Last night of the PROMS?

The future of the national Patient Reported Outcome Measures programme is uncertain as the latest changes to the NHS take effect.

Speaking at a PROMS Summit in Manchester last week, Professor Nick Black from the Department of Health National PROMS Operation Board said nobody really knows what will once the NHS Commissioning Board takes over from the Department of Health:

“Whether there will actually be something called the national PROMS programme after Christmas is a little uncertain.

“There’s much shuffling around between the DH and the NHS Commissioning Board. There certainly won’t be an operation board; that’s now being closed down.”

Despite this, he said he was sure that PROMS would continue to be a high priority for government.

”It’s extraordinary; you can pick up any government document from Number 10, the Department of Health, or [Sir] David Nicholson over the last three to four years and it seems that the answer to any problem the NHS faces is PROMS.”

PROMS were introduced as a result of one of the last, Labour government’s reviews of the NHS, led by Lord Ara Darzi.

He argued that a new way of collecting information on the quality of care was needed that focused on the experience of patients.

PROMS were introduced to the NHS in 2009, and are still used in just hip and knee replacements, varicose vein surgery and groin hernia surgery, despite expectations that their use would be extended.

Patients are asked to answer the same set of questions before and after an operation. The data is then be used to calculate a numerical value for the improvement to their health.

Some hospital departments have devised electronic ways for doing this. However, Black acknowledged at the summit that there was still a problem with clinical engagement. “There are still clinicians who ask ‘what does it matter what the patient thinks, we know what’s done well’,” he said.

Early reviews of the PROMS programme noted that while PROMS had the potential to transform healthcare, a lot would depend on how they were managed and whether the NHS acted on the results.

A report in 2010 from the King’s Fund concluded that: “Ultimately, whether the NHS gets the most out of PROMS depends on the willingness of decision-makers to make tough decisions about services that are ineffective and to promote practices that benefit patients the most.”

The PROMS Summit heard a lot about issues with data collection and measuring, but rather less about changes that had been made as a result of research programmes.

Andrew Street, the director of the health policy team at the Centre for Health Economics at the University of York, suggested that one of the ways to tackle this would be to pay for the system by building PROMS into Payment by Results.

“The problem is that there’s no incentive for good practice. What you might want to move towards in the future is having higher pay for better work,” he said.

“That isn’t embodied in the current system. You can have performance based payment like bonus for meeting a standard or a penalty for missing a standard.”