Bookmarkers beware: Bookmarks to pages other than the home page may not work after we change our server in April Editor's Choice | This Week in BMJ | Press releases BMJ No 7128 Volume 316 News Saturday 31 January 1998 British government launches performance framework Teams of doctors and managers will be sent into failing hospitals, and league tables of various clinical indicators will be published in an attempt to improve clinical performance, the government has announced. Launching the new national performance framework, which was heralded in the recent white paper for England, health minister Alan Milburn said: "If targets aren't met then there will be sanctions to penalise failure just as there will be incentives to reward success. In the new NHS, where performance is not up to scratch, there will be rapid investigation and, where necessary, intervention. Failure will not be tolerated." The framework document, which is out for consultation until 20 March, suggests six areas in which to assess performance - health improvement, fair access, effective delivery of appropriate health care, efficiency, patients' and carers' experiences, and health outcomes of NHS care (box). The document proposes several indicators in these areas - for example, death rates, emergency admissions for elderly people, the costs of NHS treatment, and the length of stay in hospital. Examples of performance indicators in new framework Health improvement - for example, death from all causes, the number of people diagnosed with cancer Fair access - for example, surgery rates, conception rates for girls aged under 16 years, numbers of people registered with an NHS dentist Effective delivery of care - for example, rate of hip replacements for people aged over 65 years, uptake of breast cancer screening Efficiency - for example, rates of day case surgery, generic prescribing rates, unit costs Experience of patients and carers - for example, waiting times, numbers of first outpatient appointments for which patients did not attend Health outcomes of NHS care - for example, avoidable deaths from asthma, peptic ulcers, or tuberculosis League tables containing the information will be published so that comparisons can be made. Mr Milburn said: "There are appallingly wide variations in standards across the NHS. For example in one area emergency readmissions to hospital are 70% higher than in another." A Commission for Health Improvement - which will include doctors, nurses, managers, academics, and patients - will be responsible for spreading good practice. The commission will also be able to send out troubleshooting teams into failing hospitals and will have the power to sack NHS trust chairpersons and non-executive directors. Later this year the first ever audit of patients' experiences in the NHS will be conducted. This national survey will operate at both health authority and national level and will range from the quality of hospital food to the quality of pain control after an operation. The results will also be published and if there is "conspicuous or continual underachievement of local health services in the views of patients" this should prompt NHS trusts, health authorities, and primary care groups to sort the problem out. The Commission for Health Improvement could also be called on to investigate. James Johnson, chairman of the BMA's consultants committee, said: "We welcome the involvement of clinicians in helping hospitals to improve their performance. As far as league tables are concerned, the key question will be, do they measure something meaningful and is the measurement valid?" (See p 322.) A National Framework for Assessing Performanceis available from Response Line - 0541 555455 Jacqui Wise BMJ Home | Current issue | Past issues | Classified ads | Career Focus | Feedback Collections | About this site | About the BMJ | BMA | Medline