In medicine you have to measure outcomes and that means doing post-mortems on the dead to find out why they died, and talking to the living to find out if you’ve made any difference to their lives.
Well guess what? We’re moving to an outcomes-led NHS. How do I know this? Because PharmaTimes has invited me to a meeting where the great and the good will discuss this exciting new frontier. PharmaTimes, as you will realise, is never wrong.
I was calling for an outcomes-led NHS in 1992 in the wake of the Bristol heart scandal. And ever since then, I’ve argued that the single most important NHS reform would be to measure all sorts of outcomes, adjust them to allow fair comparisons and then put them in the public domain. That would lead to the most significant improvement in quality we could possibly imagine, far greater than any ridiculous market reforms.
It would automatically create a market in quality, where patients could decide to stay local and support their nearest hospital, which has a 5% mortality for aneurism repair, say, or travel 200 miles to a hospital with half the death rate but which is much harder for the relatives to visit. My guess is that many patients would still decide to go local, but the very act of publication has shown that it drives up quality. Doctors are hugely competitive, and the publication of death rates for heart surgery has helped enable huge improvements in outcome.
Measuring and publishing patient experience is as important as measuring and publishing clinical outcomes. If you want to know whether the treatment was kind and humane, and whether it improves the quality of the patient’s life you have to ask the patient and the carers. Then you have to publish it to guide other patients and carers where to go to get the best care. It’s not rocket science, but it’s taken the NHS years to cotton on.
My medical hero is an American surgeon called Ernest Codman, who tried to change the world with passion and sincerity: “I am called eccentric for saying in public that hospitals, if they wish to be sure of improvement, must find out what their results are, must analyse their results to find their strong and weak points, must compare their results with those of other hospitals, must care for what cases they can care for well, and avoid attempting to care for cases they are not qualified to care for well. They must welcome publicity not only for their successes, but for their errors. Such opinions will not be eccentric a few years hence.” And that was in 1910.
Codman was, and still is, spot on. To have any idea if anything works in medicine, you have to measure outcomes and that means doing post-mortems on the dead to find out why they died, and talking to the living to find out if you’ve made any difference to their lives. People snort at the friends and family test, but if 90% of patients filled it out it would provide a much better barometer of care in the NHS than reading the Daily Mail. If you want to find out what sort of doctor I am, you can read the comments of my patients and colleagues on my website, and you can read postings about me on I Want Great Care. Technology and innovation is finally dragging the NHS into an era of transparency and accountability, and about time too. Now we just need the pharma industry to follow suit and publish all trials for all treatments currently in use.
Join us on 21 November to get the inside track on one of the biggest challenges facing pharma over the next few years. Speakers include NICE chair David Haslam, the Office for Health Economics’Nancy Devlin, Jeremy Taylor, National Voices and Andrew Vallance-Owen, Southwest Peninsula AHSN. To see the agenda, click here, and to book your place, click here.
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