This review was asked to look at how targets and indicators for health and social care align with the Government’s strategy for the future of NHS and social care services and support the best use of public resources.
Sir Harry stated that, “I have tried to do this by engaging with a variety of groups and individuals including… the Health and Social Care Benchmarking Network improving the provision of adult care services in Scotland.”
The report briefly describes the purpose of targets and indicators as a way of expressing the priority of an organisation. Setting a target lets members of the organisation know what is expected of them in terms of delivery of a service to the public. Indicators show how an organisation is progressing in pursuit of its aims. Together, they let citizens know what to expect of the organisation.
The challenge for the review was to suggest a process of designing targets and indicators in association with those who deliver services and those who use them. In that way, frontline staff can be encouraged to innovate and, through working with those who use services, find ways of improving them more effectively.
The report reviews evidence as to how targets and indicators could be developed or improved as effective measures of progress of the aims and objectives in the health and social care system. It concludes with a view that “the effectiveness of targets depends on how they are designed and implemented.”
It supports the need for a ‘systems thinking’ approach which is about having an understanding of a system by examining the linkages and interactions between the elements that compose the whole system, including the Third Sector.
Sir Harry calls for an overhaul of the system using a quote credited to Albert Einstein: “we cannot expect to solve all our problems if we use the same thinking we used when we created them.”
The report examines all the indicators used in all parts of the system including sections on ‘opinion indicators’ and end of life care which are relevant to Health and Social Care Partnerships. It supports the view that the involvement of people in shaping their own services is of considerable importance in improving outcomes.
At the end of this section a recommendation is made which states:
Existing indicators should continue to be collected since they provide a national baseline for measuring progress locally. They should, however be supplemented by more regular assessments of service utilization and effectiveness. Methods for current and relevant data collection are being developed. A small working group to consider more effective ways of collecting data on people’s views of services should be convened and a strategy for rapid, locally sensitive feedback of opinions should be developed.
There are 7 conclusions at the end of the report. We have highlighted three which are a call to action and surely resonate with members:
The present system of targets and indicators is fragmented and many of the indicators do not lend themselves to effective improvement interventions. A different approach to targets and indicators is necessary.
It is recommended that we move to a system of indicators and targets which allow improvements across a whole system of care to be tracked. It is important that frontline staff, managers accountable for performance and the people who use services coproduce the activities which they can then use to drive improvement.
Scottish public services are effective and efficient. A new approach to improving those services can deliver further success in comparison to many other systems.