Measurement may be the key to the success or failure of neighbourhood health.
In healthcare, measurement is often an afterthought. It comes at the end of policy documents, contracts and project plans. Capturing data is something we typically do after the ‘real work’ of delivering care.
But measurement often decides where power goes: what gets paid attention to, what gets funded and what gets done.
And that makes how we measure neighbourhood health far more important than simply choosing the right set of indicators.
We have national targets for what neighbourhood health should achieve. But do these measures actually tell us how to act? And what happens when the things we measure start shaping everything we do?
Table of Contents
What Are the Headline Measures for Neighbourhood Health?
It is important to acknowledge that there are already headline measures for neighbourhood health.
The Neighbourhood Health Framework, published in March 2026, sets out national goals and measures including:
- Reducing avoidable hospital admissions and bed days.
- Improving prevention and management of long-term conditions.
- Improving access to primary and community care.
- Reducing unnecessary outpatient appointments.
- Delivering better coordinated, personalised care.
- Improving patient outcomes, patient experience and staff experience.
The NHS Oversight Framework 2026/27 works differently. It assesses NHS providers and Integrated Care Boards (ICBs) across areas including population health and inequalities, access to services, allocation of resources, effectiveness and experience of care, patient safety, finance and productivity, and their people.
There is an important difference between the two.
The Neighbourhood Health Framework sets out what the NHS wants to achieve through neighbourhood health. The Oversight Framework helps determine how NHS organisations will actually be judged.
Although the Oversight Framework includes measures relevant to neighbourhood health, it doesn’t yet directly capture the full set of neighbourhood health ambitions. Some of the longer-term and more personalised outcomes are still being developed or aren’t reflected in the measures used to score organisations.
And that distinction matters. A lot.
These are things we can collect and report. But do they tell us how to act?
Why NHS Measurement and Performance Targets Have So Much Power
I want to be fair to the headline measures, because I’ve been on both sides of the table.
When I’ve developed programmes, I’ve had to put together business cases showing how we would measure impact. I’ve also sat on the other side, deciding which ones to fund and how to manage them once we did.
Money is scarily tight in the NHS right now, and many Trusts are struggling to make their numbers add up.
NHS decision makers are under extraordinary pressure, not just to hit their financial targets but to demonstrate value for money and show the real impact of their work. At the same time, they’re continually being told by every other department and organisation that they need more of everything.
They spend a lot of time fielding requests and demands. Unfortunately, it creates a tough decision-making environment with strong opinions.
In that environment, numbers gain power.
They seem fair. They can be compared and justified. They’re seen as a reliable way of telling what’s going right and what’s going wrong. This inadvertently creates a spiral of control that is hard to escape.
So it’s no surprise that more and more measures get written into contracts and used to judge the performance of everyone and everything.
The problem is that this often creates an insatiable appetite for more information, more data and more measurement.
It creates a monster.
The Measurement Monster: When NHS Data Collection Takes Over
One of my biggest frustrations in the NHS was the constant need to feed the measurement monster.
More and more of my time went on writing reports, collecting data and reporting upwards, to prove that the team was doing the right thing and the work was having an impact.
It was deeply frustrating, because it took time directly away from doing the work and working with my team: helping them with problems, helping them work together, and making the biggest impact we possibly could.
I know so many people in the NHS who feel the same.
The measurement monster eats away at their time and makes many people’s jobs deeply unsatisfying.
And the more we feed it, the hungrier it seems to become.
The Evolutionary Trap: How Measurement Changes What We Do
The measurement monster doesn’t just sit there sapping everyone’s time and energy.
It swipes at the things it doesn’t like.
And the effort of feeding an ever hungrier monster starts to shape what everyone does.
When the same measures are written into everyone’s contracts, the work slowly evolves around them. We end up doing the things that feed the measurement monster, because that’s what gets rewarded, funded and protected.
Over time, things evolve under the same pressures and everything starts to look the same. Everyone and everything is held to the same selection pressures.
If it doesn’t feed the monster and keep it happy, it’s treated as a distraction.
The services that do something different, that work over a longer period of time, build relationships or deal with things that are harder to count, get selected out. Not because they don’t work, but because they don’t show up in the data.
The real damage comes when the cuts come, because the things that get cut are the things the monster doesn’t see.
It looks like progress, because the monster is being fed more efficiently. After a while neighbourhood health gets sucked back by the whirlpool and is hard to distinguish from the rest of the NHS.
But a system where everyone does the same thing is fragile. It has nothing to fall back on when the problem the data was supposed to solve changes.
And in our communities, the problem always changes.
Why Measuring Neighbourhood Health Is More Complicated Than Counting Activity
Problems don’t stay where you put them
Take falls.
You can target falls directly, perhaps by commissioning a falls team, and the numbers may look good for a while.
But if nothing is done about why people are falling in the first place, such as people becoming less fit and mobile, anxiety, unsafe homes, or nobody being around when they do fall, the problem doesn’t go away.
The costs move from the things we can see to the problems we can’t.
At least until it’s too late.
There’s a deeper tension underneath this.
A lot of NHS measurement is cost driven. It designs the work around what can be counted and paid for, like tightly scheduled, time-limited appointments.
Practice-driven measurement asks something different: did this person actually benefit, and did their life improve?
It’s very hard to optimise for both at the same time, and when money is tight, cost tends to win.
It’s the same pull I wrote about in the Bermuda Triangle of NHS reform, where performance, finance and change compete, and reform quietly disappears.
Neighbourhood health is particularly vulnerable to this.
Much of what makes neighbourhood working effective happens between organisations, over time, and through relationships. These are precisely the things that traditional NHS performance measurement can struggle to see.
Taming the Measurement Monster: How We Increased Data Collection From Under 50% to Over 96%
A few years ago I worked on a hospital-run programme out in the community.
We were working alongside other organisations to find people, diagnose them, and support them through treatment and beyond.
The programme sat under a hospital board, and the board struggled to see it as important. They heard stories about our work from clinicians, but in their world it felt like nice, fluffy work, a world away from their focus on hospital performance and managing the money.
So I translated our work into their world.
I built a dashboard that let them see what was going on and build a story around it that made sense to them.
Frankly, it was the only way we were going to get funding to the people and places that needed it.
The board were delighted, because I’d built it around what they wanted to know.
That fixed one problem and created another.
The clinicians and charities we worked with hated the data collection. The hospital systems were clunky and slow, with endless clicking through screens, and that wasn’t something I could fix.
People saw it as extra work on top of their job, and we were only capturing around 40 to 50% of the data.
So I adapted the dashboard to make it as useful as possible to them too, fitting how they worked.
The team could see how each patient and each area was doing, compare them, and spot patterns, gaps and the things that were working well.
I focused on making the data useful and meaningful to them, and it became part of how they ran their multidisciplinary team (MDT) meetings.
Data collection went from under 50% to over 96%.
Not because of compliance and control, but because we tried to make the data genuinely powerful and useful to them.
That experience has stayed with me.
We didn’t need a bigger stick to make people collect data. We needed to give people a reason to want to use it.
Making Friends With the Measurement Monster: How Should We Measure Neighbourhood Health?
Measurement can be a source of power.
But when it only flows one way, it creates a monster with all the power and none of the understanding.
If measurement is where power sits in neighbourhood health, the question isn’t whether to feed the monster.
It’s how we tame it and make friends with it, so it helps all of us.
Rather than sapping our time and energy, measurement can be shaped to fit our work.
Used well, measurement can tell us who, how and where to act.
In neighbourhood health there are so many things we could do that being able to find the right point to act will be crucial. The alternative is trying to do everything and being spread too thinly.
This means thinking about measurement as more than simply demonstrating performance against national targets.
We need to understand what’s happening in our communities, where people are struggling, what is changing, and which actions are actually making a difference.
And that means recognising the different needs of the people using the data.
A hospital board needs to understand the impact on performance, finance and outcomes.
An integrated neighbourhood team needs to understand who needs help, where to focus its effort, what is working and what needs to change.
Communities need to understand whether things are improving for the people who live there, in ways that actually matter to them.
These aren’t necessarily competing needs. But they are different perspectives, and forcing everyone to look at the world through the same dashboard risks losing much of what makes neighbourhood health valuable.
Intelligence that’s shaped around the work is what gives measurement its real power.
Without care, we risk creating another measurement monster for neighbourhood health, one that disempowers the people doing the work and distracts us from the real job of helping people and communities.
If we want neighbourhood health to find its true power, we have to tame and befriend the monster, so it works for us, with us and with our communities.
Join Us: How Do We Measure Neighbourhood Health?
I’ll be exploring this at the next Neighbourhood Health Academy Live: How Do We Measure Neighbourhood Health?
Wednesday 11 November 2026, at 1pm. Online and free.
There are many good ways to measure neighbourhood health, but working out which is right for you is the tricky part.
We’re inviting people to describe how they measure in their own work, what it’s good at and where it struggles.
If you’d like to share yours, get in touch.
You can join the conversation and learn alongside others who are working through these challenges.
Visit the Neighbourhood Health Academy
Or sign up directly for NHA Live.
Let’s work out how to make measurement a source of power for the people doing the work, rather than another monster we have to feed.
