The NHS Outcomes Framework is structured around five domains which set out the high-level national outcomes that the NHS should be aiming to improve:
Domain 2: Enhancing quality of life for people with long-term conditions;
Domain 3: Helping people to recover from episodes of ill health or following injury;
Domain 4: Ensuring that people have a positive experience of care; and
Domain 5: Treating and caring for people in a safe environment; and protecting them from avoidable harm.
The intention is for a series of indicators to be used in each domain. The policy document The NHS Outcomes Framework 2012/13 (published in December 2011) updated the Government’s plans in this regard but, importantly, inserted a ‘placeholder’ under Domain 2, reflecting the need to develop indicators in this area. Current thinking is that the generic health-related quality of life measure EQ-5D could be used for this purpose.
The Coalition Government also published A Vision for Adult Social Care in November 2010 and proposed a new strategic approach to quality and outcomes in adult social care, aimed at achieving the principles of the Vision and laying the foundations for the future reform of social care. The Adult Social Care Outcomes Framework was regarded as a critical element of the Government’s approach to transparency and accountability. As described in the DH’s consultation on the outcomes framework, it is a set of outcome measures which is brought together to support a high-level view of the outcomes which are being achieved for people who use social care in England.
Transparency in outcomes: a framework for quality in adult social care. The 2012/13 Adult Social Care Outcomes Framework published in March 2012 laid out four key domains:
Domain 2: Delaying and reducing the need for care and support
Domain 3: Ensuring that people have a positive experience of care and support
Domain 4: Safeguarding adults whose circumstances make them vulnerable and protecting from avoidable harm
The overarching measure in Domain 1 is ‘social care-related quality of life’ (SCRQoL), and the ASC Outcomes Framework uses the Adult Social Care Outcome Toolkit (ASCOT), developed by PSSRU, as the composite indicator with results from its application in the Adult Social Care Survey.
In our earlier Phase I work, we argued the need for a new quality of life measure to be used for people with long-term conditions on the basis that (a) there was a very under-developed set of indicators for Domain 2 in the NHS Outcomes Framework, and that EQ-5D was not an ideal measure; and (b) that the interdependency of health and social care (for people with long-term conditions) meant that a common or joint measure of outcomes was needed. Furthermore, although there are an enormous number of PROMs for individual long-term conditions, a case could be made that this approach is not sustainable across the full spectrum of long-term conditions and that a more generic approach to outcome measurement was needed, not least because many individuals have more than one condition.
In Phase II we wish to continue the work, and outline proposals for the development of outcomes indicators for people with long-term conditions. In addition, given the centrality of ASCOT in the ASCOF and also its high level of use in social care research and by social care stakeholders, we are proposing an on-going support and development project around the ASCOT measure.