Headlines: January 28th, 1998

The introduction of a measuring framework for the NHS is a key element in the Government’s strategy to improve standards. Alan Milburn, Health Minister said: “We want to see more patients getting better, and getting better treatment from the NHS.”The proposed framework will include measures of efficiency, effectiveness and quality. It has the appearance of being a ‘balanced scorecard’. There will be a comparison of hospital running costs. This is currently an area of concern with hospitals differing by up to 400%, but care will have to be taken to ensure that like is being compared with like. There are also variations in the ‘productivity’ of consultants treating outpatients, some achieving an output of almost 70% more than others.

Effectiveness will be measured by such factors as death rates and emergency re-admissions. Currently there are no figures on death rates, but re-admissions vary by up to 70%.

The new dimension of the measures lies in the proposed quality indicators and it is here that the patients’ views will predominate. An annual survey of some 100,000 patients will seek views on how well they think consultants and GPs treated them. Patients will also be asked about the quality of hospital food and whether they received the appropriate level of painkillers.

The measuring framework is likely to develop into a stakeholders’ charter. All stakeholders in healthcare will be empowered. Patients will pressurise GPs to refer them to the hospitals providing higher quality and lower death rates. They will also be able to make better informed choices about which GP to choose. GPs will be influenced by the same factors.

Consultants will be able to see the comparative administration costs carried by the Trust and managers with higher figures will be pressurised to make reductions. Managers will have comparative information about the ‘productivity’ of the consultants and be in a strong position to press for improvements.

Trust and Regional Health Authority Boards will be empowered to make better informed calls for improvement action. With greater freedom of information, including opening meetings to the public and publishing minutes, individuals in local areas will be able to judge if Boards are pursuing improvements with sufficient vigour. This will provide a spur to the Boards. Finally Ministers, and the NHS Executive will have a reasonably clear picture of how the NHS as a whole is performing. Should this array of stakeholders fail to secure the required improvement, the Health Improvement Commission will have power to intervene.

‘What gets measured gets done’ applies to all forms of activity, including health care. The danger in selecting indicators to make up the overall picture is that attention is focused on what is easily measured, leaving aside what is important but difficult to measure. The intention behind the framework is clear: ‘to drive up standards’ but the risk is that when it comes to the detail, the measurable will push out the important.