This account from the front line clearly explains two things:

1. How targets can damage the medical care of patients and
2. How you cannot trust government official statistics claiming to show improved patient care.

Where's my patient?" asked Ruby looking around A&E frantically. "I've lost her. She was here a minute ago." She stood by the cubicle where her patient had been and looked around. "Maybe she's discharged herself," I suggested. "She's just had a stroke and the left side of her body is paralysed, so I doubt it," Ruby replied. "I only turned my back for a few moments."

Now, it's not unheard of to lose things in a hospital: a handbag, even your sanity, but a patient? Surely an A&E cubicle would be a safe place to leave a bedridden patient? Apparently not, as Ruby and I discovered that evening.

"Oh, here she is," I said, looking on the inpatient system on the computer. "She's not in the cubicle, she's upstairs." "How did she get there? She can't even sit up, how could she make it up stairs?" replied Ruby, perplexed. "She's in a bed in the acute assessment unit. Someone's moved her," I replied. "What?" shouted Ruby. "She's not medically stable. She's not ready to go to a ward. There must have been a mistake."

After several frantic phone calls, it transpired that there had been no mistake. The decision to move the patient out of A&E had been taken not by a member of the medical team but by a manager, because the lady was about to breach the A&E waiting target of four hours. The decision as to when a patient is medically fit to be transferred was once purely clinical. Now, it's financial.

With the introduction of targets came financial penalties for hospitals that failed to meet them. Of course, targets were introduced with the best of intentions: to improve patient care. But they have metamorphosed into a stick with which clinicians are threatened by an increasingly powerful non-clinical management.

When I began my training 12 years ago, it would have been unthinkable for a manager to interfere with patient care, let alone act unilaterally. Now, it's commonplace. The shocking story of Mid Staffordshire NHS Trust is an indication of how far things have gone. A litany of failings was uncovered between 2005 and 2008, and managers were accused of putting targets and cost-cutting ahead of patient welfare, leading to as many as 1,200 needless deaths.

The article was by Max Pemberton, a doctor who writes regularly in The Daily Telegraph.

The full article (and the rest of it is worth reading) is here.http://www.telegraph.co.uk/health/healthadvice/maxpemberton/5061576/NHS-Have-targets-become-more-important-than-patients.html

Posted by James Bartholomew • Indexed in NHS

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