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NHS performance frameworks need radical simplification and alignment, The King’s Fund review finds

The approach to performance assessment in the NHS requires radical simplification and alignment in future, a review by The King’s Fund finds.

This should include a consolidation of the three national outcomes frameworks into a single framework covering the NHS, public health and social care.

The review of how to assess the performance of local health systems, commissioned by the Department of Health, finds that the number of national bodies involved in assessing performance results in duplication of effort and unnecessary complexity. It also recommends a rationalisation of the disparate public-facing websites to provide the public with an integrated view of services in an area.

The Fund recommends that information be made available at three levels of detail. First, a small set of headline indicators should be selected to enable the public to assess how the local health system is performing. Second, a broader group of indicators should be developed based on existing frameworks. The final level would include a more detailed set of indicators that provide as comprehensive a picture as possible of local health system performance for commissioners and providers to assess the quality and effectiveness of local services and identify areas for improvement. At all levels, information should be available to patients and the public. 

The review considered the case for publishing an aggregate score that would provide an overall rating for the local health system in CCG areas. It concluded that an aggregate score can mask good or poor performance on individual indicators and therefore would not be a meaningful picture of performance. Instead, we recommend that the data on the performance of local health systems should be made available for the purpose of transparency and to support the improvement in care by commissioners and providers.

Chris Ham, the Chief Executive of The King’s Fund 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.’

Notes to editors: 

For further information, or to request an interview, please contact the Press and Public Affairs team on 020 7307 2632 (if calling out of hours, please ring 07584 146 035).

The terms of reference set out the Department of Health’s ambitions to develop a ‘scorecard’ of local health system performance. The Department of Health’s stated aims for the health system scorecard are to: 

  • allow commissioners to assess the quality and effectiveness of local services and identify areas for improvement 
  • provide accountability to patients and the public, allowing them to compare local health services on the basis of objective information 
  • help NHS England identify areas where CCGs may need targeted support to improve quality of care and health outcomes. 

The full terms of reference can be found as an annex to the report.

The Health Foundation has carried out a review of indicators of quality of care in general practices in England. Their review is also published and is available on the Health Foundation’s website.

Between July and September 2015 The King’s Fund carried out the review requested by the Secretary of State for Health. It included a consultation with technical experts and stakeholders such as clinical commissioning groups, professional societies, national bodies and patient groups. 
The King’s Fund is an independent charity working to improve health and health care in England. We help to shape policy and practice through research and analysis; develop individuals, teams and organisations; promote understanding of the health and social care system; and bring people together to learn, share knowledge and debate. Our vision is that the best possible care is available to all.

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