Wednesday, 5 March 2008

Spinning the lists

From a personal point of view I am sick to the back teeth of stupid politically driven targets. In surgery for instance care is now driven towards targets that are not clinically driven, meaning that there is simply no clinical common sense in place. Patients with urgent problems go into the same 18 week statistics pot that patients with very non urgent problems go into, the word 'treatment' is now redefined to mean any contact with anyone who resides vaguely near a hospital and patient pathways are fiddled about in order to improve statistics, rather than simply improving care via clinical drivers. While the enforced market via 'Choose' and Book has meant that patients get an impersonal service with no continuity of care, so much for Alan Johnson's personal NHS, it's only personal for the damn Labour party.

It is therefore rather ironic that average NHS waiting times have actually gone up under labour, a story that has hit the news this week. Most importantly clinical imperatives are now overridden by political ones. Urgent cases are now delayed because non urgent ones must be carried out, in order to meet the holy targets and it results in more patient suffering than strictly necessary. In health care one has to be very careful what one measures, as once something becomes measured it changes its nature entirely. In health care measures can also be rather meaningless and deceptive, for example as regards productivity; if productivity is simply seen as completed patient contacts then one could increase productivity by replacing all doctors with monkeys, however logically this is clearly a daft idea, it's a great shame that the likes of Simon Fradd and the government like the monkey thesis. Targets continue to appear a bad idea on many levels, and this situation will not be helped by the government introducing more targets to cover the previously un-targetted areas. I wonder, would this government fix a leak in the roof by taking the roof off? I sincerely suspect they would.

1 comment:

Anonymous said...

Counting patient contacts also encourages unsatisfactory behaviour.

If an elderly patient is admitted, treated, and cared for in hospital until properly well enough to return home; thats one patient contact.

If the same patient is admitted, treated and sent home too early without proper aftercare, and is subsequently re-admitted in a poor state; 2 patient contacts!

Kerching! Shame about the patient, but in the ruthless world of bean counting there are always going to be some casualties. But these will not be the bean counters or their political masters. They make sure of their golden parachutes as rewards for all their stirling work towards the triumph of the expensive and pointless. And politicians wonder why we are so cynical.