What gets measured gets done – are we measuring the wrong things?

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Systems are designed to get the desired results. To get different results needs a new system. One of the biggest barriers to the NHS making the significant changes it needs to is how it is measured.

I’m not arguing for no measurement – it’s right that there’s a way to assess quality. But any significant changes to the NHS will be hampered if the key measurements aren’t reassessed.

The move from curing illness to facilitating wellbeing

The NHS needs to change. Formed as a paternalistic system responsible for looking after the health of the nation, its new role must be to facilitate patients’ ownership of their own health and wellbeing.

But while ever the major metrics discussed by hospital trust boards are A&E performance, waiting list numbers and length of stay, there cannot be a proper focus on this attitude shift. And don’t get me started on the payment-by-results system of financing.

Policy-makers and regulators need to step up to the challenge. How can we arrive at a new series of metrics which measure what’s really important? How much longer can the metrics on which trusts are judged be at odds with the realities of the changes that need to be made?

Capitalising on Covid-19

Covid-19 has provided the perfect context to discussions about NHS change. It has shown what’s possible, but there’s also a real temptation to slip back to old ways. There is a limited amount of time during which change will be possible.

If we continue to measure activity over outcomes, especially if it’s the wrong kind of activity, we will truly reap what we sow.

So what could the new measures be? How can we accurately measure the outcomes to show that the UK population is less dependent on the NHS? What numbers would indicate that people take responsibility for their own health and wellbeing, supported by the NHS rather than looking to the NHS to carry that responsibility for them?

Integrated Care Systems (ICSs) could provide the answers. Created as a way to consider a population as a whole, rather than people as patients, their metrics could hold the key. Measuring the impact of changes made by the partners in the ICS would give us new information.

If we can get those metrics right – and if regulators and policy-makers would accept them instead of the current volume data – we might end up with a new system. One that’s designed to get the right results for 21st century health and wellbeing.

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