This document offers a précis of the publication of the NHS outcomes framework which follows the responses to the consultation ‘Transparency in outcomes: A framework for the NHS’. A central component of the government’s health policy is the intention to focus on outcomes and not targets and this publication begins to realise that ambition.

The outcomes framework builds on the five domains originally identified in the consultation and will form part of the mandate that the Health Secretary will set the new NHS Commissioning Board once established. It lists the outcomes and indicators that will be used by the Secretary of State to hold the NHS Commissioning Board to account for its management of the NHS. There are 5 domains with 10 overarching indicators and a total of 31 improvement areas. Given the ambition of the outcomes framework a number of the indicators identified require further work or are yet to be developed.

This publication is the beginning of a systematic attempt to develop a focused but balanced set of progressive outcome indicators that will provide an indication of the overall performance of the service. There will eventually be three outcomes frameworks covering the NHS, adult social care and public health for an integrated cross service approach. Some indicators will be the same in all 3 outcomes frameworks to promote joined up working between the different areas of care.

It will be for the NHS Commissioning Board to determine how best to deliver improvements in health outcomes by working with GP led commissioning consortia. Drawing on quality standards developed by NICE, the NHS Commissioning Board will translate the national outcomes into local outcomes and indicators for GP led commissioning consortia in a Commissioning Outcomes Framework. This will be used to hold consortia to account. A ‘quality premium’ will now be linked to certain outcomes in the Commissioning Outcomes Framework thereby providing a financial incentive to GP led commissioning consortia to deliver improvements.

A new initiative is for the Health Bill to propose continuous quality improvement in the NHS by placing a duty on the Secretary of State for Health, the NHS Commissioning Board, the economic regulator Monitor and GP led commissioning consortia to improve outcomes.

A major focus will is on reducing health inequalities; outcomes are chosen so that they can be measured by different equalities characteristics and geographic area.

Points for pharmacy:

• The NHS Outcomes Framework will shape the way in which NHS services are delivered, measured and prioritised in the future. The pharmacy profession needs to ensure the services they provide relate to this framework
• The document acknowledges that joint-working is essential in delivering healthcare. Pharmacy is a profession that cuts across the NHS, public health and social care.
• The focus on patient safety suggests that the pharmacy profession may face greater scrutiny and pressure to reduce errors and increase reporting of mistakes where they occur. The Department of Health should be reminded that criminalisation of dispensing errors has the opposite effect and that addressing this issue is vital.
• With such prominence given to patient safety, the Society should be able to demonstrate leadership in communicating the potential for pharmacists to help NHS organisations deliver on these measures in relation to medicines.

Domain 1: Preventing people from dying prematurely

Overarching indicators:

• Mortality from causes considered amenable to healthcare
• Life expectancy at 75

Improvement area indicators:

• Reducing under 75 mortality rates from cardiovascular disease; respiratory disease; liver disease
• Increasing one and five year cancer survival from colorectal cancer; breast cancer; lung cancer
• Reducing under 75 mortality rate in people with serious mental illness
• Reducing infant mortality and perinatal mortality (including stillbirths)

Domain 2: Enhancing quality of life for people with long-term conditions

Overarching indicators:

• Health related quality of life for people with long term conditions (EQ-5D)

Improvement area indicators:

• Increasing the proportion of people feeling supported to manage their condition
• Improving employment of people with long-term conditions
• Reducing unplanned hospitalisation for chronic ambulatory care sensitive conditions & unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s
• Enhancing health related quality of life for carers (EQ-5D)
• Increasing employment of people with mental illness

Domain 3: Helping people to recover from episodes of ill health or following injury

Overarching indicators:

• Emergency admissions for acute conditions that should not usually require hospital admission
• Emergency readmissions within 28 days of discharge from hospital

Improvement area indicators:

• Improving outcomes for planned procedures through Patient reported outcomes measures (PROMs)
• Reducing emergency admissions for children with lower respiratory tract infections (LRTIs)
• Improving recovery from injuries and trauma*
• Improving recovery from stroke*
• Increasing the proportion of patients recovering from fragility fractures at 30 days and 120 days
• Increasing the proportion over 65’s still at home 91 days after discharge from hospital into rehabilitation services

Domain 4: Ensuring that people have a positive experience of care

Overarching indicators:

• Patient experience of primary care
• Patient experience of hospital care

Improvement area indicators:

• Improving experience of outpatient care; accident and emergency services; maternity services; community mental health
• Services & inpatients’ personal needs
• Improving access to GP services and dental services
• Improving the experience of care for people at the end of their lives;* children and young people’s experience of healthcare*

Domain 5: Treating and caring for people in a safe environment and protecting them from avoidable harm

Overarching indicators:

• Patient safety incident reporting
• Severity of harm
• Number of similar incidents

Improvement area indicators:

• Reducing the incidence of hospital related venous thromboembolism (VTE); healthcare associated infections (HCAI) MRSA and C difficile; newly acquired category pressure ulcers; incidences of medication errors causing serious harm
• Reducing the number of full term babies admitted to neonatal care
• Reducing the incidence of harm to children due to ‘failure to monitor’

* Denotes that an indicator needs to be developed.

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