We are at risk of losing sight of what matters to the populations we serve. The move towards system working in health and care is commendable and offers an opportunity to begin to reverse some of the fragmentation that has evolved over the last few decades. There is clearly a significant desire to move towards funding and monitoring arrangements that are based on outcomes. This is particularly important as systems aspire to take responsibility for optimising health and care resources. So, in these systems, what is measured will really matter.
But the primary purpose of our services is to improve the lives of people. To what extent do we really understand what they value, what matters to them? Or the degree to which services make a difference to their lives? There’s a strong policy steer towards a person-centred worldview – with personalisation and involvement coming to the fore. And many health and care systems have explicitly stated intentions which support this, intending to implement measures which focus on the needs of the people they serve and to involve them in the process of deciding what to measure and how to measure it. We would describe this approach as ‘person-centred intelligence’.
However, we’ve observed a series of challenges that can undermine these efforts. All too frequently, little effort is expended towards finding out what really matters to the population of interest. Involvement can be surface level or an afterthought, the preferences of a few individuals can be inappropriately extrapolated, or it gets put in the ‘too hard for now/TBC’ pile and ultimately side-lined. There is also often a limited awareness of the data that is already being collected and the lessons that can be learned from elsewhere. Systems can unnecessarily feel as though they are starting from scratch. Elsewhere, we’ve seen large quantities of data being collected without a clearly articulated purpose, leading to disengagement from frontline staff – which seems to represent a huge missed opportunity. Even where well-defined, quantitative measures have been chosen (such as PROMS), lack of resources or a lack of overall direction has caused projects to stall in the early stages of implementation.
How could we do things differently? There is certainly a need for more structure and discipline in implementation. But we think the answer is predicated on spending far more time on the question of ‘why’ in the first instance – and to do that in partnership with the population that is being served. Why are we looking to measure something? What decisions will it inform? What impact are we hoping it will achieve? In health and care, we’re entrusted to make decisions that use the benefits of our knowledge, skills and experience – but that doesn’t extend to making assumptions as to ‘what matters’ to the population. It is therefore our responsibility to seek out the opportunities to build our understanding, to provide the mechanisms for involvement in the decision-making process, for those who want it. And to keep returning to ‘why’ and ‘what matters’ as the touchstone questions as work progresses.
So, ICSs need a route to implementation which is practical, flexible and can be applied to a wide range of local settings. In response, we’ve outlined a high-level approach in our guide to implementing person-centred intelligence. It is supplemented by a series of ‘explainers’ which explore key considerations in more detail (for example designing and selecting a sample, choosing methods for data collection etc.). Our work is informed by the views of national policy experts, clinicians, researchers and practitioners, as well as our findings from a detailed review of the current evidence. We have also drawn on expertise and experience from our team at The Strategy Unit and Ipsos MORI. And it is accompanied by an offer of support at every stage, which can range from informal advice, through to acting as a delivery partner at each stage of implementation. We want this to be the start of a move towards systems making a significant effort to genuinely understand the preferences of their populations and to involve them in the decision-making process about what to measure and how. If you’d like to be part of this – please get in touch.