Ministers, data and tackling variation some thoughts

Therese Coffey has listed her priorities as ABCD but really they are about the letter V.

Variation is front of mind for the new Health and Social Care Secretary and Ministerial team as they try to recover NHS performance.

As our research published today shows (Future Health Report – ICS FINAL), areas are heading into winter in very different places. But the data does not tell the full story or itself provide the answers to the challenge. Indeed there are a host of problems facing someone in Victoria Street trying to tackle variation across a system as large and complex as the NHS. Below I list some of the learnings and watch-outs for Ministers as they start to scrutinise pressure, performance and variation:

Make sure you have the data – One of the main measures of the Health and Social Care Act 2022 was to provide DHSC with more powers over NHSE. These need to be used to ensure Ministers have the up to date data they need. Full transparency at the top is critical given where the system performance is at

Make sure you have the context – The data on its own will not tell you a huge amount. You need the context to understand the why; including historical and on the ground trends (for example what was the impact of Covid in this region?) A mechanism needs to be developed to feed all this in

Make sure you have the expertise – My former boss had technology as one of his three priorities. He brought in a Chief Technology Officer to private office and set-up a counsel of outside experts to advise him on how to make change happen. Bringing in data and analytical capability close to Ministers would support improved Ministerial briefing and decision making

Don’t focus on single data points – Our research shows that prevailing health narratives such as ‘people who can’t get a GP appointment overwhelm A&E’ are not correlated in the data – there are pockets where pressure may be linked, but it is far from universal. Don’t buy assumptions, challenge them

Look system wide not just at organisational data – As we have moved away from competition to collaboration it is critical to start moving the data assessment away from single entities to a wider horizon. Our research for example maps primary and secondary care metrics across geographies, but you could factor in others such as social care and population health too

But also drill down – ICSs are large organisations and the variation within them will be as important as between them. The NHS has numerous tools at its disposal to look at place-based outcomes and this granularity and scrutiny can help identify where challenges are occurring

Push on qualitative data – The NHS has reams of quantitative data but is less good at collecting and publishing qualitative data. Patients are voters. What do they think? One of the interesting findings from our work was that the area with the highest percentage of patients waiting three weeks or more for a GP appointment, also has the highest level of patient satisfaction, a fact that would not be uncovered if you relied on the quantitative data alone

Invest in the data – With efficiency savings coming it really is critical to continue to invest in improving the NHS data infrastructure so that data can flow better in real time. This will improve productivity and efficiency and these should be arguments when engaging in the upcoming Treasury review

Push for better good practice sharing – This is notoriously difficult in the NHS but building a framework where areas can learn and share more easily with each other should be explored. Some budget to support collaboration and change management might act as an accelerator

Central targets are a blunt tool – If you accept there is variation across the system central targets are unlikely to be that helpful in driving change. Instead better to use the insights gathered from the exercise above to set each system on its own performance trajectory that can get it moving towards recovery. Properly stress test this and get them to publish this in their upcoming forward plans