Modifying clinical practice: two initiatives in the English National Health Service.

Area of Science:

• Health Services Management
• Health Informatics
• Healthcare Administration

Background:

• The English National Health Service (NHS) faces challenges in comparing service delivery across different administrative units.
• Existing information systems require enhancement for better resource allocation and performance evaluation.

Purpose of the Study:

• To describe and discuss two key information systems within the NHS.
• To evaluate the utility of performance indicators for comparing district health authorities (DHAs) and hospitals.
• To report on experiments with management budgeting and resource management for a more patient-centered accounting system.

Main Methods:

• Description and discussion of the NHS performance indicator scheme.
• Analysis of health service input and activity data for indirect quality assessment.
• Reporting on experiments with a new patient-based NHS accounting system for cost identification.

Main Results:

• The performance indicator scheme facilitates comparisons of service inputs and activities between DHAs and hospitals.
• Limited inferences about quality of care can be made from input and activity data.
• Budgeting experiments are exploring a shift towards patient-based costing for clinically meaningful patient groups.

Conclusions:

• Performance indicators provide a basis for comparing NHS services but do not directly measure quality of care.
• The success of proposed NHS reforms hinges on the effective implementation of patient-based budgeting experiments.
• Information systems are evolving to support data-driven decision-making and resource management in the NHS.