By Lilian Anekwe
The Government has launched a major shift toward the use of outcome measures in the health service, by ramping up its focus on outcomes and patient-reported outcome measures (PROMS) as part of its sweeping NHS reforms.
The Department of Health announced that the responses to its consultation on the idea have been ‘broadly supportive’, and have vowed to roll out a series of tough outcome measures across the NHS.
In its response to the consultation, the DH confirmed that under GP commissioning, NHS performance will be judged on outcomes included mortality, cancer survival and hospital admissions.
The DH admitted that many responses to the consultation highlighted concerns around the difficulties of measuring outcomes and the risk of creating perverse incentives.
And the document also acknowledges: ‘The majority of respondents felt that the suggested indicators, while imperfect, were the best available options. Many highlighted the issues around interpretation of readmissions data.
‘For example, readmission may not result from poor care, and may not even be linked to the previous episode. Many respondents also stressed the importance of choosing the right definition for conditions usually managed in primary care.’
But they responded: ‘While both focus on hospital admissions, the indicator on “emergency admissions for acute conditions that should not usually require hospital admission” is widely accepted as a proxy for the effectiveness of primary care, so this part of the system is captured.’
The full NHS Outcomes Framework for 2011/12 contains details of the outcomes the NHS Commissioning Board will be asked to achieve.
It includes indicators on life expectancy, mortality in the under 75s with cardiovascular, respiratory and liver disease, access to GP services and the patient experience, cancer survival and unplanned hospitalisations for under 19 year olds with asthma, diabetes and epilepsy.
A separate Commissioning Outcomes Framework will also be developed, which the Board will use to ‘hold GP commissioning consortia to account’.
‘Linked to this a quality premium will reward consortia for certain improved outcomes they achieve and for the effectiveness with which they manage their resources.’
Acting NHS Confederation chief executive Nigel Edwards said despite the shift to outcome measures, targets within in the NHS ‘are not dead’.
‘Measuring outcomes is extremely difficult and in especially complex cases a process target might be the only way of ensuring a treatment is being performed properly.
‘It can take some time for improvements in care to show up through improved outcomes. There will therefore need to be some flexibility over how and when those delivering health services are paid for the outcomes they achieve.’
Emergency hospital admissions are part of the Government’s outcomes measures for the NHS