1. Principles

by Department of Health on 04 August 2010 | 11 comments

What are the principles that should underpin the NHS Outcomes Framework?

The proposed principles that will guide the development of the NHS Outcomes Framework are:

  • Accountability and transparency
  • Balanced
  • Focused on what matters to patients and healthcare professionals
  • Promoting excellence and equality
  • Focused on outcomes that the NHS can influence but working in partnership with other public services where required
  • Internationally comparable
  • Evolving over time

Further information can be found in the consultation document on page 10, paragraph 2.6.

Please add your comments below.

Comments

  1. Measures need to be practically and reproducibly measurable in a way that is not too time-consuming.

  2. Outcomes can be influenced by many other factores apart from the healthcare team specifically the patient themselves. It is important that this is taken into account

  3. focusing on what matters to patients is extremely important, especialy in the mental health sector, on matters such as medication and alternative methods of treatment

  4. accountability should be looked at, as currently human rights law is being broken under and because of the existing mental health act

  5. There needs to be a seamless relationship between all health care providers.
    NHS care IS the best and should be available for all. Medical care on its own cannot be the best without nursing, midwifery or interprofessional care. Private care does not necessarily mean quality if there are no quality controls/accountability in place.
    Giving all funding decisions to GP consortia will only work if on the body making the decisions are representatives of members of the whole primary health care team.

  6. Whose opinion on efficacy of treatment will be considered more important, the clinician’s or the patient’s? Who will decide on which outcomes are included in the framework, patient, clinician, monitor, DH? If they are to be internationally comparable, are you looking at outcomes already monitored elsewhere and, if so, how does this tie in with the opinions of UK clinicians and patients? As they evolve over time how will you ensure that the infrastructure required to monitor and report on the outcomes will be updated in a timely fashion? How do you propose factoring in the large number of variables that can affect an outcome to ensure that they are standardised and therefore useful for comparing levels of excellence and equality. Who will be accountable and how will that accountability be made transparent so that patients can make sure that their concerns are being acted upon?

  7. Person Centred care and treatment at the heart of the NHS. Seeing people as people and not a collection of body parts. Working with other public sector organisations when required so that people receive a seamless and timely service on discharge from hospital.

  8. The consultation document (paragraph 2.23) rightly points out the difficulties of making international comparisons & hence the attraction of making intra-UK comparisons. I strongly support the proposed policy of the Department of Health ‘to support the development of metrics that allow intra-UK comparisons to be made’. To this I would emphasise two points.

    First, as the Nuffield study showed, there are serious limitations in the conventional comparisons of England with the three devolved countries (Scotland, Wales & Northern Ireland). It is much more meaningful to compare regions in England with the three devolved countries. This is because the concentration of teaching & research in London, distorts some statistics for England & the characteristics of the populations of the North East & North West of England & more similar to those of the three devolved countries. With the abolition of SHAs it is important that data continue to be collected on a regional basis for England.

    Second, the data collected on health care on a comparable basis over time across the four UK countries are extremely limited; and, if anything, devolution seems to have reduced the willingness of the devolved administrations to collect such comparable data. While the UK Statistics Authority has a crucial role in monitoring the quality of statistics produced by each country, it does not appear to have the power to require governments of the UK to produce comparable data on public services. If the governments of all four countries were confident that they could demonstrate that their policies would deliver better NHS performance, they would welcome the opportunity to demonstrate this in comparison with one another. If they are reluctant to allow such comparisons to be made, this suggests that they are fearful that their policies will be found wanting. UK taxpayers have a right to know how well the different governments are, or are not, securing value for their money so that there can be open public scrutiny of performance of governments empowered to pursue different policies financed by the UK taxpayer. Such information would also inform the electorates of each country how well each government is running its NHS.

  9. The consultation paper rightly observes that ‘Interpreting international comparisons is complex and making comparisons for new indicators is costly and takes time’ and emphasises the importance and attraction of making intra-UK comparisons. It also observes that this ‘can be a relatively simpler approach’. The data collected on health care on a comparable basis over time across the four countries are, however, extremely limited; and, if anything, devolution seems to have reduced the willingness of the devolved administrations to collect such comparable data. While the UK Statistics Authority has a crucial role in monitoring the quality of statistics produced by each country, it does not appear to have the power to require governments of the UK to produce comparable data on public services. If the governments of all four countries were confident that they could demonstrate that their policies would deliver better NHS performance, they would welcome the opportunity to demonstrate this in comparison with one another. If they are reluctant to allow such comparisons to be made, this suggests that they are fearful that their policies will be found wanting. UK taxpayers have a right to know how well the different governments are, or are not, securing value for their money so that there can be open public scrutiny of performance of governments empowered to pursue different policies financed by the UK taxpayer. Such information would also inform the electorates of each country how well each government is running its NHS. Hence I strongly endorse ‘the proposal that the Department of Health will support the development of metrics that allow intra-UK comparisons to be made’. To make sense of intra-UK comparisons it is much more informative to compare three devolved countries (Scotland, Wales & Northern Ireland) with regions in England with the averages for England. Hence a key role for the Department of Health in supporting the development of useful metrics is to ensure continuity in the collection of regional statistics after the abolition of the Strategic Health Authorities.

  10. The above objectives could be achieved by giving every patient a state of the art transparent written explanation for each clinical encounter. This would be a list of current tests and treatments, transparently linked to each of these actions, the diagnostic term and transparently linked to each diagnostic term, the current finding(s). This would be the individual’s outcome for each encounter with the NHS or private care and could be updated next time for seamless care. It would inform patients and professionals (e.g. when requesting second opinions) and be a data source for audits of quality and outcome.

  11. I think that the government needs to look at all aspects of chronic disease management and not just a few as respiratory care for long term conditions such as asthma, COPD, etc., have been missed out totally from this consultation document.
    This is clearly of concern as it could have an adverse impact upon existing or developing respiratory services. It could also negate much of the clinical strategy work which has been ongoing since 2004.