A ‘single definition of success’ for health systems should be created in the form of a ‘single, coherent’ performance and quality framework, the King’s Fund has told the health secretary.

  • King’s Fund rejects idea of aggregate or population group ratings based on data
  • CCG assurance framework expected to create overall CCG ratings
  • Performance system should be simplified with “small number of headline indicators”
  • Would create “single definition of success” and “future proof” assessment system as commissioning changes

However, the think tank rejected proposals that have been floated by Jeremy Hunt to give single “aggregate scores” to clinical commissioning group areas based on quality indicators, and for scores across population groups such as “children and young people” and “people with mental health conditions”.

Mr Hunt asked the King’s Fund in July to report on how to “publish ratings on the overall quality of care provided to different patient groups in every local health economy”, following disagreement with commissioners over CCG ratings.

At the same time he asked the Health Foundation to review metrics and a potential “scorecard” for GP practices.

Both reports are scheduled to be published today and have been seen exclusively by HSJ. They both advise:

  • against single composite or aggregate scores based on performance indicators;
  • the creation of a top level “small set of headline indicators to present key performance information to the public”; and
  • consolidation of the “disparate array of websites presenting information to the public and the NHS”.

Mr Hunt is considering the reports.

NHS England is currently reviewing its CCG assurance framework and is expected to give CCGs single ratings such as “requires improvement” from next year. However, these are likely to be based on judgements about factors such as CCGs’ transformational capability and efficiency, “system resilience” and leadership, rather than only on metrics.

Chris Ham

Current ways of measuring CCGs and health systems need ‘simplification’, Chris Ham said

King’s Fund chief executive Chris Ham told HSJ: “It doesn’t make sense to do an aggregate summary score or rating based on performance indicators alone. If the Department of Health wants to do that we think it could be done better through the CCG assurance framework.”

However, he said current approaches to measuring CCGs and health systems, including the NHS outcomes framework, CCG outcomes indicator set, and CCG assurance framework, needed “simplification and alignment”.

This would create a “clear line of sight from the secretary of state through CCGs to the populations they serve”, the report says. He said it would also “deliver the ‘single definition of success’ for local systems of care and CCGs that the secretary of state has spoken of as being needed for providers”.

The report says the three current national outcomes frameworks – for the NHS, public health and social care – should be combined.

It says existing indicators should be grouped into three levels. The top level would be “a relatively small number of headline indicators… of particular relevance to the public” and “provide a high level picture of overall performance”.

It says establishing a clear framework for measuring health systems, independent of CCGs as organisations, would “‘future proof’ performance assessment at a time when commissioning is in a state of flux”, including moves “blurring the boundary between commissioners and providers”.

Mr Hunt is expected to address the recommendations shortly. A DH spokeswoman said: “We are determined to make our NHS the safest healthcare system in the world. Improving transparency and using data are key to achieving this and we are pleased to see both the Kings Fund and the Health Foundation endorse this approach.”

The full report will be available from 10am.

Exclusive: 'Single definition of success' for health systems recommended