&gt; objective [...] subjective<p>They should be trying to capture the subjective stuff too.  See, for example, the Friends and Family test which is everywhere. Service Use Experience Committees also try to capture the subjective stuff.  Complaints department mostly deal with subjective stuff.  Healthwatch independently deal with mostly subjective stuff too.  There&#x27;s a wide range of subjective stuff that&#x27;s measured using things like PLACE (Patient Led Assessment of the Care Environment) or 15 Steps Challenge.<p>But people paying the money tend to like things that are more directly measurable.  They might have CQUINs (Commissioning Quality through Innovation (or something like that) to ask people to implement 15 steps challenge, without worrying too much about what the results are.<p>&gt; They have a bunch of numbers they have to make, but what do the numbers actually mean? What happens when people end up gaming the system, because the rules tell them to?<p>I dislike the focus on numbers, but if you compare areas where they have strict numbers (4 hour A&amp;E limit) and areas where they don&#x27;t (access to talking therapy) you see that most (it was national scandal when it dropped to 85%) people who attend A&amp;E are triaged and then treated + released or admitted into hospital within four hours versus, well, untold wait.  Very recently (or maybe it&#x27;s not in place yet) there&#x27;s an 18 week limit for access to community based psychological therapies, so it&#x27;ll be interesting to see if it makes a difference.<p>&gt; What happens when people end up gaming the system, because the rules tell them to?<p>Various regulators and scrutineers hate that, and they have some power to drive change.  Or NHS England &#x2F; DoH force change.  Some hospitals were transferring people to an observation ward from A&amp;E, rather than treating them or admitting them into hospital.  That got stopped pretty quick.