The must-read stories and debate in health policy and leadership.

What gets measures gets gamed

It’s always been hard to tell how well people have been treated but bums on seats is much easier. By this most countable of measures, the number of people waiting for treatment performance has never been worse.

The referral to treatment time figures show that this May was the worst May since 2008 on the 92 per cent target (or that no more than 8 per cent of people should wait more than 18 weeks, to look at it from another angle).

People are waiting longer and the waiting list is unprecedentedly big. The 4.39 million people awaiting treatment comprise 8 per cent of England’s population.

Why? Let us recite factors old and new: the ageing population, more referrals from GPs, never-ending pressure on accident and emergency leading to lists cancelled, the medics pensions issue, and a reluctance to outsource to name a few. 

More important than all of these is RTT got deprioritised by the centre.

Multiple huge trusts have lost track of their waiting lists, and, in some cases, patients have come to severe harm.

It’s against this backdrop that NHS England announced the 12 trusts that would be trialling a new way of calculating performance.

Why would we need to change this? To avoid gaming? Everything measured gets gamed to some extent.

Waiting times experts said of the new measure being trialled: “Average waiting time targets will make the numbers look smaller, but that’s about it.”

One commenter beneath our report story said the existing measure was doing its job. “Changing the KPI won’t change it but will make it less visible,” they said. “The figures look bad because the situation is bad”

Sceptical and doubtful

Boris Johnson’s address to the Commons at Thursday lunchtime gave us some more punchy talk on the NHS. Among it was the pledge of “urgent funding for 20 hospital upgrades”. Other oaths included “drastically reducing waiting times and for GP appointments”, which the new prime minister said he had already approached officials to draw up policy proposals for, and funding for ”winter readiness”.

Unfortunately, there was no elaboration on what exactly a “hospital upgrade” was, nor where the money to get the NHS ready for winter would actually be fed into. As for the bit about waiting times, as this week’s The Integrator notes, that sounds pretty similar to work already being carried out.

But perhaps Daily Insight is wrong. As Mr Johnson put it: “We are going to prove the doubters wrong again, not just with positive thinking and a can-do attitude… but with the help and the encouragement of a government and a cabinet who are bursting with ideas, ready to create change and determined to implement the policies we need to succeed as a nation.”

Speaking of the cabinet, one thing very much unchanged in the line up of new faces is Matt Hancock, who was reappointed as health secretary.

Despite the many rumours he was in line for a promotion, Mr Hancock put on his brave face, tweeting: “I love the NHS - it’s a great honour to be asked to drive forward the health & care of the nation - with big & exciting commitments from our new prime minister.”