David Cameron adds some flesh

Nearly a year and a half ago I wrote here about the Conservative "Outcomes Not Targets". Well we have a bit more flesh on the bones with the release of the green paper "Delivering some of the best health in Europe".

Now obviously I come at this from a certain angle. What does it mean for GPs and especially QOF? Well the answer is initially not very much. QOF only gets a single mention in the whole of the Green Paper and even then it is only in passing. Most of the examples related to hospital care. We do get a feeling for the way that thinking is going though.

The paper acknowledges that outcomes are difficult to measure in any objective way and at individual patient level it is almost impossible. There are public health and systematic outcome targets stated in the paper but at the individual patient level the big thing is Patient Reported Outcome Measures or PROMs. It would be over simplistic o liken these to the little cards you get in hotel bedrooms with a chance of winning a free holiday but that would not be a bad place to start thinking about them. How these are to be translated into cash incentives is not clear but this is widely used in industry. When I bought a new car recently the salesman explained that much of their commission was based on these things and they would be very grateful if I could hold back my British reserve and go for excellent rather than very good. They had helpfully laminated an example with the excellent column highlighted. Similar things seem to be happening in education.

The other big thing is that the information will be freely available in a pretty raw form for others to turn into services to patients.

Our policy generates significant value for the NHS that far outweighs any potential cost implications. The NHS will not be expected to do anything other than collect, collate and publish the required information. Experience in other areas and other countries – such as crime mapping in the US – shows that third parties like Dr Foster, Google and others can creatively use this data and turn it into products that are available to patients and commissioners at zero cost to the user.

Well that is why I try to do here! The phrasing certainly plays down the difficulty, complexity and quantity of the work that the NHS will have to do but it is also true that there are several such mechanisms already in place. A lot of data is already generated and opening this up would be very welcome. This struck a chord when reading about suggested architectures for public information. In that architecture the analysis layer can be repeated many times but this seems a pretty good way to open public data to imaginative analysis. This is much more the US model where the government is forbidden from owning copyright on anything coupled with a rather more permissive freedom of information legislation.

But with all of these thing I like to see specifics. There are lots of specific examples in the Green Paper of problems with the target regime. I would love to see just one worked example of a PROM and its consequences for the provider. Another year perhaps?

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