The Today programme carried an interesting piece this morning on the effects of target driven outputs in the NHS. In an attempt to make emergency treatment in hospitals a priority, a 4 hour treatment target has put almost unbearable pressure on some A&E departments and clinical staff. This was summed up by Dr John Heyworth, Chairman of the College of Emergency Medicine:
"We've had nurses reduced to tears. We've had very senior consultants in emergency medicine threatened with a disciplinary process. This is an outrageous misuse of the standard. It's not what the clinicians are in the emergency departments for. But it's representative of the immense pressure being put on chief executives and all managers downwards from there to comply with the target."
These top-down targets from central government arm ministers with politically expedient figures to fire off in debates and in the media. And it’s certainly a noble ambition to treat every patient within four hours; common sense says the quicker hospitals can treat people in A&E the better. Dictating from the centre that it must be done at all costs is clearly having negative consequences though. We've seen that a narrow focus on inputs (i.e. a huge increase in funding) to achieve basic outputs (targets) means that the quality of care suffers (productivity). This has more disastrous consequences than Today's story of course - Mid Staffordshire being a recent case in point.
Today’s story compounds others like it, such as the high level of readmissions supposedly due to patients discharged too early, in order to meet targets. We can put the focus back on patient care by making the NHS less centralised and monopolistic, with improvements driven by clinicians, not politicians. Our report Wasting Lives sets out exactly why this is so vital.