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The National Health Service (NHS) outcomes frameworks for public health, health and adult social care in England were launched in 2010–2012 with ambitions that they would transform health outcomes in England. However, unprecedented financial pressures in the NHS are compelling changes in government policy designed to make the NHS financially sustainable while ensuring high-quality care for a population with a growing burden of chronic disease and multimorbidity. Radical changes in the way health and care services are commissioned and delivered locally are under way or planned. The models of care emerging are almost without exception predicated on greater integration of public health, health and care services, making the three discrete outcomes frameworks increasingly anomalous. As a centrally funded service working to policies defined by government, the NHS needs a performance framework that clearly articulates national priorities and the systemic changes needed to deliver them. The authors argue for a review of the NHS outcomes frameworks, rationalisation of the disparate performance requirements the NHS is expected to comply with and make suggestions for an alternative model more fitting for the challenges the NHS faces.
New governments like to put clear water between themselves and their predecessors. However, the political currents unleashed by the 2017 UK election mean that major changes in health policy and direction are unlikely. But it is an opportune moment for the government to give a facelift to long-standing policies that most informed consensus would describe as obsolete and in need of a rethink.
The 2010 coalition government hailed its NHS Outcomes Framework (NHSOF) for England1 as a radical transition from the previous Labour government’s process targets to measuring outcomes of healthcare. The Public Health Outcomes Framework (PHOF) and Adult Social Care Framework (ASCOF) followed shortly thereafter.2 3 The frameworks were designed to show performance nationally …
Footnotes
↵i Accountable care organisation comprise a provider/s or other organisation commissioned to deliver a wide range of health and care services to a defined population, under a contract that specifies the outcomes and other objectives deliverable within a given budget and period of time.
Handling editor Mary Dixon-Woods
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Author note The Department of Health commissioned The King’s Fund to report on how clinical commissioning groups (CCGs) are using the NHS Outcomes Framework and whether changes to it are indicated. The King’s Fund submitted its report to the Department of Health in May 2017. The Department did not fund this paper, or have any role in the writing of it or the decision to submit it for publication. The views expressed are those of the authors.