A new report by think-tank Policy Exchange supports the idea that higher-quality patient outcomes data will help to boost the National Health Service’s performance, and makes several recommendations to better healthcare measurement.
Measure for measure describes how raising the quality of healthcare information will provide more accountability, promote increased patient trust, and improve the Service’s performance. But its authors, Richard Hamblin and Janan Ganesh, say that three basic problems with the present system are holding this back.
Currently, they say, data collected by the NHS focuses on mortality and hospital readmission rates, but this is too limited and must concentrate more on the ‘patient experience,’ to include factors such as the standard of facilities and equipment, qualifications of medical staff, food quality, accommodation and cleanliness, for example. Moreover, they point out, while it is recorded whether patients die or are readmitted, information such as if they actually get better is not being collected.
‘Confusing’ and ‘underdeveloped’
With regard to the regulatory framework, the current systems for monitoring healthcare quality are confusing and underdeveloped, it says. “In a system which is supposed to be pluralistic and decentralised, it makes no sense to judge the same service provided by the NHS and independent sectors according to different criteria,” the authors stress.
They also point out that it is unclear how two different policies designed to boost quality relate to each other - Healthcare Commission inspections and patient choice, the flagship of improving care as outlined in the white paper Our Health, Our Care, Our Say and a key player in reform. The reports argues that access to “specific and timely information” on services is crucial in driving up quality through patient choice, but that specific service assessments carried out by the Healthcare Commission have centred on chronic conditions “which are less susceptible to improvement through competition.”
Lastly, the report claims that there is “a lack of understanding among policy makers about the ways in which information can improve the quality of healthcare.” And it warns that linking incentives to quality measurement - such as pay for performance – might “encourage unintended perverse responses such as the falsification of data.”
Raising the standard
The report makes several recommendations to bring the system in line with its vision for better healthcare measurement in the future. For one, it says, the Healthcare Commission should take the lead in publishing information about minimum acceptable standards of care and value for money, and that there should be a constantly updated “accountability balance sheet” offering data on the quality of care at each hospital or GP practice.
“There remains a real lack of understanding about the clinical effectiveness of treatments,” commented Gavin Lockhart, Policy Exchange’s Public Services Research Director, and explaining the need to improve on healthcare measurement within the NHS, he said: “There is an expectation that health service spending will continue to increase at a much reduced annual rate of between 3% and 4%...if limited resources are to be used most effectively, investment decisions must be made on the basis of expected health benefits with a renewed emphasis on the measurement of outcomes and cost-effectiveness coupled with purchaser incentives to improve productivity.”
And the British Medical Association told PharmaTimes UK News that it “agrees with the Healthcare Commission that we need more robust data to assess health outcomes, and a comparable clinical governance system put in place to ensure the highest standards of care are being provided…Patients must be able to make choices about their treatment based on the clinical outcomes of operations.”