Policy, Workforce & Organisation of Care
Improving quality of NHS care is critical to ensuring a sustainable service for the future. Below, we give some examples of exciting health services research in this area.
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Financial incentives - advancing quality
Financial incentives may have an important role to play, but must be evaluated to ensure that they create value and do not lead to unintended consequences.
Advancing Quality is a programme providing financial incentives for Improvements in quality of care for NHS patients in the North-West of England
In 2008, a scheme was introduced offering the potential for health-care providers to earn financial rewards by improving quality for NHS patients. All 24 eligible hospitals in the North West region of England participated. Impact was measured by looking at whether or not it had improved the death rate of various conditions. These were adjusted for risk and known as ‘risk-adjusted mortality’.
An evaluation of the programme, funded by the NIHR HS&DR and supported by the Health Services and Delivery Research specialty of the Clinical Research Network, showed that the scheme was associated with reductions in mortality over 18 months, with an estimated reduction in numbers of deaths of around 890. The scheme was also cost-effective.
The results were published in the New England Journal of Medicine and encouraged continued support for the scheme and extension to new regions.
Personal health budgets
Personal health budgets are designed to increase patient choice and control over how their health and care services are delivered. A budget is agreed between the patient and the local clinical commissioning group to support the patient’s healthcare and wellbeing needs. The programme was launched as a pilot by the Department of Health in 2009, and a national evaluation was commissioned to run alongside it. This evaluation aimed to see whether access to these budgets led to patient benefit, and whether it was cost effective compared to the use way of delivering services.
The evaluation used a controlled study to compare the outcomes and costs of patients selected to receive a personal health budget with those continuing with conventional support arrangements (the control group). Just over 1,000 individuals recruited to the personal health budget group and an additional 1,000 recruited to the control group were followed by the research team for 12 months.
Full details of the evaluation are published - Personal health budgets evaluation
The NIHR Clinical Research Network (CRN) supported local pilot sites with recruitment, exceeding the target numbers required. The NIHR CRN also supported the data collection that was required as part of the study, involving a baseline questionnaire and interview with patients.
Outcomes and findings
Net benefits were measured in terms of care-related quality of life on the Adult Social Care Outcome Toolkit (ASCOT) measure.
After a year, the use of personal health budgets led to a significant improvement in patients’ care-related quality of life and psychological well-being. The personal health budget group showed greater benefit (quality of life) at less cost, on average, than the control group.
Whilst these budgets did not impact on outcomes such as health status, mortality, health-related quality of life or costs, overall they were considered cost-effective. Budget holders experienced greater benefits than people receiving conventional services, and the budgets were worth the cost.
Value to the NHS
The net quality of life benefit was between £1,520 and £2,690 greater for the personal health budget group than the control group. Overall, the results suggested that personal health budgets could cost-effectively improve care-related quality of life results, without negative effects on health status. The evaluation supported wider roll-out of personal health budgets in the NHS in 2014.
