Changing the Currency

Our guest blogger Gemma Self of Reimagine Health gives her perspective on the confusion of measurements and payments in the NHS and makes a plea for change

Sophisticated currencies or entangled net?

We don’t often like to consider money and health in parallel.  It feels like it impacts our decision making adversely, or devalues conversations about more important things like wellbeing or our feelings.

However, linking investments to health can, like any investment, lead to a positive and constructive future.

Over the last 10 years in health, we have developed some sophisticated currencies – tariffs associated with different procedures and activities undertaken to monitor disease progression in primary care.

We have also measured the impact of investments by monitoring waiting times, satisfaction and length of stay.

The academic H Thomas Johnson said “What you measure is what you get”.   As an example, the introduction of the 18 week waiting time target and rigour around measuring waiting times led to a reduction in extortionate delays in elective care.  It also set the priority for timeliness over quality and prevention. So other measures were required to monitor the other elements of the same system such as experience and compliance processes.

Now we have a health system entangled by a net of measurements and regulatory regimes focusing on the myriad of demands.

However, for quite justified reasons, we haven’t measured and aligned payment to the things that we have been aspiring to change, namely improved health and wellbeing.

Yes someone might have an elective procedure within 18 weeks, good food in the hospital and observed professionals washed their hands every time they saw a patient. But did they actually have improved health and functionality as a result? Do they feel in control of their lives?

Have we lost sight of what we are here to do?

By micro-measuring every part of the system, we have become stuck in the detail.  But what if we take a step back and consider why we all decided to work in health and care?  Typically all of us want to prevent or treat ill health to ensure people feel better.  Arguably we are all here to improve wellbeing and therefore happiness.

What if we judged and invested in our health system based on how people are feeling, how their health is and how well they recover from illness? If the success of a health system was measured by this how different life would be.

There is increasing evidence for the impact of measuring and comparing the performance of services by outcomes.  Complex cardiac surgery and transplants used to have widely varying outcomes until measures were agreed, regularly reported and compared.  Just this act led to improved outcomes as poorly performing organisations recognised their position and took action to follow the best practice of the top performing organisation.

Measuring success by improved health and wellbeing could also lead us to organise our services differently.  Moving from organisations defined by physical or mental health treatment options.  Or by geography or history.  There could be organisations dedicated to older peoples health or management of cancer.

This all needs to start with changing what we monitor and how we articulate quality and success.  By maintaining a currency that pays for processes and the detailed steps of care we will never be able to make a leap to improvements in our wellbeing.

By Gemma Self

Reimagine Health

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