Going to the PROM

Released 30/03/2010

by Matt Jane

Suzannah Wright voices concerns over patient-reported referral management

I'm a fan of PROMs. Not the teeny-bopping American tradition, nor the patriot-bobbing Albert Hall bonanza, but patient-reported outcome measures which allow us to judge the success of a procedure or service according to the people it aims to help.

We reported on them back in 2008 when they were first introduced, and I'm in agreement with the Tory policy of linking QOF to some kind of PROM system.

I'm a bit more cautious, however, about the idea of using PROMs to manage referrals. A recent King's Fund report discussed the points-based system in use in some countries, whereby patients' assessment of their health and quality of life contributes to the decision on whether they should have elective surgery.

Normally I'm a big fan of patient empowerment, and I think an open and explicit discussion about healthcare rationing is vital for a 21st century NHS. So it surprises me how uncomfortable I feel with this idea. Is it that I fear well-educated, informed patients will make the most of the system to access care above others in need? One thinks of the way in which middle-class parents take full advantage of application processes to secure places in more successful schools for their children.

Am I being too paternalistic, too cautious? Certainly we need some radical thinking in the NHS over the next few years and this could be a promising way to address waiting lists in a more subtle way than the hated target culture. But as with any radical thinking, I hope it would be accompanied by some proper investment in preparations, education and support to make sure that the system is fair for all patients.

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