The Coalition Government has come to power with an aim to restructure the provision of healthcare in England. It has published an introductory white paper and several subsequent consultation papers. This document offers a précis of all the consultation on ‘Transparency in outcomes: a framework for the NHS’.

The proposed outcomes framework would be used by the Secretary of State to hold the NHS Commissioning Board to account for its management of the NHS. This consultation 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, social care and public health for an integrated cross service approach. While the government will no longer hold the NHS to account on points of process, there is an assumption that process measures will still be needed in the normal management of organisations. The Framework is intended to replace the current national targets and provide a focused set of national outcomes and aims to provide accountability focused on the outcomes of care, not processes or structures.

The NHS Outcomes Framework will be made up of a focussed set of national outcome goals that will provide an indication of overall NHS performance and will act as a catalyst for driving up quality. Data against each of the outcomes in the Framework will be made publicly available.

Once decided, the NHS Commissioning Board will be responsible for delivering within this Framework, making use of the various tools and working with GP consortia for example by commissioning Quality Standards from NICE. A Commissioning Framework for GP consortia is being developed separately and will need to support the delivery of these overarching goals.

The principles proposed by government to guide the Framework are:

• Accountability and transparency
• Balanced
• Focused on what matters to patients and healthcare professionals
• Promoting excellence and equality
• Focused on outcomes that the NHS can influence but working in partnership with other public services where required
• Internationally comparable
• Evolving over time

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

Five domains are proposed;

1. Preventing people from dying prematurely
2. Enhancing quality of life for people with long-term conditions
3. Helping people to recover from episodes of ill-health or following injury
4. Ensuring people have a positive experience of care
5. Treating and caring for people in a safe environment, protecting them from harm

For each domain, the NHS Outcomes Framework will identify a set of outcome indicators, linked to specific improvement areas. The whole framework will be underpinned by a suite of NICE Quality Standards, 150 of which are due to be produced in the next five years. The following visual representation is intended to demonstrate the structure of the Framework, focusing on the patient safety elements.