Wednesday, 27 February 2008


Targets - the NHS is full of them. There are targets for how long you wait to see a GP, how long you wait in A&E, how long you wait to be seen by a specialist. Where do all these targets come from - and are they any good?

Targets are part of performance management and quality assurance, making sure that everyone has a good level of care. The targets from a wide range of places. Colchester General (Essex Rivers) has recently had its PEAT inspection. PEAT stands for Patient Environment Action Team. It's part of the National Patient Safety Agency and has been inspecting hospitals since 2000, looking at cleanliness and the food available.

NHSLA is the NHS Litigation Authority - formerly known as the Clinical Negligence Scheme for Trusts or CNST. The NHSLA works for Trusts when claims of negligence are made against them. The more a Trust can be shown to be working to avoid negligence claims the less insurance it pays to cover itself against such claims. NHSLA looks at governance, "competent and capable workforce" (which includes the training people have access to), environment (which is about the human environment - bullying and harassment - as much as about avoiding hazards for slips, trips and falls), clinical care (including record keeping), and "learning from experience" which is about record keeping, complaints procedures and so on.

Next up is Standards for Better Health. These standards cover safety (child protection, infection control, waste disposal etc), clinical and cost effectiveness, governance (corporate and financial, including training staff), "patient focus" (food, patient information, complaints systems), "accessible and responsive care", care environment and amenities (safe and clean), and public health.

The four hour wait in A&E is a Department of Health checklist and the 18 week target - which has a website of its own - is an NHS initiative. NICE does some measuring, too, as does Dr Foster (but not on the public website), and the Healthcare Commission provides an "annual health check" on all trusts.

So many targets - but do they do any good? In 2004 the government pledged to reduce the number of NHS targets. Academics accuse NHS managers of fiddling targets, while ministers admit that trusts are "systematically rigging" targets. The 18 week targets means it's impossible to book an appointment in advance and the 4 hour wait target is adversely affecting patient care because the clock has become more important than the needs of the patient.

However, targets have helped drive down waiting lists. Targets measure (some aspects) of what goes on and encourage improvement and change. If a trust is very good then it can rise to foundation status, freeing it from some of the targets and central government control so that it can work flexibly to provide what is needed locally.
Books in the library on quality and performance management? But of course.

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