Improving healthcare outcomes

The next installment of my series on the Health and Social Care Bill. I’m still ploughing my way through the white paper . . .

Improving healthcare outcomes

I think the first sentence of this section bears repeating:

“The primary purpose of the NHS is to improve the outcomes of healthcare for all: to deliver care that is safer, more effective, and that provides a better experience for patients.”

How can you argue with that? The section continues with a thoughtful discussion of targets. The key phrase on removing process-oriented targets is “These targets crowd out the bigger objectives of reducing mortality and morbidity, increasing safety and improving patient experience more broadly“. There is more on targets, but sensibly focussed on safety, outcomes and patient experience.

Another key section talks about replacing the relationship between politicians and professionals with one between patients and professionals, reinforcing the removal of political interference.

The NHS Outcomes Framework

This section states the intent to provide separate frameworks for the NHS and for Public Health (and Social Care) and then outlines the NHS Outcomes framework and how it translates in to a commissioning outcomes framework for consortia.

This framework will cover effectiveness (i.e. outcome), safetly and patient experience. The consulting process and the goals and focus (outcomes, safety, and experience) of the framework seem sensible.

Developing and implementing quality standards

This section outlines what quality standards for care will be implemented, the expectations on these standards, and the timescale for rolling them out. It envisions some 150 quality standards over the next five years. At the time of publication, three had been implemented (on stroke, dementia, and prevention of venous thromboembolism). The example shown (on the prevention of thromboembolism) has seven quality statements and looks sensible (but really I’ve not that much idea as I avoid most medical stuff as it is just too icky and I’m rather squeamish).

Overall, the goals and timescale look reasonable, though I can’t assess what fraction of common clinical pathways are covered by 150 or so individual standards.


A short section on the importance of research. While the statements here are admirable, the brevity of the section highlights the woeful lack of scientific knowledge within government! I would really have expected an outline of a framework and some tentative goals (though this is always tricky with research – you never know quite what you’ll find).

Incentives for quality improvement

A complex section on development of payment systems, currencies, and tariffs. I’m not sure I fully understand this yet, and need to read it carefully. On first reading, it seems to promote payment for quality over mere cost but I’m unclear how the payment systems work and whether this intent to provide quality of outcome incentives will or can work. I’ll revisit this after talking to a few who may know!

Overall: Looks sensible, and other than what I think is my own lack of understanding, I can’t find much to quibble about. Oh, yes I can: we need more people with at least a basic understanding of science in government!

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