2. Structure and approach

by Department of Health on 04 August 2010 | 8 comments

What structure and approach could be used to develop the Framework?

The proposed NHS Outcomes Framework is structured around five high level outcome domains. These are intended to cover everything the NHS is there to do. These five domains are:


1. Preventing people from dying prematurely
2. Enhancing the quality of life for people with long-term conditions
3. Helping people to recover from episodes of ill health or injury

Patient Experience

4. Ensuring people have a positive experience of care


5. Treating and cating for people in a safe environment and protecting them from avoidable harm

Further information can be found in the consultation document on page 14, paragraph 2.25.

Please add your comments below.


  1. I would like to see a more pro-active approach to health and an emphasis on healthy living/an increase in the quality of health in general as an outcome.

  2. The domain effectiveness does not seem to encompass morbidity after procedures – mortality yes, but not morbidity, which is at least as important on a population basis.

  3. pro active healthy living is good approach

  4. I think vulnerable groups need more all round, consistent and long term support to effect positive health outcomes. For example it is not enough to simply tell someone with mental health problems or with a learning disability to ‘eat healthier, exercise more, stop smoking etc.’ These groups need regular contact and emotional support over a long period of time. In the long run this will cut healthcare costs.

  5. People living with long-term neurological conditions (eg epilepsy) need specialist help and support to achieve not just the best achievable level of healthy living but also to utilise their abilities eg to work, live independently, be active socially and otherwise. Generalist help is not sufficiently expert to achieve this outcome. Specialist nurse availability is essential.

  6. These five domains have been in place since 1948 and have been supported by the majority of staff who have worked in the NHS since then. The problem has always been how to collect the necessary data and analyse it to ensure that the information produced isn’t skewed by one or more of a myriad of variables. Skewed information leads to impaired decision making which, in turn, can adversely affect patients, NHS staff, organisations and whole health communities. How do you propose to ensure that this latest quest to improve quality of care won’t repeat the mistakes of the past?

  7. Although I agree that the 5 elements identified are crucial to best care I also agree with one of the previous comments that morbidity is almost as critical as mortality. More specifically and I am uncertain as to how best nutritional care, in which I have very specific interest, will be incorporated within this structure and I suspect that there are other elements of best ‘basic care’ that might be overlooked. To my mind (and that of the CQC, NICE, CHief Nurses etc. ) ensuring good nutritional care is essential to all elements of quality and has been proven to: prevent people dying prematurely; enhance quality of life for people with long-term conditions; help people recover from episodes of ill health or injury; impove patient experience; and improve safety/ reduce avoidable harm. Please ensure that it has due prominence in all areas of the outcomes framework.

  8. In order to be consistently transparent, the structure of the NHS Outcomes Framework should address individual outcomes in a transparent way as well as population outcomes (see comment on Principles, 11th October).