Wednesday, 7 December 2011

Does Dr Lansley really know best, with his blitz of 60 NHS targets that exclude waiting times?

Today, the Health Secretary, Andrew Lansley, has launched his 60 targets for the National Health Service. This from a Secretary of State who, in opposition, said that he would be getting rid of NHS targets. But, then, this was the same politician who misled voters (and, possibly, the Prime Minister) about his true intentions for the health service. Apparently his structural overhaul plans were hidden in an obscure speech somewhere that sadly didn't make it to the Tory manifesto writing meeting or the script for Conservative candidates.

To be fair, it is hard to find a lot to disagree with in the good intentions behind targets that range from reducing mortality rates for people with several different conditions enhancing the quality of life for carers. Few would argue that the NHS should not be doing all those things. But it is the presumptiveness behind the whole exercise that is more worrying.

Mr Lansley tells us in the same breath that all these measures matter to patients, whereas they care not whether they wait four or twelve hours in A&E on a trolley, or whether they are seen and treated in 18 weeks rather than 18 months by a consultant. On both these measures, of course, he is busily undoing a huge success of the Labour government in reducing patient waiting times drastically, whilst at the same time, incidentally, significantly improving patient outcomes and the quality of many hospitals and GP surgeries.

But, no, the word 'waiting' appears nowhere in the 56 pages of targets unleashed on the NHS today. 'Doctor'
Lansley thinks we mere mortals shouldn't worry our pretty little heads about how long it takes to get seen by a doctor, just as long as they are meeting wider outcome targets. Instead of objective measurable data on waiting times, we are instead expected to rely on the NHS version of those ghastly happiness surveys that have been foisted on us by No 10. Ministers will say that the 18 week guarantee is enshrined in the NHS constitution: if this is to be more than a paper promise, it should at least form one of the 60 targets that the NHS will apparently be judged on. As the Kings Fund has said:

With the spending squeeze beginning to bite, the number of hospital inpatients waiting more than 18 weeks for treatment is already at its highest level for more than three years and waiting times for A&E and diagnostic services have also risen. As the government has said that it is opposed to targets, it now needs to be clear about how this pledge will be measured and enforced.

The Government has already weakened the A&E target so that hospitals are expected to allow waits of no longer than four hours in 95% of cases rather than 98% under Labour. Yet, even in the summer months, this less rigorous target was breached by 29 hospitals, according to the Kings Fund, while longer diagnostic to treatment waits are creeping up.

The trend since June 2010 for the proportion waiting more than 6 weeks for diagnostics has been upward and the percentage waiting more than 6 weeks has risen from 1.13 per cent in August 2010 to 2.0 per cent in August 2011 – equivalent to a rise in the number of patients from 5,800 in August 2010 to more than 11,400 in August 2011.

The Kings Fund points out that, in 2007, a third of patients had waited more than six weeks, a measure of Labour's success in cutting waits since then. How many more hospitals will ignore maximum waiting times, now that the health secretary has said he doesn't think it matters to patients how long they wait? Meanwhile, we are told in today's document that are no indicators available yet for 'ensuring that people have a positive experience of care' and that these are being 'developed'. In other words, instead of using existing waiting times data as a benchmark (even the laxer A&E data), new figures will be dreamt up and approved by the omniscient Lansley to confirm that things are getting better.

But there is a bigger problem 'focusing' on so much data, and it is echoed to a lesser extent at education. Without a clear focus on a small number of straightforward national targets, one might as well have no targets. In Labour's early years, the Treasury bombarded departments with new targets that were intended to show that the extra money on offer would be well spent. It was only when these were heavily stripped back that they had any impact. Michael Gove has recognised at education, floor targets related to national tests at 11 and GCSEs helped lift standards significantly in weaker schools, just as maximum waiting times in the NHS helped measure systemic change there. Of course, there is always some gaming with any targets, but the reality is that in both cases, most of the improvements have been real and substantial. It is hard to see the same energy being devoted to all of Lansley's 60 targets announced today, not least at a time of real terms cuts in most areas. In the end, we may not be able to see the wood from the trees.

But we don't need to worry, do we? After all, Dr Lansley knows best. Doesn't he?

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