Muir Gray: Ten essential questions that only systems can answer

Muir GrayI have met clinicians and patients in many parts of England in the last five years and here is a list of the type of questions that cannot be answered.

1.    Is the service for people with seizures and epilepsy in Manchester better than the service in Liverpool?

2.    Who is responsible for the headache service for people in Warrington?

3.    How many liver disease services are there in England and how many should there be?

4.    Which service for frail elderly people in London provides the best value?

5.    Which mental health service for children with mental health problems improved most in the last year?

6.    Who is responsible for the quality outcome and value of the service for people with bipolar disorder in Norfolk?

7.    Who is responsible for the service for women with pelvic pain in Devon?

8.    How many services are there for people with musculoskeletal disease in London, and which gives best value?

9.    Is the variation in outcome heart failure increasing or decreasing?

10. Who is responsible for publishing the annual report on care for people with Parkinson’s disease in England?

Forget the names, you can put any name of almost any health problem and any place in any question and still not answer it, so here are some generic questions:

1.     Is the care for people with XXXX better in A than in B?

2.     Who is responsible for the care of people with WWW for the population of D?

3.     is the variation in outcome for ZZZZZ increasing or decreasing?

4.     Is the service for people with TTTTT improving in E?

5.     How many population based local services are there for frail elderly people in YYYY and who is in charge of each of them?

It seems inconceivable that we cannot answer these simple questions. We can answer questions about individual patients. We can answer questions about the service that is provided by institutions, for example the number of people attending respiratory clinics in a particular hospital, and we can of course answer to the nearest pound details about the real estate, but we cannot answer these simple questions.

As the going gets tougher we need to get more value from resources and we will only do this by having population based accountable integrated services. I am very confident that we will be able to answer the above questions within five years, but then again I have been very confident about this for the last 30 years. (1)

1. Gray JAM. Four Box Health Care—development in a time of zero growth. Lancet 1983.

Muir Gray is visiting professor of knowledge management, Nuffield Department of Surgery, University of Oxford.