The NHS performance framework: taking account of economic behaviour

The provision of quantitative information has been given a key role in securing good performance in the new NHS. A new National Performance Framework has been proposed encompassing a number of dimensions of performance. Whilst this approach to managing the NHS is welcomed, it is essential to understand the strengths and limitations intrinsic to the use of performance indicators for this purpose. In particular, complex behavioural consequences may arise in response to the collection and dissemination of performance data, some of which may be unintended, potentially dysfunctional and damaging for the NHS. Results from a recent study on the performance of NHS Trusts are used to illustrate the sort of unintended side-effects which occur within the current system and which may in principle be replicated in the new system in future. Whilst the possibility of such consequences does not invalidate the potential of the new Performance Framework to secure the desired changes in the NHS, it does suggest that careful attention needs to be paid to the assessment of unanticipated side-effects.