Paying doctors for quality

Paying doctors for quality (Reseach in Public Policy, Spring 2008)

Research on GP QOF incentive scheme indicates that there is evidence of GPs manipulating their figures by increasing the number of patients reported as excepted from treatment. Also, it appears that in areas for which there is data, achievement was trending upwards before the introduction of QOF and QOF has had very modest impact – evidence that a rigid performance scheme will not deliver high quality results from groups already governed by strong social, self and professional controls.

A matter of facts, by Roger Dewhurst

A matter of facts, by Roger Dewhurst (PF 14/3/08)

Historically, the NHS has been data-rich but information poor. The World-class Commissioning agenda will require the harnessing of the data to support planning, benchmarking, monitoring and financial management.

Secondary Uses Service to support management and provide data to public through NHS website.

NHS waiting times officially up on 1997

NHS waiting times officially up on 1997 (PF 7/3/08)

Median waiting times have increased even though average waiting times have fallen, due to focus on the patients who had been waiting the longest. Example of misleading performance info. The 18 week target should bring median down in future.

The numbers game, by Tony Travers

The numbers game, by Tony Travers (PF 23/11/07)

Difficulties in measuring public sector output: e.g. putting a teaching assistant in a class causes a fall in productivity, spending more on health has led to a fall in NHS productivity. Are the techniques for measuring productivity really helpful or appropriate? Leads to temptation to make excuses by attacking the numbers.

Time to come clean, by Noel Plumridge

Time to come clean, by Noel Plumridge (PF 16/11/07)

NED at Kent Trust where 90 people died from C-difficile: “Patient care was supposed to be the top priority, but in reality external pressure meant that it had to be balanced against achieving government targets and financial balance.” DH accused of running NHS on a command and control basis.

DH reliance on inspection, performance management and fear of punishment has been accompanied by high-profile political interventions.

Reason for success of military hospitals: infection can close a hospital. Keeping hospitals open is critical to military missions, therefore there is clarity that a key goal is infection control.

News analysis – Northern NHS trusts outperform those in the South

News analysis – Northern NHS trusts outperform those in the South (PF 26/10/07)

Article presents data on performance divide and lots of speculation as to reasons, but none of the data seems to help interpret and solve the problem – this is measurement, not management.

Financial targets no excuse for poor service, NHS trusts told

Financial targets no excuse for poor service, NHS trusts told (PF 19/10/07)

Trusts using targets, particularly financial targets, as an excuse for failing to deliver on quality of care issues. Indicator that move to a more relational model might just result in more excuses?

Health Secretary in talks with weakest trusts – evidence of an ‘intervention’ approach to management – maybe a little relational?

Comment – NHS checks its own pulse, by Anna Walker

Comment – NHS checks its own pulse, by Anna Walker (PF 12/10/07)

Healthcare Commission NHS Annual Health Check. Assesses in two broad areas: Core standards and Finance – rated weak – excellent. What does this really tell us?

Measure for Measure: Using outcome measures to raise standards in the NHS

Measure for Measure: Using outcome measures to raise standards in the NHS (Policy Exchange, 19/7/07)

Critical of NHS measures: e.g. outcome measures focus on mortality and readmission rates, excluding 90% of admissions. Necessary information for improvement is not available and information doesn’t equal improvement. Giving trusts overall ratings doesn’t help.

Incentives lead to gaming and falsification, publishing leads to behaviour change.

Targets: doing less of the wrong thing is not doing the right thing

Targets: doing less of the wrong thing is not doing the right thing (Public Service, 15/2/07)

Examples of dysfunction:

- GP appointment bookings. Patients required to book appointments within 48 hours, rather than at a convenient time.

- Local government. Targets to get things done in 8 weeks don’t say anything about the end to end time for the customer, but encourage the provider to focus on ’stopping the clock’ by sending the customer to do something. Causes waste.