ONE suspects that many people working at the sharp end hear the nation’s politicians discuss healthcare, and shrug their shoulders as they get on with their jobs in the real and complex world. The crowing and finger-pointing, the posturing and pretences, must often constitute an unhelpful distraction from the vital work at hand. It’s not that the politicians don’t care or aren’t doing their best. Try as they might, they themselves are prone to being blamed for circumstances beyond their control or for failing to meet their own declared aspirations. They should be in a position to understand then that, in the health service today, a culture of blame and unreasonable demands has developed through the setting of neat and tidy targets for work that can get complicated and messy.
Sir Harry Burns made the point earlier this year, in his review of NHS targets, when he said of tidy targets that “clinical practice isn’t like that”. He called for the prioritisation of clinical issues over target-setting, and for some perspective when it comes to the complicated business of healthcare.
Now, Dr Peter Bennie, chairman of the British Medical Association’s Scottish Council, has echoed that assessment, describing targets as “crude measures” in a complex field. They may have their place but are not the only way of judging performance. Worse still, they create a “culture of blame” and put undue pressure on clinicians.
The focus, Dr Bennie says, should rather be on outcomes for the health service as a whole, on doing the right thing for patients, and letting doctors use their clinical judgment without recourse to the demoralising dictum that says: “Get them out the door as quickly as possible”.
Targets have their uses but can’t be the be-all and end-all in a health service, which by its nature is beset with complications and shifting demands. In this sector demand shifts only one way: upwards.
Where unfilled vacancies and inadequate funding are further factors (though we accept that funding demands only ever shift upwards too), targets recede into the distance. Everyone accepts there’s a place for standards, monitoring and measuring in the health service. It’s important to know where things are falling behind, and where they are doing well. But, by the same token, there is no point in setting targets if they are missed and, short of all the political hullabaloo and finger-pointing, nothing is done to address the situation. Targets are part of the bluster of politics: “We are going to do this.” But the actual doing is done in the operating theatres and on the wards, and should not be hampered by abstractions, numbers and political chest-beating.
Yesterday, it emerged that, in the week ending December 17, 81.1 per cent of accident and emergency patients were seen within four hours, well short of the Scottish Government’s 95 per cent target. This was attributed to an “unprecedented” surge in orthopaedic cases caused by icy conditions and to patients reporting with flu-like symptoms. The figures were met with unhelpful, knee-jerk comments about “SNP mismanagement” and “meltdown”.
Thus, the Scottish Government experienced first-hand how unforeseen circumstances can clutter the tidiest of targets. Responding to Dr Bennie’s remarks, Health Secretary Shona Robison said targets were part of a “balanced approach” to managing the NHS. However, the point is precisely that the situation has become unbalanced, which is why Dr Bennie has called for a “fundamental shift” of approach.
We urge Ms Robison to take these words seriously. Yesterday, she herself experienced the culture of blame that targets produce, and tried introducing some perspective. That is now necessary as regards targets and their place in a beleaguered health service dealing with unpredictable demand.
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