The National Health Service will have to reduce premature mortality from illnesses such as cardiovascular disease and cancer and enhance the quality of life for patients with long-term conditions as part of a new outcomes framework unveiled by the government this week.

The plans show that a much closer eye will be kept on the outcomes the health service delivers, as the new NHS Outcomes Framework has been developed to provide a national level of accountability as well as act as a catalyst for boosting quality improvement throughout the system.

The Framework - which is the first of its kind for the NHS - is based on five different domains seeking to improve effectiveness of care, the patient experience and safety, thereby shifting the emphasis from centrally-driven process targets to issues that are closest to the hearts of patients, the government said.

As such, the Framework will be reviewed on an annual basis to ensure that it continues to accurately reflect what matters most to patients, and, pending the parliamentary say so, will also be used to hold the NHS Commissioning Board to account for the outcomes it secures for patients in its position as regulator of the commissioning process which, from 2014, will handed over to local GP commissioning consortia.


The NHS Commissioning Board will be responsible for deciding how best to deliver improvements by working with GP commissioning consortia - which will be rewarded financially for achieving certain outcomes - and making use of tools such as the National Institute for Health and Clinical Excellence’s Quality Standards, markers of excellence that set out the best structures and processes of care as well as ideal outcomes for a particular clinical area.

And in order to well and truly embed a focus of improving outcomes into health service culture, the Department of Health has confirmed that the new Health Bill will suggest placing a duty to “secure continuous quality improvement in the NHS on the Secretary of State for Health, the NHS Commissioning Board, the economic regulator and GP commissioning consortia”.

“Our ambition is to achieve health outcomes at least as good as any in the world. To achieve this, we need to focus on outcomes and their robust, continuing measurement,” said Health Secretary Andrew Lansley. “Our focus on improving health outcomes will give the NHS, public health organisations and local government a benchmark for what the public expects to see from their health services,” he explained.

Acting NHS Confederation chief executive Nigel Edwards also agreed that the next step forward has to be a focus on outcomes, as “they have genuine potential to deliver better care for patients”.


However, “it is worth pointing out that targets are not dead,” he stressed, as “measuring outcomes is extremely difficult and in especially complex cases a process target might be the only way of ensuring a treatment is being performed properly”.

In addition, Edwards noted that as it can take time for care improvements show up through improved outcomes, there is a need for “some flexibility over how and when those delivering health services are paid for the outcomes they achieve”.

Public health consultation

Alongside the NHS Outcomes Framework the DH has also published proposals for a Public Health Outcomes Framework that set out how society, government and individuals share in the responsibility of improving and protecting public health.

The consultation, Healthy Lives, Healthy People: Transparency in Outcomes, looks at five areas that aim to: protect the public’s health from major emergencies; address factors affecting health and wellbeing and inequalities; encourage healthier lifestyles; and premature death.