How Do We Measure Quality in a Failing Healthcare System?

This week brought more rhetoric in political circles about the NHS, what should happen with waiting lists and how GPs interact with their patients. The threat of ‘hit squads’ for those practices using innovative strategies to maximise efficiency with increasing patient demand has caused anger among many in Primary Care.

In Secondary Care, the rise in Covid cases and hospitalisations compared to other European countries has reduced the amount of elective work to try and clear the pandemic backlog.

In all of this, there are multiple competing demands. From a patient perspective, some feel they cannot see their GP face to face as Primary Care is delivered more innovatively. Others think the system lets them down after paying years of taxes, and others are frustrated at not getting the surgery they need. Politicians want to govern the system and use the key levers of money to mould the system and often fail to understand some complexities, such as the lack of a workforce to throw the money at. Finally, clinicians and frontline NHS workers are frustrated at crippling increases in demands, high levels of regulation and a chronic workforce shortage.

This all points to a system that is starting to fail. What all of these stakeholders want is very different. How they perceive and measure the success of the NHS is very different. Many metrics have been used at the individual and organisational levels to measure quality and success. Patient satisfaction, volume, safety measures (e.g. significant events), inspections, revalidation, waiting list times. This week others have been added, not in an evidence-based way but largely at the whims of politicians and right-wing media. This week’s quality is measured by the number of face to face interactions not across the whole system but in one particular area, e.g. Primary Care.

There appears to be no strategic overview at the individual or organisational level (or the interaction between the parts of the system) about measuring quality as demand increases and the workforce shrinks. Perhaps it was time we had an open and honest debate about what we should measure in a system under significant and existential strain.