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Feature Assessing Patient Care

NHS goes to the PROMS

BMJ 2008; 336 doi: (Published 26 June 2008) Cite this as: BMJ 2008;336:1464
  1. Nicholas Timmins, public policy editor
  1. 1Financial Times, London
  1. Nick.timmins{at}

Sir Bruce Keogh has been credited for encouraging cardiac surgeons to publish their results. Now, as the medical director of the NHS, he’s turning his attention to other specialties. Nick Timmins investigates

More than 12 years after the Conservative government first announced that the NHS would publish measures of outcome and mortality, the data are coming.

Previews of the first risk adjusted data on mortality from hip and knee replacements and aortic aneurysms are already on the NHS Choices website. Lord Darzi’s next stage review will promise much more, along with the development and publication of patient reported outcomes (PROMS), which use questionnaires on pain, mobility, depression and anxiety, and the ability to undertake the normal activities of daily life. Advocates of the questionnaires, which patients complete before and after treatment, say patient reported outcomes provide a remarkably sophisticated measure of whether a treatment has worked in the rather important sense of whether the patient feels better, and how much better.

Writing on the wall

How much hospitals get paid for a procedure may soon (possibly too soon) depend in part on such measurements of outcome. The man in charge is Sir Bruce Keogh, former president of the Society for Cardiothoracic Surgery and now the NHS medical director. “The writing has been on the wall for some time,” he says. “There has been a lot of talk for a long time about quality, and now we need to move forward quite quickly in trying to measure clinical outcomes.”

For Professor Keogh, the moment of truth came when he was summoned, as the man in charge of the cardiac surgical register, to Sir Ian Kennedy’s inquiry into the paediatric cardiac surgical deaths at Bristol Royal Infirmary in the mid-1990s. “Two things became apparent,” he said. “One was that our data weren’t as robust as they …

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