resources. This score was based on information received from the Audit Commission. Further information on the performance of this organisation for use of resources can be found on the Healthcare Commission's website at www.healthcarecommission.org.uk, and on the Audit Commission's website at www.auditcommission.gov.uk.

Quality of services
The score for quality of services covers a range of areas within a healthcare organisation that can affect the care and treatment a patient receives, including access to services, safety and the way an organisation is run. In particular, it reflects whether an organisation provides the basic standard of care required by the Government and whether it strives to improve the care and treatment it provides for patients. Dartford, Gravesham and Swanley Primary Care Trust scored fair for quality of services. This score was based on the results it received in the following areas. Component Getting the basics right Assessment of compliance with core standards Existing national targets Making and sustaining progress New national targets Review of substance misuse Review of tobacco control Review of services for children in hospital Review of adult community mental health services Weak Fair Good Not Applicable Good Almost Met Almost Met Results

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Review of admissions management Review of diagnostic services Review of medicines management

Not Applicable Not Applicable Not Applicable

This organisation could not achieve an overall score of good for quality of services because it received a score of weak in new national targets. Appendix A sets out the rules that are used to determine which score an organisation receives for quality of services.

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Assessing compliance with core standards

In 2005/2006, we asked organisations in the NHS to declare publicly how well they had met the core (basic) standards set by Government. In many cases, other groups from within the local community, including overview and scrutiny committees and patient and public involvement forums, were also asked to give their views on the performance of their local healthcare organisation. This assessment was designed to reflect an organisations performance over the whole year and recognises those organisations that improved their level of compliance throughout the year. Dartford, Gravesham and Swanley Primary Care Trust was given a score of almost met for the assessment of compliance with core standards. This organisation was not selected for an inspection.

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Meeting existing national targets

By looking at whether organisations are meeting existing national targets set by Government, we can get a better understanding of, for example, how patients gain access to the healthcare services they need and how long they have to wait for care and treatment in the NHS. Healthcare organisations must be able to demonstrate each year that they are meeting these targets. Dartford, Gravesham and Swanley Primary Care Trust was given a score of almost met for existing national targets. Dartford, Gravesham and Swanley Primary Care Trust was assessed against all of the 21 existing national target indicators. The organisation achieved 15 indicators, underachieved 4 indicators and failed to meet 2 indicators. The performance of this organisation against the indicators for each of the existing national targets is shown in the table below. These indicators are measures that capture how a particular aspect of a service should be provided. Please note: organisations in the NHS are assessed against all indicators that relate to their various functions. Primary Care Trust
Indicators Total time in A&E: four hours or less Access to a GP (48 hour target) Access to a primary care professional (24 hour target) The percentage of category A calls receiving a response within eight minutes The percentage of category A calls receiving a response within 14 minutes in urban areas or 19 minutes in rural areas The percentage of category B calls receiving a response within 14 minutes in urban areas or 19 minutes in rural areas All cancers: two week maximum wait from urgent GP referral to first outpatient appointment Patients waiting longer than three months for revascularisation (coronary artery bypass graft or percutaneous transluminal coronary angioplasty) Has the PCT increased its funding of child and adolescent mental health services and carried out a full local assessment of need? Are crisis resolution/home treatment services provided to all who need them? Thrombolysis: increasing the percentage of heart attack patients who receive thrombolysis within 60 minutes of calling for help Delayed transfers of care Convenience and choice: PCT facilities in place to support patients in choosing their hospital All cancers: one month maximum wait from diagnosis to treatment All cancers: maximum two month wait from urgent GP referral to treatment Achievement of plan for increasing the number of people who have quit smoking after four weeks Level of performance Achieved Achieved Achieved Achieved Achieved Trusts achieving indicator (%) 92% 95% 97% 88% 84%

Underachieved

37%

Achieved Achieved

99% 98%

Achieved

78%

Failed Underachieved

40% 46%

Achieved Achieved Achieved Achieved Underachieved

85% 80% 98% 58% 67%

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People with diabetes receiving diabetic retinopathy screening Number of inpatients waiting longer than the standard time for their treatment Number of outpatients waiting longer than the standard time for their appointment Convenience and choice: booking of appointments, mapped to the PCT Practice based registers: patients with diabetes or at risk of coronary heart disease who are called for review

Achieved Achieved Achieved Underachieved Failed

86% 95% 98% 33% 23%

Further information on the performance of this organisation in meeting existing national targets can be found on the Healthcare Commissions website at www.healthcarecommission.org.uk.

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Meeting new national targets

The Governments new national targets focus on the ways in which healthcare organisations can help to improve the health of the population in England. They are targets for the entire NHS. Our assessment looked at the contribution of individual healthcare organisations in meeting these new national targets. Dartford, Gravesham and Swanley Primary Care Trust was given a score of weak for new national targets. Dartford, Gravesham and Swanley Primary Care Trust was assessed against 26 of the 28 new national target indicators. The organisation achieved 18 indicators, underachieved 4 indicators and failed to meet 4 indicators. The performance of this organisation against the indicators for each of these new national targets is shown in the table below. Please note: organisations are assessed against all indicators that relate to their various functions. Primary Care Trust
Indicators Blood pressure levels of patients with coronary heart disease Cholesterol levels of patients with coronary heart disease Blood sugar and blood pressure levels of patients with diabetes Cancer mortality rate in people under 75 Cancer: implementation of NICE guidelines on organising treatment Proportion of women aged 50 to 70 years screened for breast cancer Percentage of working age users of adult mental health services on the enhanced level of the care programme approach (CPA) followed up within seven days of discharge from an inpatient setting Assertive outreach services provided to all who need them Rate for smoking during pregnancy, assessed against PCT plan Rate for breastfeeding initiation by new mothers, assessed against PCT plan Smoking status among the population aged 15 to 75 years recorded by GPs Patients, who smoke and have coronary heart disease, diabetes, stroke, chronic obstructive pulmonary disease (COPD) or asthma, who are offered smoking cessation advice by GPs GP recording of status of body mass index (BMI) Teenage conception rates Percentage of patients getting access to genito-urinary medicine (GUM) clinics within 48 hours of contacting the clinic, assessed against PCT plans Percentage of NHS terminations undertaken at up to and including nine completed weeks gestation Change in hospital bed days (number of patients multiplied by length of stay) following emergency admissions commissioned by the PCT Level of performance Achieved Achieved Achieved Achieved Data not available Achieved Underachieved Trusts achieving indicator (%) 85% 84% 87% 92% 100% 88% 82%

Failed Achieved Achieved Underachieved Achieved

62% 79% 94% 62% 94%

Underachieved Achieved Failed

71% 92% 56%

Achieved Achieved

64% 92%

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Community matrons against plan Number of very high intensity users against plan Patients waiting longer than 26 weeks for an MRI or CT scan at the end of March 2006 Number of patients who misuse drugs accessing treatment, assessed against PCT plan Practices with validated registers of patients at risk of coronary heart disease Increase the percentage of people sustained in treatment in community services for 12 weeks Percentage of community equipment items delivered within seven days of decision to supply Processes in place to control infection Proportion of data with useful ethnic group coding Data quality measure on waiting times for MRI and CT scans Cardiovascular disease mortality rate in people under 75

Achieved Failed Achieved Achieved Achieved Data not available Failed Achieved Underachieved Achieved Achieved

72% 39% 91% 96% 56% 93% 38% 91% 50% 83% 97%

Further information on the performance of this organisation in meeting the new national targets can be found on the Healthcare Commissions website at www.healthcarecommission.org.uk.

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Reviews
Our improvement reviews look at whether healthcare organisations are striving to improve the care and treatment they provide to patients. They focus on areas of priority for the NHS, including the experiences of specific groups within the general population, and help organisations to identify where and how they can better perform.

Substance misuse services

Our review of substance misuse services was carried out in partnership with the National Treatment Agency. It looked at the way in which drug action teams provide substance misuse services to meet the needs of their local population. Dartford, Gravesham and Swanley Primary Care Trust was given a score of fair for this review. The overall score for this review was based on the results achieved by these drug action teams: Drug Action Team Kent Score Fair

Further information on the performance of Dartford, Gravesham and Swanley Primary Care Trust for this review can be found on the Healthcare Commissions website at www.healthcarecommission.org.uk/serviceproviderinformation/reviewsandinspections/im provementreviews.cfm.

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Tobacco control
Our review of tobacco control looked at how healthcare organisations were helping to reduce the number of people who smoke and minimising the impact of second hand smoke on their local community. Dartford, Gravesham and Swanley Primary Care Trust was given a score of good for this review. The review of tobacco control examined organisations against six criteria. The scores given to this organisation for each criteria are shown in the table below. Criteria The PCT delivers an effective service to help people to stop smoking The PCT reduces the prevalence of smoking in the local population, particularly among vulnerable groups who are most at risk from the effects of tobacco use and exposure The PCT develops public health skills and expertise within its workforce, including independent contractors, to reduce smoking prevalence The PCT promotes healthy lifestyles among the workforce and minimises the risks from smoking and exposure to second hand smoke The PCT works with partners to address the needs of the local population in relation to tobacco use and control The PCT champions the tobacco control agenda and promotes the benefits of becoming a smoke free community Score Fair Good

Fair

Good

Good Good

Further information on the performance of Dartford, Gravesham and Swanley Primary Care Trust for this review can be found on the Healthcare Commissions website at http://www.healthcarecommission.org.uk/serviceproviderinformation/reviewsandinspectio ns/improvementreviews.cfm.

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Adult community mental health services

Our review of adult community mental health services was carried out in partnership with the Commission for Social Care Inspection. It looked at the way in which mental health and social care services for people aged between 18 and 65 years are provided in local communities. Dartford, Gravesham and Swanley Primary Care Trust was given a score of good for this review. The review of adult community mental health services examined organisations against three criteria. The scores given to Dartford, Gravesham and Swanley Primary Care Trust for each criteria are shown in the table below. Criteria West Kent LIT Community services are accessible to people according to their presenting circumstances Care arrangements are holistic, focusing on a range of needs and outcome for people who use services and their carers People who use services, and where appropriate their carers, are involved in decisions and are able to make choices about their care Score Good Good Good

Further information on the performance of Dartford, Gravesham and Swanley Primary Care Trust for this review can be found on the Healthcare Commissions website at www.healthcarecommission.org.uk/serviceproviderinformation/reviewsandinspections/im provementreviews.cfm.

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Appendix A Key rules for aggregation for the score for quality of services
1. The score for quality of services will be excellent, good, fair or weak. 2. A trust that is not met in core standards will automatically be weak for quality of services 3. A trust that is not met in existing national targets will automatically be weak for quality of services (Note Learning Disability trusts are not assessed against existing national targets) 4. To be excellent for quality of services, a trust must achieve the highest scores for core standards (fully met), existing national targets (fully met) and new national targets (excellent) 5. Results from the new national targets, improvement reviews and acute hospital portfolio are only used to move the scores of trusts between excellent, good and fair. These results are not used to move the scores of trusts to weak. 6. Each organisation that existed for 2005/2006 will receive one overall score for quality of services. 7. Where an organisation is assessed against only one review, the score for that review will not be included in the overall score for quality of services. Exception The single exception to the general rules outlined above, is that mental health trusts that receive the lowest score for existing national targets (not met), will be limited to a maximum score of fair for quality of services rather than an automatic score of weak. The reason for this exception is that mental health trusts only have 2 existing national targets, and it would be unfair to automatically move the trusts to weak on the basis of such a small set of targets.

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