An introduction to the PROMs programme with Greg Swarbrick

You lead on the PROMs programme, but a lot of people won’t know what it is. Could you explain in a few short sentences?

PROMs, or patient reported outcome measures, are a way of measuring health improvement. What we're doing is we're measuring people before a treatment and how they are after that treatment. Doing this allows us to see the person’s health before but also the impact afterwards. Most of the time you expect people to get better but that’s not always the case and this measures both.

These are done as questionnaires and the questions are calibrated to the type of procedure. So for example with a knee replacement, they might be asked if they can walk up the stairs, can they do normal activities, are they in pain? Or they can include questions on mental health like how the patient is feeling, are they anxious or depressed? These all help to build a picture of the impact of treatment on someone’s health, function and quality of life.

Why are PROMs important, and are they more important in the private healthcare sector?

PROMs may be the most important measure of health outcomes because they really come down to, does the treatment work? Without PROMs many of the current indicators around quality like complaints, complications or deaths only track negative impacts. There’s also patient satisfaction which is about the overall experience, but the PROMs tells you whether it was effective.

You could call the information we collect ‘big data’ and we can use it to spot patterns you wouldn’t normally be able to notice on an individual patient basis. With these patterns, we are able to answer specific questions that clinicians, patients, hospitals or anyone interested in healthcare may have around treatment. These could include which factors have the best impact on patient recovery or what are the differences in outcomes for people in different demographic groups who have the same treatment.

It’s key that we have alignment with the NHS on how we collect and report health improvement. Many consultants work in the private sector as well as in the NHS, and one obvious question patients might be asking is, is there a difference in treatment outcomes, particularly that people tend to get treated sooner in private?

What are you working on at the moment?

For the last 6 weeks I’ve been interviewing a lot of people from around different aspects of private healthcare. Hospital medical directors and other representatives, a whole range of insurers, professional bodies like the Royal College of Surgeons and the system suppliers as well who are the tech enablers for PROMs.

What’s come out of these conversations is that actually everyone is in agreement that we want to focus on this measure and make it work. But it does need coordination, prioritisation and raising its profile. For some hospitals they are still in this area where they would like to participate in PROMs but don’t know how to make it work or know what’s involved.

So to help, we are bringing together a cross-functional working group which will be inclusive and open to all who want to participate. The group will prioritise the recommendations from a report that was carried out independently by the London School of Economics (LSE) to create a meaningful national PROMs programme across the private sector.

What are the key themes you see coming through your conversations on health outcomes?

While at first glance, PROMs sound simple enough, you find it does get quite complicated quite quickly because patients are different, treatments are different, and everyone wants to be compared fairly.

But at the other end of the spectrum, we need to be able to simplify the data into outputs that are obviously fair and easy to understand for patients and clinicians. While this can be quite complex, there is a desire to get this information to patients in a meaningful way as it has a real benefit, either for information, managing expectations or identifying any possible risks.

What and when can we expect to hear next?

There’s quite a lot to do. We’ll be sharing the LSE report and feedback and if you would like in advance, please get in touch.

For the working group, it's really important that different voices from different parts of the sector are heard, because we all impact each other. One initial focus will be to prioritise completion of the top 6 PROMs as inputs – I mean for hip and knee replacements, cataract operations, plus three cosmetic procedures - breast enlargement, rhinoplasty and liposuction.

Other elements we’ll look to later will probably include updating the profile of the system suppliers who enable PROMs to be collected, as there have been lots of improvements and new entrants to the market since we looked at this last time.

So, lots to do! And keen that this is useful for patients and clinicians alike, especially.