Trusts told what to expect from new use of resources assessment ​

But at the start of March, for non-specialist acute trusts, these new assessments are being considered as a sixth key question alongside the Care Quality Commission’s own existing quality ratings (for safe, caring, effective, responsive and well-led).

Like CQC’s five quality questions, use of resources will be given a rating of outstanding, good, requires improvement or inadequate.

This means that after the combined assessment, affected trusts will receive a:

• Rating for each of the CQC five key questions
• Combined rating for the CQC’s five questions
• Rating for UoR
• Combined rating for all six questions.

All of the ratings are determined by the CQC, but the UoR assessment is undertaken by NHS Improvement, which concludes its assessment by recommending a rating to the CQC.

The UoR assessment is retrospective, while the well-led assessment is forward-looking and focuses on governance. 

The new UoR rating was the topic of March’s HFMA Provider Finance faculty forum, with NHS Improvement and the CQC presenting alongside NHS bodies that have been through the process. Assessed bodies reflected on a positive process and there was a consensus that getting the UoR rating is not the prize – what matters is how the data is used and the feedback.

All acute trusts need to be familiar with the CQC and NHS Improvement’s assessment framework. It should be used by providers as they prepare for their NHS Improvement visit and, more generally, as a management tool to get operational engagement with the model hospital and the UoR process. A brief guide for non-specialist acute trusts is also helpful pre-visit.

The assessment visit lasts one day and follows a fixed agenda that NHS Improvement sends through in advance with suggestions for who should attend – all board members/senior managers as a minimum. Feedback is that this is an intensive day. Providers are given the opportunity to present at the start of the visit – and are told to ‘focus on what you are proud of’. They should also be aware of where things aren’t so good as these will be picked up later in the day.

All of the data used is already available – most of it in the Model Hospital database – and the focus is on unwarranted variations. Ahead of the visit, NHS Improvement asks for a short data return, although providers may produce more extensive submissions.

NHS bodies will be challenged to produce evidence to support any assertions they make – and data quality is not acceptable as a reason for variation. The oversight bodies stress the importance of NHS bodies understanding their data and are keen to underline the cost per weighted activity unit (WAU) as a key metric.

The assessment covers five areas – clinical services, people, clinical support services, corporate services (procurement, estates and facilities) and finance. The areas taking the most time are clinical support and corporate services.  The finance questions are straightforward – is the provider operating within its control total – then the focus shifts to what is driving this. 

NHS Improvement will feed back on areas of good practice and those in need of improvement. It will not give an indicative rating as this is for the CQC to determine. The final report will include a detailed report and action plan.