• Quality improvement
• cost-effectiveness
• decision making
• health policy
• performance measures

For many years, our understanding of what ‘quality’ and ‘performance’ mean in health services has been limited to analysing counts of how many patients are treated (admissions, patient visits), how quickly that is done (waiting times) and how often things go wrong (complications, re-admissions, deaths). All of these things are important, but they don't tell us about something of fundamental importance: how have those health services affected health?

In 2009, the UK Department of Health introduced the routine collection of patient-reported outcome measures into the English NHS via the PROMs programme.1 2 In doing so, it became the first healthcare system in the world routinely to collect patients' self-reported health status in the context of normal health services delivery. The scheme initially focused on collecting these data before and after four elective surgical procedures, with plans to extend this across a number of other important areas, including chronic diseases. The PROMs programme should not be seen as part of the latest set of NHS ‘reforms’, because it predates them by some years. Instead, it should be viewed as the latest stage in an attempt to improve how the performance and quality of health services is measured and analysed. Rather than being a step in the dark, it might be better described as an attempt to cast some further light on important areas …