09.09.16
New NHS performance measures to be implemented next year
NHS England is to introduce new measures on the performance of a whole healthcare system that will require a “change in mindset” from next year.
Speaking at the NHS Expo conference, Professor Jonathan Benger, national clinical director of urgent and emergency care at NHS England, unveiled a new set of standards the NHS has developed.
At the moment, the key measure of NHS performance is whether 95% of hospital A&E patients are seen within four hours – something the NHS as a whole has failed to meet for years.
Professor Benger criticised the standard itself, saying: “There comes a point where we have to ask whether we are now hitting the target but missing the point, or, in this country now, missing the target but missing the point.”
He added that once providers “maximise the amount of improvement you get from a particular standard”, they start finding “increasingly inventive ways to meet it”.
Eventually, he said, “there’s a very strong risk that every improvement we’ve seen in a number doesn’t really represent an improvement in the way the patient’s looked after, but represents an improvement in the way the measures are calculated to get the right number”.
NHS England recently announced that it is replacing the system-wide targets with individual targets for specific trusts in a bid to help tackle trust deficits.
In addition, Professor Benger said the four-hour standard is not adequate to measure an entire healthcare system.
“A four-hour standard doesn’t necessarily tell us what’s going on in all parts of the system in terms of what’s going on in primary care, in terms of what’s going on in 111, in terms of what’s going on in ambulance services,” he said.
After two years of work, Professor Benger’s team have developed standards based on three main areas – clinical pathways, patient experience and staff experience.
Each area includes a number of specific measures. For example, clinical pathways include population mortality rates, case fatality rates for specific emergency conditions, and the amount of patients who can be discharged to their normal place of residence.
Figures from June show that delayed transfers in the NHS are at their highest since records began.
The staff experience aspect of the standard will look at areas such as staff’s levels of stress. Professor Benger said changes in staff feedback are “one of the earliest indicators of problems”, but are not being “adequately used as an effective barometer”.
The measures have been piloted in a number of areas and are due to be introduced across the NHS in 2017.
Professor Benger said feedback from pilots had been largely positive but had highlighted areas for improvement, such as the need to accompany the measures with supporting material on what organisations should do if they receive consistently poor results.
He said the new measures will be introduced alongside the four-hour performance target instead of replacing it. However, he said the measures will require a “change in mindset”, because they will be used as a “quality improvement mechanism” instead of a “stick for providers”.
He added that the measures will be used to assess a health system as a whole instead of to compare providers to each other, and would avoid providers blaming other organisations in the area for performance problems.
“These measures will reflect the whole system and they’ll drive the kind of system behaviours that we want to see at a local and community level,” Professor Benger said.
The new measures will not create additional expenses because, initially, they will only use data that is already being collected centrally via measures such as the NHS Staff Survey, although respondents will now be required to say whether they work in emergency care to help with data collection.
Professor Benger said there could be potential for additional data collecting if the first measures are a success.
(Image c. Andrew Matthews from PA Archive)
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