The Healthcare Commission had a role in promoting quality in healthcare through providing an independent assessment of the standards of services provided by the National Health Service, private healthcare and voluntary organisations in England. The commission also had the responsibility of coordinating organisations that inspect, regulate or audit health bodies. In order to do this, it established the Concordat between bodies inspecting, regulating and auditing health or social care. The Healthcare Commission aimed to promote improvement in the quality of NHS and independent healthcare across England and Wales. The Commission's main statutory functions in England were:
Assessing the management, provision and quality of NHS healthcare and public health services
Reviewing the performance of all NHS trusts and award an annual performance rating to each trust
Regulating the independent healthcare sector through registration, inspection, monitoring complaints and enforcement activities
Publishing information about the state of healthcare in England
Investigating serious failures in healthcare services
Independently reviewing patients' complaints about NHS services that have not been resolved by the trusts involved
Promoting the coordination of reviews and assessments carried out by the Commission and other regulatory organisations
The Healthcare Commission had a limited role in Wales, complemented by that of Healthcare Inspectorate Wales, which is part of the National Assembly for Wales. The ability to inspect all sectors, provide guidance and act if that guidance is not acted on was possible because the Healthcare Commission was independent of the government.
Annual health check
For the first two years of its existence, the Healthcare Commission continued the annual reporting of NHS providers using star ratings where NHS trusts were awarded one, two or three stars based upon their performance measured against clinical targets. From 2006, an "annual health check" replaced the star ratings assessment system and looked at a much broader range of issues than the targets used previously. It sought to make much better use of the data, judgements and expertise of others to focus on measuring what matters to people who use and provide healthcare services. Trusts had to declare their compliance with the core standards set out in Standards for Better Health, published by the Department of Health in 2004. The overall aim of the new assessment of performance, and the information gained through the process, was to promote improvements in healthcare. The annual health check process was designed to use views of patients and users of services as well as robust data sources for the arms-length monitoring of clinical performance. This lessening of the target setting by Whitehall was in line with the light-touch strategy set out by Gordon Brown in his 2005 budget and compatible with the vision proposed by David Cameron at the 2006 Conservative conference. It also aimed to help people to make better informed decisions about their care, promote the sharing of information and give clearer expectations on standards of performance. The new ratings effectively graded NHS organisations on the quality of services and use of resources with services deemed to be one of four levels: Weak - Fair - Good - Excellent. Trusts that met the clinical targets used in the previous star ratings achieved a rating of Fair. Good and Excellent ratings were awarded to organisations that could demonstrate that they had processes in place to improve their services.
