For 60 years, NHS policy makers, in common with counterparts in all healthcare systems, public and private, have believed that regular 'redisorganisation' of structures, combined with increases in funding to increase activity, improved patients' health, writes Alan Maynard
The first female member of the Royal Statistical Society, Florence Nightingale, pointed out 150 years ago that achieving value for money required measurement and management of whether patients were "dead, relieved or unrelieved". Some bolder managers used this classification in the late 19th century, although the Royal College of Surgeons did their best to destroy this work in the early 20th century.
After 60 years of fixation on organisational structure and funding, the NHS is at last planning to invest in determining whether patients get better as a result of spending£100bn. Hidden away (is the department embarrassed?!) in the English Operating Framework for 2008-09 is a recommendation to use patient reported outcome measures (PROMs) for patients before and after hernia and varicose vein repairs and replacements of hips and knees. This will demonstrate whether we make patients better or not.
The next step is to put PROMs into the GP contract so that they regularly measure the physical and psychological functioning of patients. Hopefully, with Ara Darzi's help this will not take another 150 years!
Alan Maynard is a professor at York University and chair of York Hospitals foundation trust.