NHS targets to flourish under ‘arch moderniser
pharmafile | October 29, 2003 | News story | |Â Â Â
New Health Secretary Dr John Reid has committed the NHS to continued reform despite a growing chorus of disapproval over the central role of performance targets.
Quick to dub himself an 'arch moderniser', Dr Reid has indicated he will carry on the work of his predecessor Alan Milburn, who quit unexpectedly in June after overseeing nearly four years of radical change in the NHS.
Dr Reid's appointment has come just ahead of the first ever star-ratings for PCTs and mental health trusts, introduced against a background of considerable resistance from NHS managers, who say the targets are often counterproductive.
"With the arrival of a new Secretary of State for Health, a short pause to look at the whole health policy agenda would be very welcome", said Rabbi Julia Neuberger, Chief Executive of the King's Fund. She said the Government should now focus on neglected areas of health policy, and continue with its reforms, but also to re-examine its use of targets.
"For these under resourced services, to advance in terms of both quality of delivery and access, performance targets must be eased. Front line staff must be allowed to provide the care their patients need without being pressurised into meeting quick-fix, short-term goals, and local people could discuss with healthcare staff what local goals should be", she said.
"Nobody denies that targets are a useful tool, but these need to be fewer, and they need to be evaluated to make sure they do not lead to perverse consequences".
These 'perverse consequences' manifested themselves most strikingly as acute trusts across England and Wales recently threw all their efforts into hitting the target of seeing 90% of A&E patients within four hours.
A&E staff in many hospitals found dozens of extra doctors and nurses working alongside them for one week in March, only to see them leave once the performance management was complete.
Meanwhile, the national hospital operation waiting list dropped below the one million mark for the first time in 10 years in March, only to creep back up the following month.
The Audit Commission's recent authoritative report 'Achieving the NHS Plan' also expressed concerns that waiting time reductions could not be sustained, and said the Department of Health should "refine" targets where necessary.
Overall, the report found the majority of NHS trusts were making progress, but warned that very few trusts were on track to hit all their allotted targets.
The Commission for Health Improvement has now inherited the setting and monitoring of all performance targets as it prepares to transform into the all-powerful independent watchdog, the Commission for Healthcare Audit and Inspection (CHAI).
Primary care trusts and mental health trusts will receive their first ever full star-ratings this month, putting in place performance measurements across a number of core areas and directly linking these to budget allocations.
The targets are grouped under four main headings – Key Targets, Access to Quality Services, Improving Health and Service Provision. Included are three key indicators of prescribing. Firstly, the watchdog will be looking for increased levels of atypical antipsychotic prescribing, which will be used as a yardstick for uptake of NICE guidance and higher levels of generic prescribing. Meanwhile, PCTs will have to meet targets to reduce prescribing rates for antibacterial drugs and benzodiazepines as a measure of their success in tackling inappropriate prescribing.
CHI says it is now on course to publish the star-ratings by mid-July, and has made special efforts to overcome a 'them and us' feeling by giving PCTs consultation before the ratings are finalised, as well as stressing the challenges it faces itself.
Stating that it is has been working to a "precise and demanding work schedule" in order to convert a huge amount of data into "accurate and representative" indicators, CHI pleaded with PCT executives not to sabotage the process.
"While CHI is generally keen to consider the views of the service on the development of indicators, the data ratification exercise is not the occasion to focus upon the perceived merits or otherwise of particular indicators".
Many leading commentators inside and outside the NHS say Dr Reid's appointment is a golden opportunity to re-examine target-setting in the service, but short-term political imperatives may once again take precedence.
An impending showdown between the Government and consultants over deadlocked contract renegotiations may force the new Health Secretary into a combative role at the outset, which may prove difficult to shake off.
