| Abstract |
In the United Kingdom, we are about to be subjected to a process of commissioning of secondary services by the primary care doctors who are now effectively in charge of the NHS. This means that contracts for everything from hearing aid provision to head and neck or major skull base surgery have to be ‘bid’ for with the inevitable problems of balancing quality and expertise against cost. At the same time, surgeons are being made to publish individual raw data on their outcomes in the public domain, potentially without risk-level adjustment or taking into account the influence of other members of the multi-disciplinary team. Although many of us would welcome the opportunity to publicise the quality of the care that our patients receive, the potential ambiguities in the system lead to a natural nervousness and a need for even more robust outcome measures and studies to demonstrate the value of what we do. A number of the papers in this issue of the journal address these areas but also highlight some of the difficulties in undertaking these studies. |
