Are we suffering from ‘information underload’ when it comes to quality of care?

With only seven weeks to go until the general election, polls suggest that the NHS remains the top priority issue for voters. Political parties are each going to need to attempt to answer the question of how the NHS is performing and, critically, is it better or worse than five years ago?

Our latest briefing – forming part of our pre-election analysis – draws on data from our joint Health Foundation/Nuffield Trust QualityWatch programme, as well as a range of other sources to explore these questions.

And the answer is…well, it depends. Let’s walk through it.

Picture a person – let’s call him Sam. What would be different about the quality of care he receives now compared to five years ago?

We know that if Sam experiences depression, it is much more likely that he will have been offered psychological therapy now compared to in previous years (but this is still not a given). If he had attended A&E this winter, he’d still have been highly likely to be treated within 4 hours or less, although his chances of waiting for longer were slightly higher than in 2010. If Sam had been in hospital at any point over the past five years, he had around a one in five chance of reporting that he hadn't been treated with dignity and respect (a figure which hasn’t really changed over this period).

However, there’s also a great deal we don’t know. We don’t know whether Sam will experience care that is joined up and integrated across different services, or whether this is getting better or worse. We know next to nothing about how safe the care is in Sam’s primary care services (such as GP surgeries or pharmacies). We don’t know whether Sam’s care would be, across the board, any better or worse in the UK compared to in another comparable country.

And finally, this of course is all a moot point because it actually depends on where Sam lives and which organisation, which service or even which team his care is being delivered by. The system often looks at national data for what is, in reality, a very local health service. As the 2013/14 CQC state of care report highlighted, ‘there are big differences between the quality of care provided by similar organisations’. Trying to sum up a whole health system is both difficult and potentially misleading without acknowledging this variation.  

In the context of an election period, where does this leave voters? Well there is the risk that, in the absence of definitive answers, people are left to select the information which supports their preconceptions and discount any which doesn’t. For those who don’t have any particular view to uphold from the outset, it probably leaves them more confused than when they started.

In both cases, we are suffering from an information underload. That isn’t necessarily to say that we don’t, as a health system, collect or crunch enough information – some might even argue that there is far too much of that in the NHS. Rather, are we always collecting the right information?

So what needs to happen? Today’s briefing recommends three areas for focus:

• first, addressing the gaps in national quality data
• second, doing this as part of a systematic, comprehensive strategy for improving quality
• third, that this strategy should include an overhaul of the national approach to assessing and managing performance.

This means that any incoming government needs to be clear that the primary purpose of information should be to support understanding and improvement. Sometimes this means being willing to generate more questions than answers, or to explore the alternative explanation even if it isn’t backing up the story people want to be able to tell.

Only once we have a better, and more balanced, understanding of what’s really happening in terms of quality of care will we be sure that we are asking the right questions, let alone looking at the right answers.

The Health Foundation (an independent charity) will be publishing a series of briefings and blogs in the run-up to the 2015 general election, to inform the ongoing public debate on health care policy. These materials will analyse and discuss key issues raised by political parties and others about health care policy and the NHS.

Natalie is a Policy Fellow at the Health Foundation, www.twitter.com/NatalieBerryTHF