Could CTA & CTS Be the New NHS Metrics That Really Count?
In my last blog, I argued that we need a fourth “Left Shift” — from acceptance to active dissatisfaction — if we’re serious about transforming services.
This time, let’s look at how to turn that dissatisfaction into action. Hold tight — it’s going to get bumpy.
The NHS: A £190 Billion System With Too Many Metrics
The NHS is a £190 billion powerhouse running on performance measures few understand or use effectively.
Here’s a sample:
You can add ambulance handovers, GP appointments, and dozens more.
The NHS tracks every penny, procedure, and staff hour — yet still lacks simple, system-wide metrics that drive real improvement. We measure how we work today, not how well we deliver care.
That’s a blind spot — and it drives the wrong behaviours.
Could New Metrics Drive Real Change?
In every other consumer facing industry, leadership lives and dies by two numbers:
The NHS could apply the same logic to care delivery, especially where pathways cross multiple providers. Understanding variation in CTA and CTS could reveal massive waste and prompt a complete rethink of how care is delivered.
Cost to Acquire – Elective Care
Take orthopaedics. Across England, tens of thousands of outpatient referrals never lead to surgery. Consultant time wasted, MRI slots clogged, and patients deteriorating while waiting for appointments they never needed.
That’s not patient care — that’s operational theatre – excuse the pun.
If the NHS measured referral quality like retailers track customer conversion, we’d know exactly how much that waste costs.
Looking at conversion rates by GP through the CTA lens would show where support, triage, or training could improve referral accuracy — cutting cost, waiting times, and patient frustration.
At HETT last week, a clinician from Cumbria described a T&O triage model directing patients to physiotherapists when surgery wasn’t needed. They’re now close to best-in-class on conversion and wait times.
Cost to Serve – Non-Elective Care
Every winter, the story repeats:
“Demand is up, beds are full, staff are exhausted.”
But how many attendances and admissions were actually necessary? The wrong customer at the wrong door?
How many could have been handled by community teams, same-day care, or virtual wards — if we tracked the real cost to acquire a genuine acute admission?
If anyone departing or admitting without an acute intervention counts as an unacceptable cost to acquire one that does, the picture changes fast:
Each example shows how poor CTA and CTS waste money and capacity — and distort priorities.
The Performance Problem
For decades, acute hospitals have been rewarded for activity, not value.
The more patients you see, the more targets you hit.
The busier you are, the better you perform.
It’s theatre — built on volume, not outcomes.
So why measure CTA or CTS when the system doesn’t care?
Because doing so would expose that:
That’s an uncomfortable truth — except for the patient.
Patients Pay the Price
Every unnecessary referral means someone else waits longer.
Every inappropriate admission blocks a bed for a patient in crisis.
Every duplicated test or missed triage drains funds from frontline care.
The NHS is full of brilliant, committed people — but they’re working inside a machine that refuses to measure and more importantly invest in what will truly deliver value.
Until we know what it truly costs – and it will be billions of pounds less - to get the right patient to the right care, first time, every time every reform is just tinkering at the edges.
The Data Required to measure CTA & CTS Already Exists
Introducing Cost to Acquire and Cost to Serve into NHS reporting would expose:
and many, many more efficiencies. It would show which parts of the system create value — and which simply consume it.
And it could drive a revolution in patient care and taxpayer value almost overnight.
Right Provider. Right Care. Right Time.
Maybe that should be the title of the missing delivery chapter of the NHS 10-Year Plan?
The Choice Ahead
The NHS can keep pretending that volume equals value, using process metrics that say nothing about outcomes and don’t drive effectiveness.
Or it can adopt a new set of metrics that measure what truly matters and change the way we design and deliver services forever.
Because in healthcare — as in business —
if you don’t know your Cost to Acquire and Cost to Serve,
you don’t know your purpose.
Right Provider. Right Care. Right Time.
Right Now.