"The NHS will last as long as there are folk left with the faith to fight for it"
Aneurin Bevan

Wednesday, 6 January 2010

Conservative Draft Manifesto 2010: Dissection Part 1

An analysis of the Conservative Draft Manifesto 2010.

A Patient-Centred NHS

"We will scrap all of the politically-motivated process targets"

Ah targets, the Tories bugbear. Let's start by saying that targets are not perfect. They can be a blunt tool, and they are subject to "gaming" where people subject to the target go by the "letter" and not the "spirit" of the target. (An example of this is ambulance trusts being given a target to reach a category A emergency within 8 minutes, and surprise!, after this target was set the vast majority of trusts reported attendance to have taken just under 8 minutes.) This does not mean that targets are bad, just that they must be applied intelligently and they should be constantly reviewed.

One typical argument from the Conservatives is that monitoring targets means an increase in the number of administrators, so, the argument goes, if you remove targets then you remove administration. This is childish nonsense. Every organisation has quality control, and the only way that you ensure quality is to monitor it. Every organisation with quality control will know what part of their organisation is not performing well and will have a plan to make improvements to the level where they want to be. What is that level called, the one where they want to be? Well, that is a target. All hospitals have their own targets: some publish them, some do not. The government-set targets are public and the hospital has to publish them. This is a good thing, it is transparency and shows us how well the hospital is working.

If you wish to know how well a local hospital is performing you can download the data from the Department of Health website. You can also get basic information about a hospital at the NHS Choices website which also allows you to leave comments about a hospital, and allows you to view the comments of others. The Care Quality Commission website also has reports about the quality of clinical care. In addition the Dr Foster website has what they call Quality Accounts Summary for every hospital in England.

These reports all grade hospitals according to the metrics they gather. And grading is a form of target!

Abolishing targets will not reduce administration because hospitals will continue to monitor quality of care. However, abolishing targets completely will mean that the public will no longer know how the hospital fares under those specific quality measures. Is that what patients want?

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