A Utilitarian Twist? Performance Measurement in the English National Health Service

Abstract

This article focuses on the performance grading of British National Health Service bodies under the auspices of the performance assessment framework and the performance rating system. The National Health Service (NHS) in England has allegedly been subject to ongoing structural change since the early 1990s. Such has been accompanied by the increased recourse to performance management and evaluation systems, such as performance grading, systematic reviews, and clinical governance. The increased generation of information and evidence, combined with structural reform, has been hailed as affording the opportunity for the devolution of power from the organized medical profession and politicians to the wider community, particularly concerning decisions of rationing, prioritization, and funding. The optimistic scenario of community empowerment resonates with the notions of warranted knowledge and the instrumental valuation principle, as part of the process of forming efficacious policy in the Great Community. Indeed, advocates of NHS reform argue that the increased generation of information will provide an objective assessment for gauging the performance of NHS bodies over a range of activities, thereby increasing transparency and accountability, as well as furnishing agents within the NHS with incentives to enhance the efficiency and effectiveness of health care provision.