Monday, 23 March 2009

Cancer mortality unchanged and more targets

It is obvious that the government's grandiose inefficient top down schemes don't work very well, another example of this has been the government's 'Cancer plan', yet another superficially catchy plan backed up with more targets that appears not to have worked. Blanket targets that force patients to be seen within a certain time frame irrelevant of their actual clinical need are ways of robbing Peter to pay Paul.

The only way to improve our cancer mortality figures is to scrap the targets and continue to sink money into capacity on every level. This doesn't only mean quicker surgery by more operative capacity, it means more radiotherapy capacity, more capacity of adjuvant therapies like chemotherapy, easier access for GPs to diagnostic services and more capacity in the specialist clinics and in radiology departments. It would take a hell of a lot of money to drag us back into line with the rest of Europe on this one after so many years of relatively underspending.

Simon Caulkin's quite magificent article in the Guardian brilliantly exposes just how foolish the government's approach is to these complex problems:

"Target-driven organisations are institutionally witless because they face the wrong way: towards ministers and target-setters, not customers or citizens. Accusing them of neglecting customers to focus on targets, as a report on Network Rail did just two weeks ago, is like berating cats for eating small birds. That's what they do. Just as inevitable is the spawning of ballooning bureaucracies to track performance and report it to inspectorates that administer what feels to teachers, doctors and social workers increasingly like a reign of fear."

You can read the rest of this excellent critique here, it really is a fantastic piece of journalism:

"They even propose a health warning: "Goals may cause systematic problems in organisations due to narrowed focus, increased risk-taking, unethical behaviour, inhibited learning, decreased co-operation, and decreased intrinsic motivation." As a glance at Stafford hospital would tell them, that's not the half of it."


Old Codger said...

A few years back I was diagnosed with prostate cancer. The consultant gave me an operation date just over a month later. Not hearing anything I 'phoned close to the date. "We have had to shuffle the beds". The new date was about a month on. This happened a few times.

Newspapers were reporting all cancer patients received treatment within 1 month of diagnosis. I wrote to the Secretary of State (Alan Johnson), copied to the two relevant NHS Trust Chairmen, suggesting the reports were in error. The reply, from a Civil Servant, said I should complain to the Trust. I wrote to the Prime Minister (Brown) again suggesting the reports were in error and that his Secretary of State did not appear to be taking this seriously. I also pointed out that on the one previous occasion when I had cause to write to a minister I had received a reply signed by said minister. The reply, again from a Civil Servant, said in effect that ministers were too busy to reply to the likes of me, followed by detailed instructions on how to complain to the Trust.

The operation went ahead without further delay and was successful. No thanks to the government though.

Garth Marenghi said...

I think there have been many let down by the lack of capacity in the system.

A close friend of the family recently died of a certain cancer for which his treatment was delayed, delayed and delayed. He could have probably been cured if had been treated quickly and aggressively, however as things were left to spread before anything was done he died.

The targets rob Peter to pay Paul, so there are always people being let down unless the money is put towards frontline services and capacity. So much of the extra money in recent years has been wasted in ideology and consequently bureaucracy.

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