Saturday, 18 December 2010

New targets/Nurses beyond means- Same old for 2011

It does not surprise me to see a lot of the same old NHS junk repackaged and called something new under the new government. 'Targets' are being scrapped, but the new 'Targets', ie performance indicators, are coming in. Lansley keeps trying to pretend that these new targets are all about measuring quality but this is hogwash, they are just targets by another name, as soon as something is used as a performance indicator you change what you are measuring, another piece of the system is fiddled and you are back to square one again. For example the 4hr wait was never of any use in determining the quality of care or helping patients, it just showed how quickly a piece of paper could be filled in and a patient dumped on a new 'assessment' ward. The new targets will be more of the same, measuring something completely changes the process and that measure's meaning, something that stupid politicians and managers completely fail to appreciate.

Some rather interesting information and recent scientific research points to the obvious fact that the less training you give to autonomous practitioners, whether doctors or nurses or monkeys, the lower quality of service patients will receive. Some interesting research from Holland points to primary care perinatal mortality being higher than that in secondary care, something a midwife would never even dream of considering, it runs against their fundamentalist doctrine of medieval home births. Some interesting recent news on the danger in giving nurses power beyond their means has hit the headlines. I see this regularly at first hand, numerous under trained staff are given responsibility and autonomy way beyond the limits of their knowledge and training, the side effects in terms of patient harm are inevitable and regular. This does not just apply to nurses in dangerous extended roles, it applies to certain paramedics, other quasipractitioners and technicians, including health care assistants and other staff with minimal training.

Onto the topic of health care rationing, something I have no problem with as a general principle, we do not have infinite funds. However when this rationing is done in a way in which the non-medically trained are empowered to make clinical decisions that are both reckless and dangerous, then I am completely against it. Numerous PCTs have sod all cash and as a result are stopping all elective surgery that they deem to be of 'low value'. The problem is that a lot of these low value procedures are often rather essential and need to be done as almost an emergency, if not then the knock on costs in terms of patient morbidity and long term disability are far greater than the money saved it not doing a simple effective procedure. This is stupid short term NHS thinking at its best, so a new government, but the same old stupid top down rubbish spewing forth. I see more of the same for 2011.