Following NHS England telling Trusts to return to ‘near normal’ performance before winter – identifying ‘ambitious and stretching’ targets to be hit – the issue of how best to measure services is paramount.
According to Danielle Chulan, Deputy Director NHS Services at Connect Health, target setting can stifle innovation, and an obsession with quantitative measures – such as how quickly a letter is sent or an appointment is made – steals focus from the core need for value in healthcare.
Connect Health, the UK’s largest, independent provider of community musculoskeletal (MSK) and pain services, has proven its model delivers better efficiency and improved patient care, based on data from its work with Nottingham North and East and Nottingham West localities (part of Nottingham & Nottinghamshire CCG).
The purpose of the service was to help patients achieve a better quality of life and reduce inappropriate referrals for invasive and expensive joint replacements. Between 2016 and 2019:
• Conversion from a surgical route increased from 30% to 90%
• 30% less patients were referred to secondary care
• £2.6 million was saved
• DNA rates were low, at just 4%
• 1 in 4 patients joined local authority gyms, on completion of the Connect Health rehab programme
This level of improvement was maintained throughout 2019 and into 2020.
Chulan believes that:
• Under-pressure CCGs have recently had freedom to override standard and quantitative KPIs, allowing them to innovate to improve patient outcomes – and this approach needs to continue.
• Placing emphasis on activity and process commissioning stifles innovation
• Forward-thinking commissioners are looking for value and quality, and reflecting this in the targets set. Their patients are reaping the rewards
• Of course, quick access to healthcare is ideal, but targets should be grounded in evidence, not simply ticking boxes because what gets measured is what gets done
In Nottingham North and East and Nottingham West localities, targets are quality driven, hinging around patient experience and system impact, with shared decision making and patient satisfaction at the centre.
Nina Ennis, Director of Planned Care NHS Nottingham and Nottinghamshire CCG adds: “KPIs provide useful information on how services are performing, and whilst they should not be restrictive or cumbersome, they can highlight the need for change and support discussions about performance.
“Outcome measures are developed to make a real difference to our patients and working collaboratively with Connect Health (and all of our local MSK providers), these allow us to understand and improve the quality of our MSK services.
“Nottingham and Nottinghamshire CCG has a number of MSK providers, who work towards a single MSK model, and both KPIs and outcomes measures highlight areas to review and allow us to agree changes to meet patient needs.
“Our contract approach includes local incentive schemes, which supports providers to strive for high quality performance. This was paused in March to allow providers to concentrate on delivery of safe services, during the COVID period, with new ways of working developed by providers to meet restricted provision.”