Rethink on A&E target indicates we are measuring the wrong things

It recently emerged that NHS England may be closer to getting rid of the four-hour A&E waiting time target by trialling new standards. A pilot has been launched to record the length of patient waiting time in A&E departments in a small number of hospitals to find an average waiting time. This same method was employed to determine an average ambulance waiting time.

While many may see this move as a canny way to massage the official statistics of target achievement – which could leave patients waiting much longer – it also raises the question of whether target setting is really what’s best for people and patients in the NHS, particularly those in greatest need. What are we measuring, and why?

Targets, metrics and measures – oh my!

At the end of 2018 the Bevan Commission published its report, Measuring healthcare outcomes, which found that the NHS in Wales uses over 370 separate indicators and measures to monitor and evaluate its performance, leading to confusion, wasted opportunities, time and often imprudent practice.

Many of these 370 separate indicators for monitoring and evaluating health and care were based upon routinely collected data such as service and process information, rather than on patient outcomes. We also found that that the current NHS Wales performance management system does not sufficiently represent collaborative working across specialisms and organisations, which could enable better tailored support and integrated care to be provided.  

It is self-evident that an overly complex system of separate (sometimes contradictory, sometimes competing) targets helps no-one – and is at risk of misleading and confusing people and NHS professionals alike.  

What can be done?

In Wales, the Bevan Commission has called for a single National Outcomes Framework for health and social care, developed by working together with a range of partners and linking the measures to outcomes that matter to patients.

We recommend that future indicators for both health and social care should be co-created and linked to relevant outcomes for people and patients.

We also think that clinicians should be given responsibility and ownership for the clinical indicators relating to their own professional practice. NHS professionals are much more likely to engage positively with these indicators if they have helped to develop them and understand their context, rather than feeling that they are being imposed on high by some detached administrator.

Finally, we believe that any indicators used to measure NHS performance should be easily available, accessible by all and published annually to aid transparency and comparison.

We believe that this approach – bringing together patients, health and care professionals, policy makers and more – will help ensure that the NHS meets needs that really matter to people. We need to demonstrate that we are putting patients at the centre of the way we not only deliver services but also the way we measure their outcomes.

The best way to achieve this is through a single, accessible and meaningful outcomes framework.

Helen Howson is Director of the Bevan Commission, Wales’ leading think tank for health and care, hosted and supported by Swansea University School of Management.

The views contained within this blog are those of the author and do not necessarily represent the views of the Bevan Commission.

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