The Health Foundation's response to Liberating the NHS: Transparency in outcomes – a framework for the NHS
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Background
The NHS White Paper, 'Equity and excellence: Liberating the NHS', sets out how the Secretary of State for Health will hold the NHS Commissioning Board to account for delivering better health outcomes through a national NHS Outcomes Framework.
The consultation document 'Liberating the NHS: Transparency in outcomes – a framework for the NHS' sought views about how the NHS Outcomes Framework should be developed.
The Health Foundation’s response
In our response we state that we agree ‘the service must be focused on outcomes and quality standards that deliver them’ and we agree with the key principles underpinning the NHS Outcomes Framework.
We argue that it is important that all the outcomes and incentives emerging from the frameworks are fully aligned across the system and within organisations.
In practice, this means that individual healthcare professionals’ clinical decisions developed in partnership with patients should be consistent with organisational and system-wide objectives.
We recommend adopting the Institute of Medicine’s key dimensions of quality. This would expand the Outcomes Framework to include additional dimensions relating to timeliness, efficiency and equity.
Drawing on our learning about how to improve patient safety and how to improve quality by changing relationships between people and health services, we focus our comments upon:
- Domain 2 – long term conditions
- Domain 4 – patient experience
- Domain 5 – patient safety
We strongly advise against the use of ‘numbers of incidents’ as the basis of overarching indicators. Incident reporting is not an accurate measure of service safety – reporting systems pick up only around 5–7 % of relevant occurrences and such an approach is unlikely to lead to improved safety.
More productive and reliable alternatives to incident reporting include measures that relate to the reliability of processes and known points of system failure and quantifying the extent to which risk is detected.
We point out that there are evidence-based interventions available that will improve most, if not all, safety outcomes under domain 5.
High-performing organisations systematically ensure compliance, typically achieving over 95% reliability. We conclude therefore that the aim should be to ensure consistent and widespread implementation.
