Introducing patient reported outcome measures into the NHS

In 2009 the Labour government announced that patient recorded outcome measures (PROMs), a way of gathering patients’ views of health outcomes, would be collected pre and postoperatively on all NHS patients in England undergoing one of four common surgical procedures.

The implementation of this policy was in large part influenced by the work of Nick Black, professor of health services research at the School, who has been studying PROMs since the early 1990s.

For the first phase of the research Black teamed up with experts from sociology, psychology, epidemiology and statistics to develop and test PROMs using rigorous qualitative and quantitative methods. The researchers developed PROMs for a range of conditions, including stress incontinence, menorrhagia, day surgery and coronary revascularisation.

The next phase of the research was on a range of methodological aspects on the use of the research, including the influence of patients’ preoperative health and the impact of non-recruitment and non-response.

In 2005, researchers undertook a systematic review of ways to assess outcomes following hip and knee replacement, varicose vein surgery, hernia repair and cataract surgery.  This led to a study to develop pre and postoperative questionnaires for the four procedures and to test the feasibility of their routine use in the NHS. They found that it was possible to recruit patients, follow them up and make risk-adjusted comparisons of providers, all at reasonable cost.

Black reported these findings to the Department of Health in 2007 who then announced that PROMs would be mandatory for all NHS patients undergoing groin hernia operations, hip replacements, knee replacements and varicose vein operations as of April 2009. The use of PROMs continued under the Coalition government and they have been included in the NHS Outcomes Framework since April 2011.

More than half a million patients participated in the programme in its first three years, representing 70% of eligible patients. And since April 2010 the measures have been published online (

In 2011 Sir Bruce Keogh, Medical Director of the NHS, told the Financial Times newspaper that the advent of PROMs “would shift the focus among doctors [away] from technocratic results, where an operation was deemed a success regardless of whether the patient remained in pain”.  And in 2012 Professor Sir Norman Williams, then president of the Royal College of Surgeons, described PROMs as a “major development in the history of surgery”.