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a gp surgery imageNovember 21 2017

A Scottish health review in Scotland has set out key principles and recommendations for taking forward targets and health indicators.

Conducted by Sir Harry Burns, the review looked at how targets and indicators for health and social care align with the Government’s strategy for the future of NHS and social care services and how they can support the best use of public resources.

While “indicators and targets have been effective in improving performance in a number of areas of health and social care in Scotland,” the present system can be improved both in terms of its effectiveness in improving services, says the report. The current system “is fragmented and many of the indicators do not lend themselves to effective improvement interventions. A different approach to targets and indicators is necessary.”

Among the proposals are that:

  • different indicators need to have an impact on different aspects of the life course;
  • drivers of wellbeing need to be part of the system, reflecting the variation in outcomes for people living in deprivation;
  • there should be a move to a system of indicators and targets which allow improvements across a whole system of care to be tracked;
  • frontline staff, managers accountable for performance and the people who use services should co-produce the activities which they can then use to drive improvement.

“The lack of robust primary care data has been a significant challenge in the drive towards intelligence-led primary healthcare,” says the report. “The dismantling of the Quality and Outcomes Framework (QOF) and establishment of GP Clusters represents a step change in approaches for continuously improving the quality of care.”

In addition, developments such as the Scottish Primary Care Information Resource (SPIRE), and the expansion of Local Intelligence Support Team (LIST) analysts have provided “new opportunities to develop a set of indicators that will assist in understanding the contribution of the multi-disciplinary primary care of the future to improving outcomes for Scotland's people.”

The Scottish Government has said that further work will now commence “to determine the best ways to capture and report people’s wider experience of care to ensure that we’re focused on improving public health across the whole population.”

Responding to the report’s publication, BMA Scotland’s Chair, Dr Peter Bennie, said: “This is a welcome report that sets out important recommendations for how we can better use targets and indicators to improve Scotland’s health.

“The BMA has warned for some time of the risk that inappropriate targets can skew clinical priorities and those concerns are reflected in this report. Decisions over the treatment of patients should always be based solely upon clinical need. While there is important information that targets and indicators can tell us about how well the NHS is functioning, there needs to be more maturity about how we respond to such information.”

He added that the report provides “an important opportunity to develop new approaches to improving the quality of our health services. It is essential that we use it.”

Links:
Scottish Government announcement     
Scottish Government ‘Review of Targets and Indicators for Health and Social Care in Scotland’      
BMA comment

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