NHS performance frameworks need radical simplification and alignment, The King’s Fund review finds

The approach to performance assessment in the NHS requires radical simplification and alignment in future, a review by The King’s Fund finds. This should include a consolidation of the three national outcomes frameworks into a single framework covering the NHS, public health and social care.

The review of how to assess the performance of local health systems, commissioned by the Department of Health, finds that the number of national bodies involved in assessing performance results in duplication of effort and unnecessary complexity. It also recommends a rationalisation of the disparate public-facing websites to provide the public with an integrated view of services in an area.

The Fund recommends that information be made available at three levels of detail. First, a small set of headline indicators should be selected to enable the public to assess how the local health system is performing. Second, a broader group of indicators should be developed based on existing frameworks. The final level would include a more detailed set of indicators that provide as comprehensive a picture as possible of local health system performance for commissioners and providers to assess the quality and effectiveness of local services and identify areas for improvement. At all levels, information should be available to patients and the public. 

The review considered the case for publishing an aggregate score that would provide an overall rating for the local health system in CCG areas. It concluded that an aggregate score can mask good or poor performance on individual indicators and therefore would not be a meaningful picture of performance. Instead, we recommend that the data on the performance of local health systems should be made available for the purpose of transparency and to support the improvement in care by commissioners and providers.

Chris Ham, the Chief Executive of The King’s Fund said: ‘We strongly support the Secretary of State’s commitment to promoting intelligent transparency in the NHS. This demands careful attention to how performance indicators are selected and presented if it is to achieve its desired results. Done well, performance assessment can help to strengthen accountability to patients and the public, as well as to support commissioners and providers to improve care. A radical simplification and alignment of the current frameworks and better presentation would do this.’