Application Projects

At the heart of the 2010 DH White Paper, Equity and Excellence: Liberating the NHS, is the ambition to re-focus the NHS to achieve world-class healthcare outcomes. To this end, the White Paper proposes that: the NHS will be held to account against “clinically credible and evidence-based outcome measures”; inspection of services will be against essential quality standards; and payment systems will be developed to reflect outcomes, not just activity, to provide incentives for better quality. The Vision for Adult Social Care aspires for the social care system to be outcomes focused, with services and support ensuring that people have the best possible quality of life.

The NHS Outcomes Framework 2012/13 states the intention for an Outcomes Framework to provide a national-level overview of how well the NHS is performing; provide an accountability mechanism between the Secretary of State for Health and the NHS Commissioning Board; and to act as a catalyst for driving quality improvement and outcome measurement throughout the NHS. This policy statement recognises that, for accountability and performance purposes, it is crucial that methods exist which can attribute observed changes in measured outcome indicators (such as health-related quality of life) to the actions of the NHS and social care organisations, as opposed to being due to other factors.

The Application theme is concerned with how the impact of actions, activities, services and processes of the NHS and social care on outcomes-relevant indicators can be assessed. An important strand of the research under this theme of the research is how this attribution of effect can be achieved. Part of this work will be methodological (e.g. using survey data rather than bespoke research studies, such as RCTs). However, we will focus on providing analysis of the degree to which change in (population) outcomes is due to ‘mitigating factors’ and, by subtraction, how much of any change might be attributed to the activities of the health and care system.

The Application theme also covers our research as to how people (as patients, service users, commissioners, regulators etc.) actually use outcomes-relevant information in their decision-making. The distinction with the above research aim of this theme is that in that case we have a more normative emphasis – i.e. how to measure impact – whereas here we are concerned with how people use this information.

Research on these two issues is clearly highly relevant for the design of incentive, performance and accountability measures for the NHS and Social Care. Outcomes information is relevant for a range of decisions, from clinical guidance to the specification of Incentive structures – such as quality-adjusted payment arrangements: for example, QOF payments and the Commissioning for Quality and Innovation (CQUIN) payment framework.

Current Projects

Using outcomes information to improve decision-making about care and support
Patients’ and service users’ use of outcome and quality information
Use of PROMs in guiding commissioning and as a threshold for treatment
Exploring variation in population health and social care outcomes: implications for performance assessment in the NHS and Social Care Outcomes Frameworks
Maximising the value of survey data: ASCS and CES development and support
Identifying the impact of adult social care (IIASC)