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.

1. Quality and Standards in the ‘New’
English NHS: Incentives, Measurement,
Outcomes
Professor Adrian Towse
Director, Office of Health Economics
360° 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 medical
negligence claims
• Incentives for quality prescribing and outcomes
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Agenda

3. 3
Inquiries come and go …..

4. • Thatcher’s Internal Market put building blocks in place
(purchaser-provider split, Trust status) but lacked a
national quality framework of measurement, outcomes
• Labour put in place a national framework from Dobson
to Darzi: NICE, NSFs, CHI/HC/CQC, PBR, QoF, PROMs,
CQUIN, QOF, Quality Accounts)
• Lansley built on this, his legacy on quality will (on
balance) be positive: reinforcement of independence,
PROMs, CQUIN, QOF, Outcomes Framework, Quality
Premium
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Bristol 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 medical
negligence claims
• Incentives for quality prescribing and outcomes
5
Agenda

6. • “…risk-adjusted,
absolute mortality for
the 4 conditions
included in the pay-for-
performance program
decreased significantly.”
CQUINS
• 0.5% national , e.g. for
Friends and Family, VTE
• 2% local within national
remit
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Advancing 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 NHS
outcomes framework, which in turn reflects the NHS
mandate from the SoS
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Outcomes measurement and incentives are key
90% of time on
stroke ward
£1026
Initial brain scan £399
Alteplase 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, patient
experience, and more transparency
• So starting point is information on quality in the
public domain
• We need outcomes measurement and incentives
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Andy McKeon

9. Ratings matter only if they are accompanied by
incentives
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10. 10
Outcomes measurement: losing the plot on
PROMs? 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 and
medical negligence claims
• Incentives for quality prescribing and outcomes
11
Agenda

12. 12
Regulated competition is a good thing
• On the best available evidence,
competition at regulated prices has
improved the quality of some NHS services
• ‘Any qualified provider’ arrangements
allowing patients, helped by their GPs, to
choose where to get their health care are
suitable in some cases
• In other cases competitive procurement by
local NHS commissioners will be
appropriate
• Routine collection and publication of
patient outcome measures should be
expanded to enable evaluation of the
effects of competition
• Competition can help integration of care –
no evidence that it hampers integration

13. Berwick Zero tolerance is right, but incentives
are needed – medical negligence claims
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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 medical
negligence claims
• Incentives for quality prescribing and outcomes
14
Agenda

15. Evidence on factors affecting the uptake of new
medicines suggests national incentives are key
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The key factors reported as driving
different uptake patterns in Acute Trusts
Key factors reported as driving
different uptake patterns in PCTS
Source: MISG Long Term Leadership Strategy, DH/ABPI, 2007

16. To enquire about additional information and analyses, please contact
Prof Adrian Towse – atowse@ohe.org
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