I confess, maths has never been my strongest subject. I did pass my maths exams at school, but only because I was lucky to have a brilliant maths teacher who dragged the whole class through successfully.
A survey by national numeracy in 2022 suggests that most people think they are good at maths but that often they are overestimating their abilities. Forty five percent of those who rated their own numeracy as good, scored less than three out of five on a numeracy test. This suggests that their level of competence in maths is around that of a primary school child. Additionally Fifty seven percent of people surveyed didn’t see the need to improve their numeracy.
But what does this mean for social care and health workers? For many years decisions about social care and health seem to have been dominated by numbers. Whether it’s numbers of people waiting for social care and health care support, numbers of vacant posts across social care and health, or there just not being enough money to do much beyond the basics, we are told time and time again that the numbers just don’t add up.
Systemwide decisions and individual decisions are made using numbers as the justification for those decisions. Yet these number dominated decisions undermine and confuse and create perverse incentives to do things that are detrimental to peoples care, treatment and support. Hospital discharge numbers are one of many perverse incentives in the system. Instead of discharging people when they are well enough to go home and when the right support is in place to make sure they can stay at home, hospitals are judged on how short a person’s stay in hospital is and on the number of people they can successfully discharge. It doesn’t appear to matter if people are readmitted a day or so later because that counts as a new number and thus a new number to be manipulated. To me this feels as if it goes against the whole purpose of health care which is supposed to be about people getting the right care and treatment and not about how quickly people can be pushed through and out of the system.
Another numbers game that gets played a lot is the announcement of thousands of new nurses, doctors etc, or thousands more appointments at GP surgeries. Again the numbers are trumpeted without due regard for the time and patience that it takes to train and bring new people into health care (and make sure that they are safe and competent to do the job), or what impact all those extra appointments will have on the wellbeing of the GP’s and their teams.
So many partnership decisions between health, social care, education and housing seem to get hung up on the numbers. Arguments about numbers are often one of the main reasons that strategic and operational programs of work fall apart. A lot of this revolves around money numbers and who’s making the biggest contribution or who’s collecting the savings as a result of shared work. But again this numbers approach takes no account of the impact of working together on the lives of people with care, support and treatment needs.
I recently watched with great sadness as an integrated health and social care service for people with learning disabilities fell apart after 25 years because senior council and NHS leaders couldn’t agree on the numbers. Taking no account of the cost of undoing 25 years of partnership working and the impact on people with a learning disability and their families.
Bums on seats (or maybe faces on screens now) has always been an unhelpful measure of a successful workshop or training session. Whilst it tells you how many of the people who signed up for the session turned up, it gives you no indication about whether or not anything people learned at the workshop or training session made a difference to anyone’s practice. A quick survey that counts up the number of people who were satisfied with the training and in the way it was provided or dissatisfied with the training, does not give you any indication of whether or not that training made a difference to anyone’s practice. You will only find out if the training made a difference, if you go back a little while later and pull together a reflective account with the individuals about what they learnt, what they didn’t learn and whether or not they were able to put their learning into practice.
It seems to me that for many years we have become completely enslaved by the numbers and the people who use those numbers to constantly tell us that we can’t afford to do what needs to be done. I think that as a society we have been deceived into thinking (because most of us really aren’t very good with numbers) that those who purport to be good with numbers, are the only people worth listening to. Yet when you challenge those presenting the numbers, they often can’t back up their interpretation of the numbers with real life examples that demonstrate why the numbers matter more than real life outcomes. Only sharing stories and taking time for proper reflection can give us strategic and operation decisions that make the numbers add up and demonstrate what can really be achieved if we put our minds to it.
Frankly there’s no point in being numerate if you are not emotionally intelligent as well.
Jim Thomas
May 2025
Leave a Reply