Goals replace targets in DH paper

Tags: DH NICE

20 Jul 2010

The Department of Health has set out its plans to scrap centrally, set performance managed targets - and to hold the NHS to account using 'national outcome goals'.

The NHS Outcomes Framework, which is now out for consultation, will set goals against which health secretary Andrew Lansley will hold the new NHS Commissioning Board to account.

The board will allocate resources and issue commissioning guidelines to GP consortia, following the abolition of strategic health authorities and primary care trusts.

The DH said data about each of the goals in the framework will also be made publicly available, providing greater transparency about the quality of local health services.

It said this would deliver “broader and more locally relevant information” for use by patients, their carers and the public.

The document suggests five outcome domains which would then be underpinned by specific outcome measures.

The five proposed domains are: preventing people from dying prematurely; enhancing the quality of life for people with long term conditions; helping people to recover from episodes of ill health or injury; ensuring people have a positive experience of care; and treating and caring for people in a safe environment and protecting them from avoidable harm.

As well as specific indicators for each domain, the NHS Commissioning Board is expected to commission Quality Standards from the National Institute for Health and Clinical Excellence to provide more detailed commissioning guidance to consortia.

NICE published its first three Quality Standards last month and the plan is to produce 150 over the next five years.

The dcoument says indicators will include clinical outcome measures and patient reported outcome measures (PROMS), but that the NHS will only be held to account for the indicators that it alone can influence.

The DH wants to shift the focus from what it describes as the ‘national process targets’ of the previous government - such as 18 week waits and access to a GP - and instead judge the NHS on the outcomes it delivers for patients.

It says providers will not be performance managed against the Outcomes Framework.

Health secretary Andrew Lansley added: “I want to free doctors and nurses to focus on what really matters – better results for their patients – instead of them being stifled by top down targets.

“Instead of politically motivated targets which lack clinical evidence, we will measure the outcomes that are most important to patients and that are relevant to healthcare professionals.

"These will be backed up by authoritative, evidence-based quality standards that will ensure everyone understands how those outcomes can be achieved.”

More details about how data on outcomes will be made available to the public are due be included in the DH’s information strategy, planned for publication in the autumn.

The first Outcomes Framework is expected to be developed in 2011-12 and will then be reviewed annually.

The consultation on the framework runs until 11 October and is the first of several consultations on aspects of the white paper due to be published in the next two weeks.

Fiona Barr

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Reader's Comments

Own goal?

20 Jul 10 16:07

Could it be that the Microsoft EWA has been ditched by DH because Microsoft Word has "target" as a synonym for "goal"? Surely not....

funny

21 Jul 10 09:07

*thumbs up for the last comment*.... made me laugh!

Targets are dead! Long live ....

21 Jul 10 10:07

Five domains, each with an overaching indicator and up to 5 improvement indicators by which the SoS will hold the board to account.

The Board is then "free to determine how these outcomes will be translated into a broader framework... which it will use to hold GP consortia to account" {sect 2.5}

This national framework will be supported by a set of 150 quality indicators which will be available for local commissioners to use in working with providers.

... and this is just the commissioning framework. The economic regulator and the quality inspectorate have to get going yet.

A real corker is section 1.17 "The NHS Commissioning Board wil.. develop a set of indicators to operationalise the national outcome goals..they might draw upon existing measures such as Vital Signs."

My personal favorite is "Even with indicators that focus on outcomes, there is still arisk of distorting behaviour..... To avoid this, it is important that the NHS Outcomes Framework strives to be as comprehensive as possible"

So we have national outcome measures which are slow to respond to change and are generally not reported until at least a year after the year of measurement. This will be used to hold the Secretary of State to account as well as the board but will not be properly reported until after the next election. It will be "Supported" by an enourmous suite of "operational measures" by which the rest of us will be judged.

"Be careful of what you wish for" certainly seems increasingly relevent!

What's in a name!

21 Jul 10 12:07

Goals rather than targets - yet they'll still need to be met! To ensure you meet a goal you'll need to make sure processes are effective!

Is there any real difference to what we have now other than it will be a different set of indicators to be measured against - although now they'll be harder to count, fraught with differences interpretation and still little influence to people "choosing" to go to their local DGH because it's local!

Confused

23 Jul 10 08:07

Targets... Goals..... the main things to focous on... arnt all of the same just worded a bit difference for e.g expereince changed to care :)

We need some stability rather then goal posts being shifted around from one end to another.... the vision is there but the focous keeps on changing.

Goal Posts?

23 Jul 10 14:07

I think you must be confused re 3).

I assume you mean target posts surely?!?

Noble objectives - but difficult to performance manage..

maryhawking@tigers.demon.co.uk

25 Jul 10 17:07

"The five proposed domains are: preventing people from dying prematurely; enhancing the quality of life for people with long term conditions; helping people to recover from episodes of ill health or injury; ensuring people have a positive experience of care; and treating and caring for people in a safe environment and protecting them from avoidable harm."

I don't think these are contentious - unless you don't support motherhood and apple-pie.

Thinking up short term indicators for long-term outcomes is much more difficult, and I am not aware of any way of measuring outcomes which are not expected to be delivered for several years on an annual basis for accountability reasons.

"As well as specific indicators for each domain, the NHS Commissioning Board is expected to commission Quality Standards from the National Institute for Health and Clinical Excellence to provide more detailed commissioning guidance to consortia."

Too much "detailed commissioning guidance" and we won't have anything left over to commission the services one locality needs - but another doesn't. The needs of inner cities and remote rural areas actually are different...

just more confusing reports

karenconnolly09@yahoo.co.uk

28 Jul 10 09:07

At the end of the day we are just adding to the reporting burden. Ineveitably the new goals will come in and the old targets won't go away easily - they never do.

Do our NPfIT system solutions support the new goals? Probably not because the systems already struggle to meet any DSCN that comes our way and no doubt no-one has thought of that one yet.

There is a silver linig to all this - there will be a jobs boom for information management specialists. Maybe we won't be the poor relations any more!