Ministers should avoid the temptation to use the proposed new performance framework for the health service to generate league tables or to 'name and shame' poor performers, the NHS Confederation warns today.
Its response to the consultation document on the framework says that such approaches will deter clinicians from becoming involved in the first place and 'do not provide a useful incentive'. It also warns that league tables will mean health authorities and trusts may put undue emphasis on 'getting the figures right' without necessarily improving their performance.
Other concerns raised by the confederation include the ability of NHS staff to cope with the additional workload, the shortage of routine data collected in primary care, and the absence of public health and local authority measures.
But, it says, the proposed framework is 'clear, comprehensive and serves to underpin the values of the NHS', and it is 'a significant improvement on the existing Patient's Charter standards and NHS Efficiency Index'.
Confederation policy manager Tim Jones says: 'HAs and trusts are taking the proposed performance framework very seriously indeed. This is something which makes specific demands on them and on their resources.
'The majority of them have responded to the document, and it is clear from what they have said that they read it very carefully. There are extremely detailed critiques.'
Reflecting the views put forward by its members, the confederation has broadly welcomed the government's plans, set out in the consultation document A National Framework for Assessing Performance : 'The most positive thing that came through was that this was a framework based on principles, ' says Mr Jones.
'That is something the service seemed to like.
'They liked the idea that you could accept the ethical underpinning, even if you disliked specific measures.'
And there were specific measures which HAs and trusts strongly disliked.
'The use of suicide as a proxy measure for mental health was one almost no one agreed with, ' says Mr Jones. 'People couldn't understand it at all.'
The confederation's response to the Department of Health argues that 'testing of the new framework through pilots is essential' to help identify 'problem areas'.
It says: 'Clearly there will be a need for collaboration and multidisciplinary audit between primary and secondary care to reveal the complexities around chronic care management. Concern has been expressed. . . on this issue.
'There is also concern that reliance on existing data sources may overlook performance issues in the primary care setting for which no routine data collection is currently taking place.'
On workload, the confederation reports that some of its members 'expressed serious worries about the ability of existing staff and systems to cope'.
There are also criticisms of ministerial plans for a national public opinion poll. Such measures are 'a weak and possibly counterproductive tool for measuring health gain', it says.
Other concerns raised by the confederation include:
the absence of any planned indicators for learning disability services;
the validity of community nurse contacts as a performance indicator for community services;
the fear that some indicators will cover insufficient data to be statistically significant;
concern that unit labour costs will be inaccurate because they are not adjusted for contracting out or case mix.