Measuring the performance of local health systems: A review for the Department of Health

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Part of Measuring the performance of local health systems

In June 2015, The King’s Fund was commissioned by the Department of Health to review how the performance of local health systems could be assessed.

Our review looks at how to measure the performance of health services within clinical commissioning group (CCG) areas, including how well these services work with social care and public health services.

We recommend that there is a radical simplification and alignment of existing NHS performance frameworks. 

A number of national bodies are involved in assessing performance, resulting in duplication of effort and unnecessary complexity. Rather than create an additional new way of measuring performance, we argue that a better approach would be to consolidate the three national Outcomes Frameworks into a single framework covering the NHS, public health and adult social care. 

We recommend that a small set of headline indicators are selected to present key performance information to the public. It is important to engage with the public to determine what indicators should be used and what domains to be covered as this is an evidence-free zone. 

A larger set of indicators should be available to enable patients and the public to drill down into population groups and medical conditions of particular interest to them and to support commissioners and providers in quality improvement.

We do not recommend using this data to provide an aggregate score of performance – aggregate scores can mask good or poor performance on individual indicators and therefore may not be a meaningful picture of performance. Instead, we recommend that a wide variety of data should be made available for the purpose of transparency and to support the improvement in care by commissioners and providers.

We also recommend that there is a consolidation of the disparate array of websites presenting information about local health system performance.


Umesh Prabhu

Medical Director,
Wrightington Wigan and Leigh FT
Comment date
05 November 2015
We must measure outcomes and measurements must be simple and easy for patients, public and staff to understand and must be meaningful and helps us to improve the quality and safety of care to our patients.

In Wrightington, Wigan and Leigh FT we measure HSMR. SHIMI, serious harm to elderly patients including pressure ulcers, fracture in our in-patients, hospital acquired infections, complaints, litigations, SUIs, clinical incidents, Coroner's feedback, staff feedback, patient feedback, our always events. We also measure agency spends, HR matrix and outcome for cancer, cancer AE waiting times and so on.

We have reduced harm to our patients by 85% since 2008 to date and staff feedback has improved from being bottom 20% in 2010 to the second best place to work in the whole of England in 2015.

Important is to measure outcome which are meaningful to our patients, public and staff and to keep on improving the safety and quality. Measurements should not be used to blame, humiliate, punish or name the organisations which demoralises hard working staff and patients and public lose confidence in their local organisations.

Faye Creed

Registered Manager,
Workwise Healtrhcare Ltd
Comment date
19 October 2015
The Clinical Commissioning Groups are not engaging with the wider community of health and social care providers who are ready to increase the scope of their practice in the community to include health care tasks with the appropriate training. Health and social care providers in the community need to be able to plan their training activities around the demand for their services. Otherwise they may invest money on training in things for which there is no demand. If we know what types of support services are required we can plan our workforce development around that and we can train with health colleagues. A proper framework of local demand for categories of services. capacity to supply, the means to undertake them and the competence of staff involved will ensure that money is invested in the right training and clients receive appropriate and safe care. This requires an integrated approach and yet we continue to work in silos. What is required is a ' Domesday book' of care provision for each CCG so they know what services are out there in their locality. Perhaps CQC could produce something as they have their own area inspectors gathering intelligence data. We need to be creative and cynicism is not helpful.

Paul Smith

Comment date
17 October 2015
Even though it is now part of the Better Care Fund, our Freedom of Information request found that only 30/152 social care authorities in England could link Disabled Facilities Grants with their care records.

Those that can, show that it delays admission into residential care.

Pearl Baker

Independent Mental Health Advocate and Advisor/arer,
Comment date
12 October 2015
To gather information and make an informed decision you need to know who are involved in Health and Social Care outside of the agencies you mention.

I return to the CQC who inspect GP Surgeries. I am informed any complaint is only used to see if they can improve the Inspection process, and nothing else, they will NOT investigate any individual complaint, despite it being legitimate, evidence (supported), and will not respond to the complainant with their findings, this is NOT Transparency, and give the General Public absolutely know confidence that either their complaints is (upheld) or dismissed, is unsatisfactory and Not acceptable.

I know of a least one GP who doesn't have a copy of the Care Act or the MCA2005 code of practice.

The contents of the Care Act is completely ignored, and certainly not implemented.

I rest my case regarding the CQC.

Healthwatch England like myself collect information from the General Public, but do you contact them for this information?

LGO Ombudsman & the PHSO who can now investigate under 'joint' workings, again there is no mention of their involvement or 'findings'.

There appears to be know process of Carer involvement or 'feedback' to anybody! outside of your own process of engagement with your chosen groups who really do have the knowledge to enable you to make comments and statements on OUR behalf.

CCG GP LA are discharging LTC mentally ill from 'Care Plans', no Independent Advocates no Personal Budgets.

Carers request for an Assessment from the LA are ignored!

Safeguarding 'out of the window' the General Public and Carers have know ides this exists! This should be included in the 'Care Plans' and information on who to contact should be provided on the 'Care Plan' oh dear no Care Plans here.

Carers request for 'nearest relative' mental health assessment completely ignored! LTC mentally ill relative still periodically living on the streets!

No 'integration's is leading to poor health and social care, including the need to recognise the importance of Housing Associations.

Good Leadership is identified by knowing the COMPLETE system of health and social care and NOT just bits of it.

I will leave you with a phrase I often use! 'you have to live the dream to know it'

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