• Q&A

    Why are you focusing on outcomes?

    Over the last decade the hard work and dedication of staff working throughout the NHS has brought about major improvements in outcomes for patients.  However, progress has not been universal, and even where improvement has been achieved its has not always been as fast or as deep as it could have been. While process targets are of course important in their correct place, the NHS has often been hamstrung by too heavy a focus on nationally determined process targets. This has had a distorting effect on clinical priorities, disempowered healthcare professionals and stifled innovation. We need to recalibrate the whole of the NHS system so it focuses on what really matters to patients and carers and what we know motivates healthcare professionals – the delivery of better health outcomes for all patients.

    How will you pick the outcomes?

    How we should determine the outcome indicators within the NHS Outcomes Framework forms part of our public consultation.  Without prejudice to the response we receive, the outcomes will look to cover the majority of NHS activity /spend and we are likely to have particular reference to mortality and burden of disease in choosing outcomes. It will be important for us to work with clinicians, patients and their representative groups to create practical proposals that are founded on clear evidence-based criteria.

    How will you ensure the improvement areas selected avoid distorting priorities in the NHS?

    A national level focus on outcomes rather than process will significantly reduce distortion of priorities in the NHS. The five domains have been selected as a balanced set of outcomes to drive improvement across the breadth of activity for which the NHS is responsible. Progress on areas not selected as improvement areas will still be picked up by the overarching indicators for each of the five domains. We will carefully consider the potential for distorting priorities or perverse incentives in the final selection of the outcomes that will be presented in the NHS Outcomes Framework. Furthermore, the NHS Commissioning Board will have a responsibility to commission a comprehensive service.

    How will the NHS Outcomes Framework promote equality and reduce inequalities?

    The proposals for developing the NHS Outcomes Framework set out how an underlying principle of the framework will be the reduction of inequalities and promoting equality. Because of the social gradient in most health outcomes, the most potential health gain is available from the lower reaches of the gradient i.e. from disadvantaged groups and areas.  Outcomes will be chosen so that they can be measurable by different equalities characteristics and by local area. In doing so we will be in a position to ensure equality and tackle inequalities in outcomes.

    In some of the improvement areas, indicators which accurately measure outcomes are not currently measured, what will you do about this?

    In the short term the NHS Outcomes Framework will be populated by outcome indicators that are already available for measurement. It is fair to say that most indicators used in the NHS presently are focussed on processes, or are not fully concerned with measuring outcomes. Developing indicators which measure outcomes accurately and representatively takes time. Once these new indicators become available they will be used to improve the NHS Outcomes Framework’s ability to accurately judge the outcomes being delivered for patients.

    What will the NHS Outcomes Framework be?

    This framework will set the direction for the NHS by setting out a number of national outcome goals that will underpin development of an NHS Outcomes Framework.

    It will not represent a set of priorities for the NHS, rather, it will identify a focussed but balanced set of outcomes that will act as a catalyst for driving up quality across all services, and provide an indication of the overall progress of the NHS.

    What is an Outcome?

    Instead of measuring the process of delivering care, outcome indicators seek to measure the actual results of care and treatment provided to patients. These can include clinical outcome measures such as mortality /survival rates as well as patient reported outcomes measures i.e. the changing health /quality of life status following care and treatment as reported by patients themselves.

    Why are you consulting?

    The White Paper described how, in future, the Secretary of State would hold the NHS to account for improving healthcare outcomes through a new NHS Outcomes Framework. The consultation document outlines in more detail the proposals on what this framework could look like.  We need your help in developing the framework and the outcomes that will be included.  We want to work with clinicians, patients and their representative groups to create outcomes measures that have a sound evidence base and are supported by meaningful information.