NICE proposes indicators for holding CCGs to account

NICE’s commissioning outcomes framework advisory committee made the recommendations to the NHS Commissioning Board, which will decide the content of the commissioning outcomes framework (COF) for 2013-14 later this year.

They include indicators for those recovering from stroke, tackling diabetes, and improving maternal health.

They include process as well as outcome indicators – for example the proportion of patients receiving high quality stroke care. The indicators are based on NICE’s quality standards.

NICE deputy chief executive Gillian Leng said: “This will enable the groups responsible for commissioning NHS care to be held to account, and will ultimately drive up the standards of health care delivered.”

The COF, to be finalised later in the year, is expected to form part of the commissioning board’s planning and accountability framework for CCGs. The framework is also likely to include more familiar NHS performance requirements, for example on finance and waiting times. It will also reflect requirements in the government’s “mandate” to the board.

NHS Clinical Commissioners, which represents CCGs, has welcomed the COF, and warned that CCGs should not be held too strictly to a large number of requirements.

NHSCC president and NHS Alliance chairman Michael Dixon called for there to be “as few as possible” indicators in the final COF. He said CCGs should be able to pursue their own priorities.

He said CCGs “don’t want to be hidebound by having to tick lots of boxes as they have previously”, and the framework needed to “allow the head room to do changing-paradigm stuff CCGs were there to sort”.

Johnny Marshall, another senior member of NHSCC, said it was important the specific requirements in the COF did not take priority over CCGs’ general duty to deliver the best outcomes for their populations.

He said COF could “skew the value of what CCGs deliver” if, for example, it incentivised commissioners only to treat stroke patients better without reducing the rate of strokes locally.

Macmillan Cancer Support has complained that the COF recommendations do not include “key cancer survival indicators”. The only specific cancer indicator included is the under 75 mortality rate from cancer.

Chief executive Ciarán Devane said: “We are shocked that it has been recommended that the NHS Commissioning Outcomes Framework - which will be used to hold the newly reformed NHS to account - will not include key cancer survival indicators. This means commissioners will lack strong incentives to improve cancer survival rates.

“If the NHS wants to fulfil its ambition of saving 5,000 additional lives from cancer by 2014-15, then key cancer survival indicators must be included in the framework. It is also vital that the framework includes strong incentives to improve patient experience throughout the NHS. We want to work with those responsible for this surprising oversight to urgently address this.”