Performing to measure with our health

No Right Turn posts today, wondering whether the National-led government’s new intention to set targets for Accident and Emergency waiting times will actually make any difference to patient care.  And suspecting not.

I have to say I’m with him – the idea that the government is borrowing comes from Britain, and smacks of performing to measurement rather than measuring performance.  But then I lived in Britain for many years, and even visited accident and emergency departments on a couple of occasions – neither of which were a joy and a delight. 

No Right Turn points to a British documentary which showed NHS managers creating new posts to “hello” patients so they could be said to be “seen”, and taking the wheels off trolleys in corridors so they could be reclassified as beds.  Thereby meeting targets of seeing patients and providing them with a bed within required time-frames.

A survey of British A&E departments in 2003 showed that during the week they were monitored, two thirds simply put in place extra temporary staff, asked staff to work double shifts, or cancelled surgery to free up beds for A&E – so they could reach their “target” times.  Performing to measurement, not measuring performance.

To quote Mr Don Mackechnie, an A&E consultant and Chairman of the British Medical Association’s A&E committee:

“I am appalled to see how A&E departments have been forced into taking extraordinary measures for a week-long period just to meet political targets. It is completely immoral of the Government to claim that it is raising the standard of performance in the NHS when this is how they measure it. It is quite wrong for patients expectations to be raised in this way.”

A later study suggested that the most important factors in reducing waiting times was…..more hours for staff.  Senior doctors, junior doctors, nurses and non-medical staff.  The more increases the better. 

There is also the argument that dealing more effectively with social issues like domestic violence and drink-driving might lead to less call for A&E services in the first place.  But I veer towards nanny-statism I fear – as opposed to funding new bureaucratic positions to count hours. 

A lean, mean state indeed.

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