NHS ENGLAND

NHS England

NHS England

Introduction

The rise of the new public management has led to an increased emphasis on the use of formal performance measurement in most areas of the public sector. Performance schemes may be aimed at providing a degree of control or accountability for external stake-holders (such as the government or the public) or for purposes of internal management control (Arrow, 2004, 89). In many sectors an agency relationship has been introduced into the organisation of public services and the arms-length relationship between the purchaser and provider is serviced by the provision of performance data.

The NHS in England is no exception to this trend and whilst the publication of performance data in health care has been around for some time, there has been a rapid proliferation over the last 10 years (Flood, 2003, 54). Many of the indicators relate to the performance of NHS hospital Trusts and a variety of stake-holders or principals have a legitimate interest in such performance. These include the NHS Executive, including their regional offices, health authorities, and GPs, as well as patients and potential users of services (Davis, 2004, 88). In the future, Primary Care Groups will be expected to form judgements on Trust performance in order to guide their commissioning activities.

Building on some of the existing indicators and data, the current government has proposed a new performance management framework covering a wider range of areas which is at the heart of the new 'performance led' NHS in England. The new national performance framework will extend beyond the traditional focus on financial performance, to encompass aspects such as fair access, outcomes and patient carer experience, as well as the more usual focus on efficiency (Davis, 2004, 89). The degree to which this development is viewed as an improvement depends upon one's view of the desirability of attempts to capture aspects of NHS performance within a formal quantitative framework.

Whilst the proposals represent a genuine attempt to fill some gaps by identifying ways of measuring important elements of NHS performance which have not been subject to such scrutiny before (e.g. responsiveness of services, patient involvement), it could also be argued that it is misguided to assume that performance can be captured adequately using such methods (Flood, 2003, 55).

The Hard-Soft Information Continuum

Information of all kinds plays a key role in the exchange relationships of any economic system. In health care systems, problems of incomplete information in health care 'markets' and the existence of information asymmetries between buyers and sellers have been well rehearsed. However, information is not a homogeneous entity but consists of a variety of different types of data from a wide range of sources and in this paper we focus on the distinction between 'hard' and 'soft' data (Flood, 2003, 55).

It is difficult to define precisely what the terms 'hard' and 'soft' information represent as they are on a continuum, rather than being polar opposites. There is often no clear cut distinction between each type of information because the various stages of gathering, processing, disseminating ...