Turning stories into numbers: Gathering data to inform and transform health and social care systems

Lead Physiotherapists: Sue Griffith, Vic Ellis, Amanda Rutter, Jason Ellis

Hywel Dda University Health Board

This Bevan Exemplar project developed a common language and scoring system to aid decision making and provide the most effective health and care intervention for patients.


Healthcare in Wales is a complex system, incorporating social care, housing, and the community voluntary sector. Conventional means of measurement don’t assist in understanding and navigating the current system as a whole. A different way of measuring the complexity is required. This needs to be based around the human story so that patterns and themes can be explored.

ANGEL (Activities, Needs, Goals, Escalation, Location) was developed through ‘1000 Lives Improvement’ and is underpinned by complexity theory. It is an abstract summary of an individual’s needs, capturing individual presentations as data. The ANGEL scoring system starts with a measure of an individual’s need. Qualitative stories, as told by patients, become Quantitative Data which can be used to track, evaluate and inform decisions. Then, when data from multiple patients is collected, several layers of data enable patterns to emerge and trends to be analysed.

There are five pieces of information, presented as columns, which give a summary of an individual’s needs and situation at that moment in time. For each of the five columns, there are five levels used to describe the severity and urgency of the person’s situation. The quantitative data collected is scalable to whole systems and populations. With several data items, numerous opportunities emerge from the patterns and intelligence. Physiotherapists work across the whole system of health and social care services, combining knowledge and skills of physical, medical, social and psychological aspects of care, to deliver Public health prevention, self-management, rehabilitation, acute episodes and crisis management. Physiotherapists are an ideal group of professionals to see complex problems and to strive towards possible solutions.


This project wanted to explore whether a strategy could be used in health and social care in Wales to reduce needs and spend, and use resources in line with the principles of Prudent Healthcare. It examined the use of the standardised scoring template, ANGEL, as a common language across all services, to capture stories in real time.

The project aimed to equip professionals with the knowledge and skills to use ANGEL to capture patient stories and input into the system. The aim was to ‘drill down’ on the data in order to identify, for example, delayed discharges and show which part of the system could be deployed and where in a more timely way to speed up discharges.

The project wanted to use ANGEL in action. Wherever there was a Physiotherapist from the project team, across numerous settings, they collected ANGEL scores from patients and engaged other members of the team, where possible.

“The Bevan Commission created a space for innovation without criticism or judgement, but the ability to influence and transform is not balanced in the current system.”

Sue Griffith, Vic Ellis, Amanda Rutter and Jason Ellis


Key challenges included:


Next steps