NHS should focus on outcomes, not targets - Lansley

Officials have been asked to consider a cull of the most unpopular targets in a revised NHS operating framework for this year, which the Department of Health is preparing to publish in the next few weeks.

Andrew Lansley has told civil servants he wants to put the spotlight on performance against a set of national quality measures.

Those favoured include patient experience and satisfaction and several indicators of healthcare outcome, senior sources told HSJ.

Particular attention will be given to death rates for diseases amenable to healthcare and death rates after treatment for cardiovascular, cancer and respiratory disease, it is thought. Provider trusts and primary care trusts will be expected to improve against relevant measures each year.

The health secretary is also understood to be interested in using patient safety incident numbers as a measure, although safety experts argue that could deter reporting.

A new set of measures on the NHS’s contribution to society and the economy - for example through a reduction in sick days - may also be introduced.

New measures will replace those “politically motivated process targets” rejected by the new government.

Civil servants have been asked to look at the target for 90 per cent of elective patients to be treated within 18 weeks of referral, although scrapping it may be complicated by the NHS Constitution which, from 1 April, gave patients the “right” to non-urgent treatment within 18 weeks.

But officials are actively considering reducing the target for 98 per cent of accident and emergency patients to be seen within four hours to 95 per cent, rather than scrapping it altogether.

Senior doctors HSJ spoke to welcomed what they said appeared to be a focus on evidence-based outcome measures and support for quality improvement from Mr Lansley. But they were concerned scrapping targets could lead to spiralling waits if implemented quickly and while the NHS sought cash savings.

One medic and quality measurement expert told HSJ: “In principle, removing the targets is exactly the right thing to do.

“But in practice, at a time when there’s a risk waiting times will increase, we might not want to remove our most powerful lever to keep them under control.”