NHS approach to performance assessments requires 'radical simplification'

Independent charity and think tank, The King's Fund has called for an assessment on performance of local health systems in the future.

The review titled: ‘Measuring the performance of local health systems: a review for the Department of Health’ focuses on how the performance of health services is measured within Clinical Commissioning Group (CCG) areas. It specifically focuses on how efficient services are at working with social care and public health services.

The charity has recommended that existing performance frameworks are simplified and aligned, including consolidating the three national outcomes frameworks into one single framework that covers the NHS, public health and social care.

Chief executive of The King’s Fund, Chris Ham, said: “We strongly support the Secretary of State’s commitment to promoting intelligent transparency in the NHS. This demands careful attention to how performance indicators are selected and presented if it is to achieve its desired results.

“Done well, performance assessment can help to strengthen accountability to patients and the public, as well as to support commissioners and providers to improve care. A radical simplification and alignment of the current frameworks and better presentation would do this.”

The review into performance was commissioned by the Department of Health and contributes to Secretary of State for Health, Jeremy Hunt’s ambition to put ‘intelligent transparency’ at the centre of NHS performance improvement.

The findings revealed that a number of national bodies were involved in assessing performance, resulting in unnecessary complexity and duplicated efforts.

The Kings Fund was commissioned to advise on the ‘first principles of a local health system scorecard’ for the NHS in England. The scorecard would allow commissioners to assess the quality and effectiveness of local services and identify areas for improvement, provide accountability to patients and members of the public, allowing them to compare local health services.

In addition, the scorecard could help NHS England to identity areas where CCGs may need additional support to improve the quality of care and health outcomes.

The Kind Fund recommends that information should be made available at three levels of detail, first publishing a small set of headline indicators to enable the public to assess how their local health systems are performing.

The final level should include a detailed set of indicators, showing a comprehensive picture of the performance of local health systems, for use by commissioners and providers to allow them to assess the effectiveness and quality of local services and identify areas requiring improvement. Most importantly, all levels of information should be available to patients and members of the public.

Head of policy at Alzheimer’s Society, George McNamara, said: “We need a simple, accessible framework to boost performance, accountability and transparency for patients. It is right that dementia indicators are part of this and it is important there is a clear understanding of its purpose and how it is intended to drive up standards, as well as better information about the level of care they can expect in their area.

“Assessing the current performance is only the first stage, providing support and necessary resources to bring all areas up to that of the best is also necessary to ensure that it has the desired impact and that in itself will be the biggest challenge.

“There is huge scope for improvement of existing websites with varying content and formats that are not easy for the public to access or comprehend. We recommend producing a single website for all information intended for public use.”

Furthermore, the review considered the case for introducing an aggregate score to provide an overall rating for the local health system in CCG areas, although concluded that aggregate scoring could mask good or poor performance and would not give a true picture of performance.

Instead, the charity recommended that data on performance is made available to the public, for the purpose of transparency and in support of continued improvements to care by commissioners and providers.