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Quality and Standards in the "New" English NHS

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The 2013 Conference of the Association of the British Pharmaceutical Industry (ABPI) addressed the challenges and opportunities presented by the recent changes the NHS. Understanding quality, and …

The 2013 Conference of the Association of the British Pharmaceutical Industry (ABPI) addressed the challenges and opportunities presented by the recent changes the NHS. Understanding quality, and setting and meeting standards for quality, are essential going forwards. At the conference, OHE’s Adrian Towse reviewed the experiences and concerns that have shaped the approach to quality and identified critical components.


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  • 1. Quality and Standards in the ‘New’English NHS: Incentives, Measurement,OutcomesProfessor Adrian TowseDirector, Office of Health Economics360° of Health • ABPI Conference 2013 • London, 25 April 2013
  • 2. • Francis (Mid Staffs), Kennedy (Bristol) ……• We have a better framework than ever before• Outcomes measurement and incentives are key• Build on QOF, CQUINS, PBR,• Lagging on PROMs, but progress on clinical data sets• Welcome the ‘dark forces’ – competition and medicalnegligence claims• Incentives for quality prescribing and outcomes2Agenda
  • 3. 3Inquiries come and go …..
  • 4. • Thatcher’s Internal Market put building blocks in place(purchaser-provider split, Trust status) but lacked anational quality framework of measurement, outcomes• Labour put in place a national framework from Dobsonto Darzi: NICE, NSFs, CHI/HC/CQC, PBR, QoF, PROMs,CQUIN, QOF, Quality Accounts)• Lansley built on this, his legacy on quality will (onbalance) be positive: reinforcement of independence,PROMs, CQUIN, QOF, Outcomes Framework, QualityPremium4Bristol mattered, cementing the architecture
  • 5. • Francis (Mid Staffs), Kennedy (Bristol) ……• We have a better framework than ever before• Outcomes measurement and incentives are key• Build on QOF, CQUINS, PBR,• Lagging on PROMs, but progress on clinical data sets• Welcome the dark forces – competition and medicalnegligence claims• Incentives for quality prescribing and outcomes5Agenda
  • 6. • “…risk-adjusted,absolute mortality forthe 4 conditionsincluded in the pay-for-performance programdecreased significantly.”CQUINS• 0.5% national , e.g. forFriends and Family, VTE• 2% local within nationalremit6Advancing Quality to CQUINs
  • 7. • Payment by results in secondary care:• Best practice tariffs (18 in 2013–14), e.g. acute stroke care• Quality and outcomes framework in primary care• Quality premiums for CCGs linked to the NHSoutcomes framework, which in turn reflects the NHSmandate from the SoS7Outcomes measurement and incentives are key90% of time onstroke ward£1026Initial brain scan £399Alteplase top-up £828
  • 8. • Too much emphasis on financial incentives• Didn’t have the impact we expected• But don’t scrap them• We need more information on outcomes, patientexperience, and more transparency• So starting point is information on quality in thepublic domain• We need outcomes measurement and incentives8Andy McKeon
  • 9. Ratings matter only if they are accompanied byincentives9
  • 10. 10Outcomes measurement: losing the plot onPROMs? But improving elsewhere?“it’s the economy data stupid”
  • 11. • Francis (Mid Staffs), Kennedy (Bristol) ……• We have a better framework than ever before• Outcomes measurement and incentives are key• Build on QoF, CQUINS, PBR,• Lagging n PROMs, but progress on clinical data sets• Welcome the dark forces – competition andmedical negligence claims• Incentives for quality prescribing and outcomes11Agenda
  • 12. 12Regulated competition is a good thing• On the best available evidence,competition at regulated prices hasimproved the quality of some NHS services• ‘Any qualified provider’ arrangementsallowing patients, helped by their GPs, tochoose where to get their health care aresuitable in some cases• In other cases competitive procurement bylocal NHS commissioners will beappropriate• Routine collection and publication ofpatient outcome measures should beexpanded to enable evaluation of theeffects of competition• Competition can help integration of care –no evidence that it hampers integration
  • 13. Berwick Zero tolerance is right, but incentivesare needed – medical negligence claims13
  • 14. • Francis (Mid Staffs), Kennedy (Bristol) ……• We have a better framework than ever before• Outcomes measurement and incentives are key– Build on QoF, CQUINS, PBR,– Lagging on PROMs, progress on clinical data sets• Welcome the dark forces – competition and medicalnegligence claims• Incentives for quality prescribing and outcomes14Agenda
  • 15. Evidence on factors affecting the uptake of newmedicines suggests national incentives are key15The key factors reported as drivingdifferent uptake patterns in Acute TrustsKey factors reported as drivingdifferent uptake patterns in PCTSSource: MISG Long Term Leadership Strategy, DH/ABPI, 2007
  • 16. To enquire about additional information and analyses, please contactProf Adrian Towse – atowse@ohe.orgTo keep up with the latest news and research, subscribe to our blog, OHE News.Follow us on Twitter @OHENews, LinkedIn and SlideShare.Office of Health Economics (OHE)Southside, 7th Floor105 Victoria StreetLondon SW1E 6QTUnited Kingdom+44 20 7747 8850www.ohe.orgOHE’s publications may be downloaded free of charge for registered users of its website.©2013 OHE16