Health reforms – quality measurement?

As a recent cancer suffer myself, I’ve been listening to the Health Secretary Andrew Lansley on Radio 4 this week, with great interest.  Unfortunately, I’m a hopeless patient and consistently fail to remember most of the details regarding my treatment, so I make no claim to any expertise on the subject of the NHS, apart from the fact that they appear to have helped me to live a bit longer!

The reason for my self confessed poorly informed comment today, is to do with Mr Lansley’s repeated use of the words ‘quality’ and ‘outcomes’.  This is in relation to the scrapping of the previous government’s target driven performance indicators and the new government’s belief that it should be all about the two words previous mentioned – quality and outcomes.

The problem I have with this approach, as somebody who has more than a passing interest in both, is what happens when they don’t hit these targets?  Also, what does it actually mean when the targets are not met?  The merit of measuring the numbers of patients seen within a particular time frame, was that the patient was seen by an expert within a certain deadline (unfortunate inclusion of the word dead there!) and could then hopefully start treatment post haste if required.  However, now that we are going to measure ‘quality’ and ‘outcomes’, it would seem that we are going from one end of the telescope to the other.   Whereas before the target was hit by getting you to see the right doctor as quickly as possible, that no longer matters.  Now you will have to survive long enough to get to the doctor, before they start to measure the quality and outcome of your treatment.

If you don’t measure things until the end of the process, as opposed to at the beginning, does that mean that if you drop off the perch before you actually get in to the new health care system, it isn’t actually a quality failure?  And, from their point of view at least, it might not even be a bad outcome!

If I have a quality failure at work, somebody gets their a**e kicked and the job gets redone.  If I have a quality failure in my health care, it may well kill me, or at least cause me to die sooner than I might of.  Which then of course will indeed give Mr Lansley a poor outcome to measure.

As I said, I’m no expert in these things, but measuring quality and outcomes in health care, in the same way you inspect widgets in a factory, doesn’t seem like a step in the right direction to me!  Trouble is, if I’m right (and I am very occasionally) I probably won’t be around to say I told you so!

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