There is increasing recognition on the importance of measuring outcomes in health care. One method of doing this is through the use of Patient Reported Outcome Measures (PROMs). These are indicators that measure quality from the patient perspective. A recent letter published in the British Medical Journal discussed the role of PROMs in promoting equity of access to elective health care. Preoperative measurement of PROMS, which is now routine for some NHS-funded procedures, can provide information about perceived needs and how this varies across referred populations by deprivation score or other socio-demographic factors. We already know that for some interventions, including hip replacement, postoperative improvement is strongly associated with preoperative PROM disease severity. This is demonstrated by data from the English hip replacement audit in the figure above. Using PROMs as part of an intervention threshold in elective surgery could improve both equity and efficiency, and their use in this role should be explored further.
NHS budgets are under considerable pressure. It is therefore unsurprising that many NHS Integrated Care Boards (ICBs) In England will aim to prioritise price in contract awards, But this approach is a significant threat to community-centred healthcare. While competitive tendering is a legally required, an excessive focus on costs in awarding NHS contracts risks overshadowing key factors such as established community trust, local expertise, and the long-term impact on continuity of care. This shift towards cheaper, often external, commercial providers threatens to cut the links between communities and their local health services. The argument that competitive tendering is solely about legal compliance, and not cost, is undermined by the very nature of such tendering, which by design encourages the lowest bid. This approach risks eroding the social fabric of local healthcare provision, where established relationships and understanding of specific community needs are essential. Establishe...

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