In­side Health

Tar­gets are a god­send for poor man­age­ment in the NHS, says Ke­van Christie

The Scotsman - - Perspective -

The mount­ing pres­sure be­ing placed on health sec­re­tary Shona Ro­bi­son, not least from her po­lit­i­cal op­po­nents over missed NHS tar­gets, de­serves closer scru­tiny.

De­spite writ­ing con­stantly about the state of the NHS in Scot­land un­der the cur­rent gov­ern­ment and jump­ing on the weekly freefor-all around missed wait­ing times, I feel the Cabi­net sec­re­tary has been ham­strung by her own min­is­ters and NHS boards. The rea­son for this is down to the NHS Lo­cal Delivery Plan (LDP) Stan­dards or tar­gets that cur­rently have to be met on all as­pects of health­care, re­plac­ing Heat tar­gets in 2015-16.

An ea­gerly-awaited re­port which was ini­tially due in the spring by Sir Harry Burns, the Chief Med­i­cal Of­fi­cer for Scot­land from 2004 to 2015, will pro­vide ini­tial rec­om­men­da­tions into the tar­gets and in­di­ca­tors of health and so­cial care.

The prob­lem with tar­gets – and specif­i­cally those who set them – is that they are an ab­so­lute god­send for medi­ocre man­agers ev­ery­where. They should only come pre­fixed with the word “sales” and are the first port of call for those who can’t man­age ef­fec­tively. They are a tool for bosses who shy away from com­mu­ni­cat­ing with “real” peo­ple and in a worst-case sce­nario rep­re­sent a form of in­sid­i­ous bul­ly­ing.

There’s only one tar­get, es­pe­cially where the NHS in Scot­land is con­cerned, and that is to make things bet­ter.

There is no com­mon­sense or sci­en­tific ba­sis for the ac­cu­racy of most tar­gets, all they do is as­sume things will im­prove ev­ery year and of­ten a num­ber is plucked out of thin air with­out any ra­tio­nale or logic be­hind it. They don’t pro­vide an ac­cu­rate pic­ture of what is go­ing on in the NHS, the great break­throughs be­ing made in med­i­cal sci­ence for in­stance.

So, we now have the weekly feed­ing frenzy ev­ery time a tar­get is missed.

Is it re­ally a na­tional “dis­as­ter” if , for ex­am­ple, the num­ber of pa­tients hav­ing to wait no longer than 12 weeks for their es­sen­tially free treat­ment falls from the 95 per cent tar­get by a few per­cent­age points?

The 10 per cent fall in meet­ing the tar­get for key di­ag­nos­tic tests, in­clud­ing pro­ce­dures to de­tect can­cer, as re­ported yes­ter­day, marks a low point in tar­get cul­ture but it’s been com­ing.

What the Scot­tish Gov­ern­ment does not seem to grasp is that the prob­lem here could be the ac­tual tar­gets which they are re­spon­si­ble for set­ting along with NHS boards.

They have set them­selves up for fail­ure and in do­ing so have cre­ated the now ir­re­versible per­cep­tion that they are fail­ing on health.

Tar­gets are noth­ing more than a big stick with which to beat hard-work­ing staff, and give the Scot­tish Gov­ern­ment’s po­lit­i­cal op­po­nents a ready-made stock­pile of am­mu­ni­tion.

I imag­ine our ex­cel­lent doc­tors, nurses and med­i­cal staff are fed-up hav­ing to read about an­other missed “ar­ti­fi­cial” tar­get which does noth­ing for morale and paints a neg­a­tive pic­ture of the great work they are do­ing.

This cul­ture doesn’t look like chang­ing any­time soon and is all-per­va­sive through­out the Scot­tish public sec­tor, with the po­lice and other bod­ies hav­ing to meet a con­stant stream of tar­gets.

Un­less things change – and they could af­ter the Na­tional Re­view of Health & So­cial Care Tar­gets and In­di­ca­tors re­port is fi­nally pub­lished – the next in­cum­bent of the health sec­re­tary hot­seat will have no chance.

Surely, the po­lit­i­cal will has to be there to do away with these mean­ing­less tar­gets?

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