NHS targets have had their day

Lord Prior of Brampton is reported by The Times as saying: “NHS staff suffer from learned helplessness in a dysfunctional system”

So what prompted this mystifying statement?

A&E units are currently reporting their worst numbers of patients waiting longer than four hours, many on trolleys as no beds were available – the NHS Confederation of Managers says the system is “buckling under the strain of rising patient numbers”

Prior claims this is because targets, competition and a reliance on inspectors have led to a ‘disjointed system and demoralised staff’ – breaking up the NHS into autonomous hospitals has made ‘ driving an integrated strategy across the service almost impossible – you could not have designed something that had at its heart more dysfunction’

Chaotic organisation and overuse of targets has led to ‘a disempowered culture, a learned helplessness culture, a top-down looking upwards culture, a very hierarchical culture’ – targets which once worked well when waiting times were unacceptable ‘have had their day’

At present, hospital bosses are under such enormous pressure to hit their targets that there is now ‘widespread gaming of the system’ – frantic efforts are made to get patients out after three hours and 55 minutes waiting, but care stops once the target is missed

Hence, Prior seeks ways to address these cultural issues and bring back the vocation he remembers doctors and nurses once had viz:

  • Junior doctors would say ‘at the end of our day when we’re about to go home, we’d always walk back to A&E to lend a hand if there was a problem – now we go home’
  • When GPs and nurses qualified for their maximum pension, most would stay on for at least another two years – now they simply say: “I’m going”

The issue is how to regain that engaged spirit ‘which would take care of so many of the NHS’s other problems’

But Taj Hassan, president of the Royal College of Emergency Medicine, offers a cautionary note – “If policymakers and governments choose to scrap these targets, they must be held accountable for any impact on patient safety and the added risk of harm or avoidable death”

Conclusions:

Targets still have a role to play in the NHS – the issue is not whether they’re needed (some are, some are not) but how the important few are used

A wholesale NHS management culture change is indeed needed – targets should never be imposed from ‘on-high’ and managers told to ‘get on with it (or else)’ – they need to agree their targets first, taking account of the resources available to them, and then be left alone to figure out how best to meet them – words like challenge, reward, empowerment and accountability should replace the current central control, hit-squads, penalties and micro-meddling that many hospital bosses fear at present

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