Measuring What Matters in a 10-Year Plan

Writing a 10 year plan is the beginning of a journey not the end. The shelves that strategy lives upon should be abandoned if we are to make a meaningful impact upon peoples lives. In a times of ever mounting system pressures, further constrained resources, and growing inequality, the case for a bold population health strategy has never been Success of a population health strategy lies beyond dashboards or datasets. It rests on how well we align people, systems, and tell our stories of success behind a shared purpose: to improve outcomes is to tackle the causes of the causes of ill health.

Start with the Quadruple Aim.

To guide any long-term plan, begin with the Quadruple Aim. It gives a powerful framing for what is ment by success: Improve population health outcomes (Have you improved peoples lives?), Enhance the experience of care (what matters to me? NOT What is the matter with me), Support the wellbeing of the workforce (a culture where people want to come to work, to do their best to improve the lives of their own families), Improve value and sustainability (Finance yes, but also in how care is delivered across acute and community settings – investing more in prevention and upstream action.)

These four aims are interdependent. You can not improve outcomes without the people who deliver care being well. You can’t reduce cost without upstream investment in prevention. This framework helps keep strategy honest. Inequalities and the wider determinants of health ARE the causes, of the causes, of the crisis, in health and across public service. The fundamental building blocks of a healthier, happier life that not waiting time reduction, or target met can change alone. 

A 10-year plan makes the national direction clear: shift resources upstream, address inequalities, and embed prevention across services. National outcomes can only be achieved if they are translated into local workplans, KPIs, and even clinical pathway redesign.

Effective population health requires deep understanding of what’s driving demand.

The Global Burden of Disease shows cardiovascular disease and cancer as leading causes of death, but it's disability-adjusted life years that drive system pressure: long-term conditions like diabetes, respiratory illness, and emerging complexity in younger groups. Importantly, modifiable behavioural risks dominate. Cardiovascular disease is a major cause of death and disability. We know it is the leading cause of death in the UK. Improving national CVD outcomes maps into pathway work: improving statin adherence, targeted screening, and redesigning community-based rehabilitation services.

These are complex systems. Think of the obesity influence map, and an exceptional piece of work showing the energy imbalance (https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/296290/obesity-map-full-hi-res.pdf). 

In the middle we have the biology healthcare services are represented by the connections towards the bottom. Unless we address the wider determinants of income, housing, education, community, commercial, we cannot succeed. Health alone cannot solve inequality.

We can act where we have influence. A diabetes pathway model can show how we can apply logic models to identify intervention points, track outcomes. We can build meaningful KPIs across systemic pathways. This is how we begin to move beyond counting activity and start measuring impact. Moving the needle on the national outcomes is how we make data-led, needs-led decisions.

At the core of population health lies a fundamental shift in perspective: seeing the system from the person, and the person within the system. Its person-centred, digitally enabled. 

At the system level, success means our strategies are equitably funded, proportionate to need, and integrated across partners.

At the locality / place level, success means prevention is embedded in operational plans, and innovation is enabled.

At the neighbourhood level, success is visible in data: low uptake areas for vaccines or undiagnosed hypertension can be seen. Population segmentation to be able to target actionable insights; the powerhouse approach and impact region for population health. 

At the person level, success is felt: care that reflects what matters to them, not just what is the matter with them. Are we seeing personalised joined up (integrated care)? (Watch the Kings Fund Sams Story published 12 YEARS AGO! https://www.youtube.com/watch?v=3Fd-S66Nqio)

This is about more than measuring – it’s about transforming.

Framing helps ensure that measurement is meaningful. A dashboard is only helpful if it enables action that someone can feel. Success is not only hitting a metric. It’s also about creating the conditions where good things happen more often.

We need the qualitative. 

A team on a ward that redesigns discharge planning and reduces readmission's, A neighbourhood nurse who spots a cluster of respiratory cases and triggers an air quality review, A young carer who feels heard and sees a change. 

These are not stories instead of data. They are success alongside the numbers.

The system should support success across the quadruple aim, in 2025, digital is foundational.

Risk stratification tools to shared care records, digitally enabled systems help us see population needs more clearly, allocate resources more fairly, and measure impact more consistently. But digital tools alone don’t deliver change. The culture around them does. That means we must build digital into the governance, the skills, and the relationships that make population health real.

One of the most overlooked success measures in health strategy is communication. We must share progress widely and meaningfully. Does a national dashboard inspire someone in a ward team to try something new? A local story from a neighbour just might. A digital system that backs up, and automates the quantitative evidence, that their idea has made a difference pushes scale, metrics as the means to the end, not the end in themselves. 

Reporting tools need to include both indicators and narrative case studies. Celebrating success is not just about morale. It fuels innovation.

To sustain a 10-year plan, we need more: a culture where learning is shared and success isn’t just what gets reported to the Board, but what gets noticed on the ground.

We talk often about shifting from reactive to proactive, from illness to wellness, from hospital to home. That shift does not have to be theoretical. It is made real in how we define and measure success.

We need strategies that are ambitious. Measures that are meaningful. Systems that are human.

Population health is not a project. It’s a long-term movement. And success? It’s what gets counted, and what gets better.

If you’re working on population health or measuring strategy in action, think big, and think about the causes of the causes, measure what matters, people are living shorter lives and more of those shorter lives in ill health, in 10 years time do you want to talk about how your people live longer happier lives where unfair and unjust inequality is closing… or that time a percentage went from 92 to 93%.