Outcomes... How Novel!
The NHS has had many standards in place from the previous government, including things such as no person should wait more than four hours before being seen in an accident and emergency (ER) department. This is the result of infamous grousing about the long waits for assessment, treatment and appointments. Unfortunately these types of targets resulted in scandals such as occurred in the Mid-Staffordshire trusts, which had excellent compliance with the targets but an astronomically high number of mortalities due to substandard care.
In the new White Paper that has just come out, "Equity and Excellence: Liberating the NHS," the artificial targets of low waiting times and number of patients to be seen have been eliminated. In their place are something called outcome measures. The government wants to see that interventions are having the desired impacts and they will even begin paying based upon those outcomes (does this sound familiar to you?).
What amazes me is how this thinking is new to the NHS. I have taken it for granted that someone somewhere was indeed measuring outcomes. The Department of Health has been looking at things like number of alcohol-related hospital admissions by region http://www.nwph.net/alcohol/lape/ but nobody has been looking to see if ambulation has improved after rehab or that people are more mobile after a wheelchair fitting and training. I really find that difficult to believe, but it is true. The disconnect between management, government and the clinicians is astounding.
The NHS does manage to get a lot done well, mostly due to good clinicians who set outcomes and goals for their patients simply by being very good professionals.
Next week I'll reflect on my first full year abroad. Its anniversary time!