Clinical performance in the NHS

The British government has unveiled its plans to introduce new indicators of clinical performance (NHS Executive Document: Quality and Performance in the NHS: High Level Performance Indicators and Clinical Indicators, June 1999). As the authors state, this document heralds “the sustained national drive to continually monitor and improve standards of care for NHS patients”. The indicators are aimed at NHS trusts, health authorities, and primary care groups to ensure uniformity of standards across the NHS. Secretary of State for Health, Frank Dobson, is quoted as saying “ Standards matter to patients and to doctors and nurses. The government is determined to raise standards . . .”. Thus, in the continuing fallout in the wake of the Bristol affair (see Newsdesk, BJO1998;82:861), Dobson admits that it is not possible to raise standards in the absence of good information (evidence); much of this relates to clinical outcomes of treatment and effectiveness of care, in addition to efficient use of resources which has been the main focus of performance assessment until now. Dobson goes on “This is a step away from the former crude league tables which were not concerned with clinical outcomes”. Use of the 47 indicators, jointly developed with the Joint Consultants Committee of the British Medical Association, as published will allow NHS organisations to perform inter-trust comparisons, identify areas for improvements and possible action, share information and good practice to achieve best results for patients, and keep an …