OHE Commission

Is the NHS Improving Our Health?

Tuesday 18 March 2008 - Launch of the Report of the OHE Commission on NHS Outcomes, Performance and Productivity


Why measure patient outcomes?

The NHS receives well over £100bn of taxpayers’ money per year and this amount has been growing at 10% a year. It employs 1.5 million people in the UK (headcount). The purpose of the NHS is to improve the health of the UK population. Yet we know remarkably little about how much our health is being improved as a result of such massive expenditure and effort.

Routine measurement and analysis of the outcomes of health care for patients is required. The work of the OHE Commission, whose report is launched today, demonstrates that this is a practical proposition across a wide range of health services.

The Office of Health Economics established its Commission on NHS Outcomes, Performance and Productivity in autumn 2006, chaired by Professor Peter Smith, Director of the University of York Centre for Health Economics. The OHE Commission’s members are eminent experts. The purpose of the OHE Commission has been to review the evidence, commission research where necessary, and determine what patient outcomes data could and should be collected and analysed on a routine basis in the NHS.

The reward for doing so should be improved NHS performance, better use of its resources, and hence better care for patients.

Providers of health care and the clinicians and other staff who deliver that care need information on outcomes to improve the quality of their care. Patients require performance measures to enable them to compare different providers. The commissioners of care – primary care organisations and GP practices – need information on performance and productivity to decide how to get the greatest benefit from the resources at their disposal. The Government needs to know how productive the NHS is: how much health benefit the NHS is producing for the taxpayers’ funds it receives. Currently, productivity is measured in terms of the amount of activity in the NHS – numbers of patients seen and treated – but with no reference to how successful the activity is in improving patient health.

The OHE Commission commends the Department of Health for introducing in its ‘Operating Framework for the NHS in England 2008/09’ the requirement for NHS providers of hip and knee replacements, groin hernia surgery and varicose vein procedures to collect and report patient reported outcomes measures (PROMs). But it is practical, and highly desirable, to go much further than that, and soon.


Where and how soon can we measure patient outcomes?

The OHE Commission has reviewed the evidence on measures of patient outcomes in four ‘tracer’ disease areas, which together cover: acute and long-term conditions, primary care and hospital care, life-extending and quality-of-life-improving care. Outcomes measurement should be possible in all of these areas, although implementation can progress more rapidly in some than in others.

Based on its consideration of the evidence, which is laid out in the report and is available on the OHE website, the OHE Commission concludes that:

• Routine measurement of patient outcomes in the NHS is both practical and essential. It should lead to better outcomes for patients, better performance by providers of care and better productivity from the resources used.

• Although it is not practical to apply outcomes measurement everywhere at once, it is reasonable to expect that within 5 years patient outcomes data will be collected for the majority of NHS activity.

• Generic measures of health outcomes should be collected alongside disease-specific measures. Generic measures of patients’ health related quality of life before, during and after treatment, such as the ‘Euroquol 5D’ (EQ-5D), are essential to permit comparison between different types of treatment for different groups of patients, and to enable assessment of the overall productivity of the NHS. Such quality of life measures are widely used in research but not so far in routine health service provision.

• Clinicians find disease-specific measures of outcomes – e.g. blood pressure and cholesterol levels – valuable in assessing the impact of health care within groups of patients being treated for the same conditions. Disease-specific measures should also routinely be collected, in tandem with generic measures.

• For elective surgery, disease-specific and generic (EQ-5D) measures should be collected before and after surgery. This should be spread to all common elective surgical procedures over the next three years.

• Generic and disease-specific outcomes measures should both be collected at routine intervals for patients suffering from chronic diseases such as COPD (chronic obstructive pulmonary disease). The OHE Commission recommends piloting this with a few providers and commissioners for, say, COPD and then if the pilots are successful rolling them out to all providers and commissioners managing COPD patients from April 2010, and to other chronic disease areas over the following years. This will involve collecting outcomes data in primary care (GPs’ surgeries) as well as hospitals.

• For cancer patients the OHE Commission recommends a similar approach: pilot in with a few providers and commissioners for one type of cancer, colorectal cancer; roll out to all providers/commissioners from April 2010 if the pilots are successful; extend to all cancers over the following years.

• For mental health, the OHE Commission recommends use of disease-specific measures of patient outcomes before and after major interventions and on a periodic basis. However, further research is required to identify a generic measure of health related quality of life that is suitable for application to mental health patients as well as recipients of other kinds of health care. Research to that end should be funded and commissioned in 2008/09 (e.g. by the National Institute for Health Research).

• In addition to patients’ health outcomes, we recommend collection of data about the wider benefits from health services by adding questions on patients’ experience of care to the patient questionnaires used to measure health outcomes, as well as in patient and population surveys. Aspects covered should include: access to care, co-ordination of care, autonomy, choice, communication, confidentiality, dignity, quality of amenities and support for carers.

• There is an incremental cost involved in collecting patient outcomes data, but the magnitude is modest, around £3-£6 per patient in the case of elective surgery.

Contact Information – Office of Health Economics

Professor Adrian Towse, Director
T: 0207 747 1407 M: 07801 142472
E-mail: atowse@ohe.org  

Jon Sussex, Deputy Director
T: 0207 747 1412 M: 07789 435855
E-mail: jsussex@ohe.org  

Dr Karen Johnson, Business Manager
T: 0207 747 8864 M: 07889 634661
E-mail: kjohnson@ohe.org 

Notes to Editors

Office of Health Economics

The Office of Health Economics provides independent research, advisory and consultancy services on policy implications and economic issues within the pharmaceutical, health care and biotechnology industries. Its main areas of focus are: the pharmaceutical and biotechnology industry, health care systems - their financing and organisation, and the economics of health technology assessment.

The OHE Commission on NHS Outcomes, Performance and Productivity was established in autumn 2006 with the following members, who contributed as expert individuals:

Peter Smith - Chair Professor of Health Economics and Director, Centre for Health Economics, University of York
Nick Black, Professor of Health Services Research, London School of Hygiene and Tropical Medicine
Roger Boyle,  National Director for Heart Disease, Department of Health
Angela Coulter, Chief Executive, Picker Institute
Nancy Devlin, Professor of Health Economics and Head of Economics Department, City University
Nigel Edwards, Director of Policy, NHS Confederation
Mike Richards, National Cancer Director, Department of Health
Adrian Towse, Director, Office of Health Economics
Andrew Vallance-Owen, Group Medical Director, BUPA

The work of the Office of Health Economics Commission on NHS Outcomes, Performance and Productivity has been funded by unrestricted grants from the Association of the British Pharmaceutical Industry, GlaxoSmithKline plc, Roche and Sanofi Aventis. We thank them for enabling the Commission to do its work and for their support of the Commission’s aims.

We have been delighted also to receive expressions of support for our objectives and for our work towards achieving them from: the Association of Chartered Certified Accountants, the National Association of Primary Care, the NHS Alliance, the NHS Confederation and the Royal College of Nursing.

The OHE Commission worked independently, and the report expresses the personal views of the Commission’s members. They should not be taken to represent the views of members’ employers, or of the Commission’s funders and other supporters.

Copies of the report may be obtained from Dr Karen Johnson (kjohnson@ohe.org) or downloaded from the OHE website at www.ohe.org