standards in the NHS

The new framework will eventually cover most NHS work A consultation has begun on how standards in the NHS in England should be measured.

The government says it wants to move from national targets to a "set of national outcome goals".

So far it has taken a cautious response to dismantling the targets put in place by Labour.

Experts say gains made in cutting waiting times should not be lost in any changes.

In future, it has proposed the health service should be judged by measures which include how well it prevents people dying prematurely, how they recover and patients' experience of care.

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The first set of new standards is to be developed by April 2011. Under the planned shake up of the health service the new NHS commissioning board would use them to hold GP groups to account. Family doctors are due to take over NHS budgets for their local community by 2013.

The Health Secretary Andrew Lansley said: "I want to free doctors and nurses to focus on what really matters - better results for their patients - instead of them being stifled by top down targets."

So far the only target introduced by Labour to be removed outright is the obligation for GPs to offer an appointment within 48 hours to all patients.

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Much of what is proposed is already part of the performance management system for the NHS ”
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Kings Fund

Catherine Foot
Accident and Emergency departments have had the target to see patients within four hours relaxed slightly, but not removed. The promise of hospital treatment within 18 weeks of referral from a family doctor is no longer being monitored nationally but the health service has been told that long waits are not acceptable.

After angry exchanges in the Commons last week the government confirmed it would also be keeping the maximum two week wait for an appointment with a cancer specialist for urgent suspected cases.

The new outcome measures will include, wherever possible, information that can be compared internationally with standards in other major economies. This may help more accurate comparisons to be made. Andrew Lansley has said he wants to close the gap in cancer survival between the UK and other European countries.

Death rates from diseases which are treatable are one way of giving a rough idea of how well health systems are looking after their patients. Survival rates might also be important, as they take account of the number of patients suffering from any particular condition.

Performance management

The clinical watchdog for England, the National Institute for Health and Clinical Excellence (NICE), is being asked to develop 150 new outline standards for different areas of healthcare to support the new framework.

They are expected to be similar to the work it has already done in setting out what constitutes best care for groups of patients such as those suffering strokes, or dementia.

One common criticism of the targets developed by Labour was that they often had unintended consequences. Managers would focus all their efforts on improving areas where there were targets, sometimes at the cost of paying less attention to types of care which had few or no targets.

The Department of Health says the new outcomes framework should eventually cover most of the work of the health service.

Catherine Foot, senior policy fellow at the Kings Fund, said the ambition to develop such a comprehensive set of standards was welcome. But she added

"Much of what is proposed is already part of the performance management system for the NHS and it is positive to see this document building on what has been established before rather than reinventing things."

The independent health think tank says in order for the new outcomes to make a difference the NHS at a local level will probably still need to measure staffing levels and waiting times.