Patients’ views may influence NHS spending

PATIENT power could be used for the first time to influence how the NHS spends its money using new measures of outcomes from hospital operations.

More than 155,000 patients across the country have so far recorded Patient Reported Outcome Measures (PROMS) which rate people’s health and outcomes following hip and knee replacements, varicose vein surgery and groin hernia operations, which are some of the commonest work carried out in hospitals at an annual cost to the NHS of £800m a year.

Until now, the best measures of hospital care have been death rates, rates of readmission, infections and errors which fail to capture the real goal of all healthcare – the outcome for patients.

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PROMS give direct information about how patients fare up to six months after having operations.

They allow health chiefs to compare performance between hospitals in surgery but also to measure how patients’ general health improves afterwards including checks on their mobility, ability to care for themselves, levels of pain and mental health. Patients can also judge which hospitals have the best, and worst, results.

Results also show patients in more affluent parts tend to get surgery when they have fewer symptoms than those in deprived areas. Those with more severe symptoms get a bigger improvement but their symptoms remain worse than those with fewer initial problems, suggesting they would benefit if identified earlier.

Figures in the 20 months to November last year show all patients surveyed following hip replacements at the privately-run Spire Hospital in Hull said their general health had improved six months afterwards but this fell to only 77 per cent of those treated at Bradford’s hospitals.

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Of those having artificial knees fitted, 87 per cent of those treated at Airedale Hospital near Keighley said their health had improved six months later, falling to only 72 per cent of patients treated at the Doncaster and Bassetlaw trust.

Only around half of patients overall said their health improved after varicose vein surgery, ranging from 64 per cent treated at the North Lincolnshire and Goole trust to 45 per cent in York.

It was a similar picture for those undergoing groin hernia repairs, with 65 per cent reporting improvements to their general health following treatment in Rotherham, falling to 35 per cent at the privately-run Spire Hospital at Methley Park, near Leeds.

Evidence in Yorkshire suggest people tend to be operated upon later for knee, hip and groin hernias and earlier for varicose veins.

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The King’s Fund thinktank believes the measurement of diabetes, asthma, epilepsy, heart failure, stroke, chronic obstructive pulmonary disease and other conditions including mental health could also be included in the measures.

It argues hospital revenue could be linked to PROMS performance, forcing hospitals to consider how to produce better outcomes.

They also raise the prospect of assessing how much patients benefit from routine healthcare interventions, as well as exploring their cost-effectiveness. Some procedures might not be justifiable based on information supplied by patients.

Details about outcomes could also offer a better understanding of when to intervene surgically or whether to stick to less aggressive treatment.

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In an era of NHS financial restrictions, they could be used to direct spending at services that offer the greatest benefit to patients.

PROMS measures are still regarded as experimental but they are already impacting on patient care. NHS officials in north east Manchester put a bar on 57 different types of surgery earlier this year in a move to tackle budgetary problems.

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