The Involvement Team are privileged to work in partnership across departments with some really great people who connect with us in our daily work. We collect copious amounts of data in the NHS for numerous reasons and here Kevin Thompson shares in a novel way what he does with data in the Corporate Performance Team.
Hi, my name is Kevin and I work in performance in Nottinghamshire Healthcare NHS Foundation Trust. I have previously worked in data management and marketing roles within the private sector, boring huge numbers of people senseless with market information reports on anything from bagged salad (the skinny – you sell more lettuce when the sun shines) to male moisturisers (a bit like pork pies – nobody admits to buying them, but they still seem to sell).
You could understand why I wanted to switch to something more meaningful. But I found that performance in the NHS is a reporting function perceived as being somewhere between the Spanish Inquisition and the Gestapo but without the fancy uniforms.
For instance, I mentioned to my Dentist that I worked in performance in the NHS. “So you are one of those people who tell me how long I should have with my patients?” She rasped, picking up the drill. I was told that my screams could be heard above the rumble of traffic on Porchester Road.
So what do we actually do in performance? We collect and prepare and present information on range of Trust activities for a number of different bodies from the Department of Health to updates for our Trust Board of directors. This can be anything from delayed transfers between clinical units, to mixed sex accommodation breaches on our wards.
Sounds straightforward enough. However one of things people presume, not unreasonably, is that all our information sits in nicely prepared slots, like sandwiches a vending machine. That it is the future, but not quite the present. Imagine that sandwich you are looking for is currently a slice of bread in a locked cupboard in an office in Mansfield, the beef filling is still mooing somewhere in a field in Rainworth, and the butter is…well the person who did know where the butter is on Magaluf for 2 weeks.
But you overcome all that and make 1000 sandwiches, and send the report to the national sandwich counting people in London. They reject your sandwich report because they have changed the definition; all sandwiches must have butter that is spread to the right, not to the left. When you try to explain that what you made all still recognisably sandwiches, the people in London tell you that of course they no longer are, and how could you have missed this new detail when it was so clearly signposted in ‘NHS Flour based sustenance’ Document 23.1B section 5 paragraph 3, page 5456, sent out to all trust managers listed as per their 1952 official contact list.
So you then have to explain to the Directors why the Trust external performance for sandwich making is running at 3.4% versus a national average of 82%.
Obviously that is an exaggeration but it is a truism that collecting data is still a labour intensive and exercise for the NHS generally, with outcomes that are unfair – comparing apples with pears – all that work just to enable a politician is able to make sweeping generalisations.
So – an arbitrary collection of targets that unfairly stigmatises some and unfairly rewards others. Why bother? Why not ditch all these pettifogging targets and regulations –stop burdening nurses with endless bureaucracy and let them get on with their jobs?
In an ideal world perhaps…one of the news stories that most saddened me recently concerned the failures in the management of the charity ‘Kids Company’. What emerged, from all the good intentions was that its activities were not properly regulated. To quote the BBC – people didn’t know ‘how many young people used the service, let alone how many got qualifications, jobs or were spared prison because of its work.’ In short – governance was poor, and measurement of performance lacking. Without regulation, oversight and transparency, things went badly wrong.
You cannot measure change if you don’t have a starting point and a sense of what you are working towards in terms of measurable targets. The Kings Fund notes that the ‘strength of the target regime in England is also credited with having driven faster reductions in waiting times than other UK countries between 1996 and 2006 (Connolly et al 2009).’ Performance, unfortunately, is a necessary evil, enabling us, in an imperfect and unfair world to get the bigger view.
About Kevin: I toil in my garden on a regular basis, noting that the wildlife which first attracted to me to the house also does a singularly effective job of demolishing my collection of runner beans and the like; brassica remains but a distant hope – sparrows and their feathered ilk are simply eating machines with good PR… IMHO. Other than that, I try to get out on my bike when the weather is ok, although I remain ambivalent about donning Lycra in primary colours; the middle aged superhero look is something that is difficult to pull off. I try to read and attempt to get past level 125 on Candy Crush.