This recent SPICe blog explores the background behind NHS performance reporting and the use of different indicators to judge progress on improving NHS activity in Scotland.
The Scottish Government framework for assessing NHS performance has historically been through local delivery plan (LDP) standards and the Government previously reported regularly on those standards. The last comprehensive reporting by the Scottish Government in relation to these measures was published in 2022. The SPICe blog presented an update on the performance measures for Scotland overall.
As the previous blog reported, the updated guidance in 2024-25 doesn’t refer to these LDP standards, which leaves it unclear as to whether the standards are still used, where can we find the information if they are, or what has replaced them if they’re not still in use and how the Government now assesses NHS performance. We’ll address these points in turn.
Are the LDP standards still in use?
According to the Scottish Government, the LDP standards are currently under review and there will be an update once that review was completed.
Where can we find information on NHS board performance?
Since 2022 there has been no one single place to access data on NHS boards’ performance. Finding information to track delivery against the standards and compare progress between NHS boards has been difficult.
To address this gap, SPICe has created a new NHS Scotland Performance Standards Dashboard to bring together all LDP standards to make it easier to see data on how boards are performing across the standards. It also shows which standards have been met or missed in each measurement period.
Our new dashboard doesn’t contain the following four standards because they have either been paused, are no longer used or there isn’t clarity on how they’re assessed. Reasons for this are set out below:
- 18 weeks referral to treatment: 90% of planned / elective patients should begin treatment within 18 weeks of referral. Public Health Scotland has taken the decision to pause data collection on the standard to divert resource to develop statistics about NHS performance around activity for eight key diagnostic tests.
- Alcohol Brief Interventions (ABIs): Sustain and embed alcohol brief interventions in 3 priority settings (primary care, A&E, antenatal) and broaden delivery in wider settings. Scotland-wide data collection and reporting of ABIs were paused during the COVID-19 pandemic and have not resumed following a review of the programme.
- Detect Cancer Early: Increase the proportion of people diagnosed and treated in the first stage of breast, colorectal and lung cancer by 25%. The Detect Cancer Early programme has ended. A similar measure is contained in Cancer strategy 2023-2033 and cancer action plan 2023-2026.
- Financial performance: NHS Boards are required to operate within their Revenue Resource Limit, their Capital Resource Limit, and meet their Cash Requirement. It is unclear how this standard is assessed.
One further measure, Diagnostic Waiting Times, was not part of the original LDP set and is now also considered a standard: All patients should receive key diagnostic tests / investigations (upper & lower endoscopy, colonoscopy, cytoscopy, CT scan, MRI scan, barium studies, non-obstetric ultrasound) within 6 weeks.
Data in the dashboard is currently up to date for all NHS boards. It should be noted that data collection for some measures can take multiple years. The only measure with missing data is the standard relating to IVF for individual island boards, as data is only available for all island boards combined.
Does the Scottish Government still use these measures for assessing NHS board performance?
In its recent report on governance of NHS Scotland, Audit Scotland reports it has found “weaknesses within the scrutiny and assurance processes at the Scottish Government level”. It particularly points to the mix of local, regional and national partners and how that makes accountability and decision-making difficult.
So, is the Scottish Government still collating data, is that data providing a meaningful picture, and how does the Scottish Government remain satisfied about NHS board performance?
Interestingly, in a case study of NHS Lanarkshire, Audit Scotland share that the board’s governance review led to the introduction of a new Integrated Performance and Quality Report (IPQR). This report is described as a “new data led performance reporting tool, made up of standardised performance indicators”.
What alternative performance frameworks appear to be in use?
Every NHS board is governed by a Board, made up of publicly appointed non-executive members, stakeholder members and executive members. Each member is appointed by, and are accountable to, Scottish Ministers. The Board, among other things, is responsible for leadership and culture, setting strategy and ensuring accountability.
We looked at the most recent Board papers for all 14 regional NHS boards. It appears that a variety of frameworks are used to report on the board’s performance. Some NHS boards use the IPQR format within their Board papers, some use other performance reports or scorecards, and some review separate reports from various committees.
Given Audit Scotland’s spotlight on the IPQR, we thought it would be interesting to focus on those and look at what performance indicators are used in IPQRs and if the LDP standards feature.
We looked at two examples of IPQRs and concluded that:
- They don’t use a standard set of indicators. Both reports used the LDP standards in part, but some LDP standards don’t feature and both IPQRs included a range of other indicators. This was similarly true of the performance reporting of NHS boards not using the IPQR structure too. In general, additional indicators appear to be derived from key measures relating to that particular NHS board’s priorities, as set out in annual delivery plans and performance assurance frameworks.
- Even for an individual NHS board, different indicators are presented to the Board through the IPQR at different points in the year, making it hard to track performance across time in a consistent way.
What does all this tell us?
While all NHS boards are regularly reporting on performance, not all are using the same performance reporting framework. The various Board minutes seem to indicate that performance reporting is an ongoing, iterative process with reporting and different indicators being refined over time. This can make it difficult to draw comparisons and conclusions over time across all NHS boards.
It appears that many of the LDP standards are still being used to measure performance in NHS boards. These appear to be alongside other measures the NHS board has chosen to prioritise for their individual populations and service delivery.
Some LDP standards are no longer consistently being used by all NHS boards to measure performance, the most notable omission we found was in relation to dementia post-diagnostic support. We also found that data is still being collected by some NHS boards on some measures that are currently paused.
The current Scottish Government review of the LDP indicators might provide some clarity on the transparency and accessibility of performance data, when its results are published. In the meantime, the dashboard will provide a comparison of the LDP standards and continue be updated when new data are published.
Susan Brown & Maike Waldmann