NHS database of reference costs is severely flawed

EDITOR—The recent and growing emphasis on gaining a more rounded view of performance assessments in health and social care is to be welcomed. Assessments of efficiency (one of the dimensions of The NHS Performance Assessment Framework1) should take into account aspects of both quality and cost. Leaving aside the debate about how to assure and improve quality over time—the debate over clinical governance—there are sufficient difficulties in using routinely available cost information.

The reference costs database is one of the key sources of information. It is …