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Are health targets necessary?

09:46 UK time, Friday, 17 December 2010

A target requiring ambulances in England to attend less urgent 999 calls within 19 minutes is expected to be scrapped by the government. Is this a good idea?

The steps are part of Health Secretary Andrew Lansley's drive to move away from what he considers to be the blunt system of targets which have been used in recent years. In its place, a measure of the "time to treatment" is likely to be introduced.

However, Justin Bowden, national officer of the GMB union, said: "The announcement to scrap the 19-minute response time for ambulances is a shocking scaling back of the service currently provided to the public."

Is it a good idea to replace targets for non-urgent cases? Will the scrapping of targets affect the quality of care received? Are you a health service professional?

Thank you for your comments. This debate is now closed.

Comments

Page 1 of 4

  • Comment number 1.

    I don't see how anyone other than health service staff are qualified to comment on this.

  • Comment number 2.

    no ! not really .. How to run the NHS should be left to the NHS
    Not the left wing nanny ninnies

  • Comment number 3.

    When you're cutting the budget for the English NHS by 20% while pretending not to you need every bit of help to cover up your actions!

  • Comment number 4.

    I was getting irritated by the target culture imposed by labour. It always seemed to be counter intuitive and somewhere some part of the service suffered to meet targets. I hope this is a well thought out change but I am glad the number of targets are being reduced.

  • Comment number 5.

    it takes as long as it takes. I try to tell my own boss this when he puts to me ridiculous unacheivable targets. Must admit to being abit worried as in the report it says that they are making a "shocking scaling back" of ambulances. I was sort of under the impression he was going to make cuts of jobs that are not needed. The lifeboats yesterday, the ambulances today. People will die because of these 2 particular cuts. Get rid of the unecessary managers in the public sector, I know we have a massive debt that has to be paid but Im getting really worried about the changes call me Dave is making.

  • Comment number 6.

    Targets are good but target overload is not. Someone has to decide what has most importance, and a confusing raft of many targets is not a desired outcome, well-meaning yes but not that helpful.

  • Comment number 7.

    By scrapping this target, Lansley is ensuring that the management of the service can reduce the number of ambulances available. Current staffing and vehicle fleet numbers will currently be built around what is required to achieve this target.
    People must have noticed the ambulances and para-medic cars parked in laybys and by roundabouts, they are there, instead of being in the depots to ensure target reponse times are hit, it also reduces the number of staff and vehicles required, no spare capacity in the system.
    The 20% efficiencies(cuts to you and me) expected from the NHS will bring more of this.

  • Comment number 8.

    What the Health Secretary is doing is removing the point of reference - if you have to wait around for 30/40 mins then so be it! It will allow for ambulance stations to be more spread out (therefore less of them)even though it will clearly increase the travelling time.
    A few unfortunate outcomes are a price worth paying to save a few pennies!

  • Comment number 9.

    No. Nothing proposed by the Tory Lib Con Right Wing Government will be good for the rest of us.

  • Comment number 10.

    Perhaps this will make people less willing to call the emergency services for any pathetic excuse. Ambulances arriving to assist drunks, then being pelted by thugs and yobs, is not money well spent!
    An ambulance (and the fire brigade) attended a false alarm a few miles from my home earlier this year. They were hemmed in, then fire-bombed and pelted with bricks and other missiles. These are regular occurrences. Is this a cost-effective use of NHS/emergency services resources?
    I regularly see ambulances/paramedics attending to drunken louts in our town centre on a weekend. And old people are dying of hypothermia!
    Some form of authentication, with far more information provided by callers and a tracking system to identify time-wasters needs to be developed. With modern technology, this should be a breeze. Only then, when the system has been streamlined, will the emergency services be able to better focus their resources. Attendance times may then quicken.

  • Comment number 11.

  • Comment number 12.

    When Labour introduced a new target, Unions were not happy about them. Now the ConDems are removing them, guess what ? Yep, the Unions are not happy again. Basically, the Unions are like mardi children - whatever their parents do they end up bursting in to tears.

  • Comment number 13.

    The agenda of Lansley and the Conservative government is the piecemeal privatisation of NHS services. The ambulance service would be a prime candidate for hiving off to the private sector. However, as it stands, private providers would not be able to make a profit while meeting the current targets for response times. That is why Lansley is so keen to drop these targets: to make these services more attractive to the private sector.

    This really does underline the message that privatisation always delivers a poorer service. People should be urged not to allow themselves to sleepwalk into a US-style marketised healthcare system that would so the most vulnerable and most needy disadvantaged. Lansley's NHS reforms must be opposed in the strongest possible manner.

  • Comment number 14.

    The only reason Labour introduced a whole raft targets was because it wanted to be seen to be improving services as opposed to actually improving them.

    As the old saying goes, "You can't fatten a big by weighing it".

  • Comment number 15.

    What is a "less urgent" emergency call? If it's not an emergency, the emergency service shouldn't be dealing with it at all.

  • Comment number 16.

    1. At 10:11am on 17 Dec 2010, Dan_Dover wrote:
    "I don't see how anyone other than health service staff are qualified to comment on this."

    Oh no: if everyone had that opinion there would be no HYS!

    It is self evident that the NHS needs targets, otherwise what are the otherwise unemployable bureaucrats and pen-pushers going to do all day? I kow many health service workers and pretty much to a man they say that the problem with the NHS is not the targets, reorganisations, re-branding exercises and political interference, but the endless stream of sick people clammering for some kind of attention. What a nuisance!

  • Comment number 17.

    "Should time targets for ambulance response be scrapped for less urgent 999 call"? should be the HYS question based on just one of Andrew Lansley's interventions.

    'Time to treatment' is a disengenous statement. All health professionals, ambulance crews and first response teams are aware of the crucial so-called 'golden hour'.

    There are the obvious idiotic hoax callers that have always been with us, across all the emergency services, and should be 're-educated' like drink and drug drivers perhaps?

    However, in the majority of cases, those in most need are usually the most hesitant and disinclined to call for help or cause a fuss. Plus, if you are fit and well and have a vulnerable/elderly neighbour with no obvious family or friends visiting - try giving them your mobile number on a Christmas card this year?

    Furthermore - any parent of an infant or child - must trust their paternal instincts and call 999 for medical assistance - or their local GP - or both.

  • Comment number 18.

    Same old Tory tactics. Make cuts but disguise them as thought out improvements. Targets are needed in all big organisations but of course if they become the most important factor they can get out of hand that doesn't mean they should be scrapped. I don't trust the Cons with the NHS and this govt. in particular are bringing in a change a day, none of which can have been carefully assessed. We will all be so punch drunk with change soon that we will not notice their complete U-turn on campaign promises. They have already flipped several commitments, there will be many more.
    As soon as I hear a govt. minister repeat the mantra that the financial position of the country is the worst ever I know they are planning a change that will hit the poor and average wage earner. This constant repetition is deliberate in order to make the changes they always planned accepted by the public. We are financially in a better position than nearly all other EU countries and our unemployment figures were reasonable. This fact was published last week but of course didn't get reported by our drama loving media or the Govt. as it didn't fit in with their plans. If we collected all the unpaid taxes of the wealthy tax dodgers in the Tory party many of these cuts would be unnecessary

  • Comment number 19.

    If you can't measure it, you can't manage it. It doesn't matter what industry you work in or whether you call them targets, goals or standards of service, there needs to be some objective way of establishing what we are trying to achive and determining how close we are to getting there.
    To workers in the private sector, none of this is surprising. Their performance has been measured like this for decades. But for some reason, workers in the public sector (especially health workers and teachers) seem to resent having their performance measured objectively; so much so that "target driven culture" seems to have become a term of disparagement.
    As far as the health service is concerned, it seems self evident to me that waiting time is the first criterion by which most of us judge effectiveness. Whether it's how long you wait for an ambulance, to see the GP, to see a consultant or have your operation, this simple measure tells us a lot about how well the health service responds to our needs.
    Time to treatment may well be a better measure of performance than ambulance response times but, as the latter seems to be an essential component of the former, it isn't really possible to separate the two entirely. And if we don't measure all the components, how are we to know which parts are causing the system to fail?
    The important thing with all targets is to put in place measurements that accurately reflect the desired outcomes. This new measure might at least stop silly behaviours like patients being kept waiting in ambulances which, having met their own target, cannot hand their patient over to the hospital because the hospital is not ready to start their own target clock. But it's really just tinkering around the margins.
    Until workers in the public sector appreciate that we, the customers, are fully entitled to assess the quality and measure the timeliness of the services they provide, they won't really deserve the appellation public servants.

  • Comment number 20.

    2. At 10:14am on 17 Dec 2010, Lord Rant wrote:

    How to run the NHS should be left to the NHS Not the left wing nanny ninnies

    =====================================================================

    Running the NHS shouldn't be handed to the right-wing corporatists either.

  • Comment number 21.

    The only reason ambulance targets are being scrapped is because, in its current state, the ambulance service hasn't a hope in hell of meeting ANY good service targets. My 89-year-old father has recently been bed-ridden with flu, and when he didn't respond to treatment, his GP admitted him to the local hospital for tests and observation. The GP rang for an ambulance at 8:00am, the target said it should reach us within two hours. At 9:50am I received a rushed and garbled call from the ambulance service saying that they were overloaded and didn't know when they would get to us. The ambulance finally arrived at midday! (The hospital then took until 7:00pm to find my father a bed - but that's not the ambulance service fault.) Altogether a ridiculous and frustrating experience all round. And with Cameron now saying that health service spending is NOT guaranteed to be protected, things will only get worse.

  • Comment number 22.

    With UK PLC shutting down for the forseeable future, there won't be many people around to carry out work where targets matter, so I can see why the Government is scrapping them. They are unlikely to want much information on GP and hospital waiting lists, or ambulance arrival times when it will prove that they have cut services so much that even the most basic level of performance can't be delivered.

    No doubt many other targets will shortly follow as other department's prepare to shut up shop.

  • Comment number 23.

    I used to work in a private hospital which operated upon NHS patients so that the local NHS hospital could hit it's waiting list targets.This gave rise to all sorts of absurdities which I shall explain by way of this example:It was necessary to operate upon a fit,twenty five year old man to remove a tattoo rather than upon a self employed electrician who needed a knee replacement and who could not work until the surgery had been carried out.The reason was that the man needing the tattoo removal had been on the waiting list far longer than the electrician who needed the knee replacement and the NHS could not afford,literally, for the tatooed man to breach his target waiting list time.In other words,tick the box but miss the point as the electrician clearly should have had surgical priority but waiting list targets prevented this from happening.By no means was this an isolated type of case.Get rid of targets and manage on the basis of clinical need.The way everyone got around this type of problem was to admit the patient,in this case the electrician,through the local NHS A & E and straight to surgery thereby bypassing the NHS waiting list.It happened with heart surgery cases all the time

  • Comment number 24.

    Targets as guidelines are good, but if there is too much pressure to meet them, they can just distort things

    If someone has a stroke, or heart attack, or serious injury, the ambulance will get there as soon as it can. Really, having a 'target' is pointless, as the ambulance crew will WANT to get there quickly, and if they are held up by something outside their control (eg bad parking or other people blocking the road because of driving in snow when their car isn't equipped for it) then how will the target help?

    If someone breaks their finger or sprains their ankle, or just needs transport to hospital (it's cheaper than a taxi), or is psychosomatic (the ambulance crews know who they are), then the ambulance really CAN get there when it gets there. Risking accidents, or diverting from possibly more serious cases just to meet a target is not good.

    It's better to have a 45 minute wait for an ambulance if you've sprained your ankle than a 30 minute wait if you've had a stroke because the ambulances are all out meeting the 19 minute target for minor injuries.

    Targets don't account for 'bad days' - If you have a major incident at one side of an area, then 4 people have heart attacks at about the same time at the other side, targets are going to be missed, but that's not anyone's fault. If the targets are used as guidelines, that's good. If they are used to try to apportion blame where there is no fault, then that's not good.

    Also, if the targets in the NHS were cut, you could get rid of 20% of the staff instantly with no reduction in service. Masses of time is spent capturing the target data, and then generating the reports. My wife did some contracting in an NHS centre, and essentially, all her time (and that of most of the people she worked with) was spent generating reports for this or that target.

  • Comment number 25.

    ps for posting 23.

    Of course,these were targets introduced by Labour,the arch exponents of the tick box culture.

  • Comment number 26.

    17. At 11:09am on 17 Dec 2010, corum-populo-2010 wrote:

    "Should time targets for ambulance response be scrapped for less urgent 999 call"? should be the HYS question based on just one of Andrew Lansley's interventions.

    'Time to treatment' is a disengenous statement. All health professionals, ambulance crews and first response teams are aware of the crucial so-called 'golden hour'."

    As far as I know the 'golden hour' doesn't apply to broken ankles, vomiting, flu, feeling lonely, sleeping off a night binge drinking, etc. All these things will frequently result in an ambulance coming out, but the urgency is much less than for strokes, heart attacks etc.

  • Comment number 27.

    This coalition of the right is determined to reduce State provision to a minimum. They are using the mantra of 'reducing the massive debt burden' to drive through their agenda.
    They are not making cuts to balance the budget, once a service is gone it is intended that it is gone for good. The Tories intended to do this even if the economy was on an even keel, paradoxically, the crisis caused by the credit crunch enables them, together with their Orange Book Lib-Dem free-market devotees, to cut deeper and faster.
    Lansley's plan for the NHS is to replace a publicly funded, publicly provided health care system with a privatised, market driven system.
    It's in the Tory policy documents published in 2007, strangely not referred to in their election manifesto.

  • Comment number 28.

    This is just another cost cutting exercise that WILL reduce the current level of service irrespective of the smoke and mirrors tricks the ConDem party will try and dazzle us with and my how the LibDems have changed. Vince Cable sounded like a staunch Tory on TV yesterday.

    Whilst on the subject of cost cutting and austerity measures I came across and article yesterday on the Daily Mail website about how the palace was concerned there would not be enough troops to line the State Funeral route in the event of Lady Thatcher’s demise.

    Surely since we are all in this together and if the Lady herself had any morals such plans for a state funeral should be shelved in order to save costs and in the interest of public safety!


    PS I see someone mentioned the lifeboats in their comment. Luckily the RNLI is a self run charity and therefore cannot be touched by the government.

  • Comment number 29.

    I don't want a health service driven by targets, I want one driven by compassion!!

  • Comment number 30.

    I imagine those that drive for the 999 services get to where they need to be ASAP as a matter of course. Having a target is just extra stress and hassle when people are doing the best they can.

  • Comment number 31.

    When Labour introduced a new target, Unions were not happy about them. Now the ConDems are removing them, guess what ? Yep, the Unions are not happy again. Basically, the Unions are like mardi children - whatever their parents do they end up bursting in to tears----------

    So where do you get this little gem of information from?

    The Royal College of Nursing and Unison ,the Largest Two Nursing Unions have no problem with targets provided that resources are made available.

    Scrapping targets because you're cutting resources is detrimental to patient outcome.

  • Comment number 32.

    #9 Pamela Read ranted: No nothing proposed by this Tory,Lib,Con right wing government will be good for the rest of us. So you'd rather have carried on with Labours targets that meant patients being hidden in side rooms so that the A&E target can be reached? Ambulances are in the wrong places to keep on target? It's people like you and your incompetent and inept Labour government that has got us in this mess. With luck both of you will be consigned to the not fit for purpose bin where you belong.

  • Comment number 33.

    If it's non-urgent then where did the original target of 19 minutes come from?

    I see nothing wrong with the ambulance service using the triage methodology to determine who gets to be seen quickest.

  • Comment number 34.

    All this user's posts have been removed.Why?

  • Comment number 35.

    When Tony Blair took office he identified and introduced "targets" in NHS like, for instance, reducing waiting time between referral by Doctors to being seen by consultants. But unfortunately the abuse sets in when officials start ticking boxes on paper rather than actually carrying actual treatment of patients. Sad to say in some Hospitals where we used to have matrons, we now have health managers who know exactly buggerall about nursing or healthcare. I visited a friend recently in hospital, and there were always cleaners about either wiping or mopping, and even advising me to use gel on my hands for health reasons, well done there. But of course these things are not easy, but we are lucky to have NHS in this country which we can all access.

  • Comment number 36.

    28. At 11:25am on 17 Dec 2010, RonC wrote:

    ...

    I see someone mentioned the lifeboats in their comment. Luckily the RNLI is a self run charity and therefore cannot be touched by the government.


    But isn't that an example of what this Government calls the Big Society, namely independent charities running essential services.

  • Comment number 37.

    The problem with targets is that staff are needed to record and analyse the data. The parameter that cannot be measured is good-will; the ingredient that exists within publicly employed staff and to a much lesser extent in profit-led private service.
    The computer has brought many benefits to us all but the downside is that it has spawned a culture of measuring "the efficiency" of every damn thing we do. The result is a cynicism that pervades all publicly funded services i.e. never mind the quality, feel the width.
    And you cannot blame people for playing along because there can be bonuses to be gained or perhaps jobs to be lost based upon the results.
    I would like to see wholesale scrapping of targets, performance indices etc. and a return to the culture that existed before this all started; and end to the age of "bull****".

  • Comment number 38.

    A revelation? We have targets that are pretty pointless.

    What next? League tables are pointless? Targets are pointless? Private contracts are pointless? Thatcher was pointless? Tories are pointless?

    Is the Coalition disappearing up its own exhaust pipe?

  • Comment number 39.

    The advocates of moving to a US type health system need to consider that whilst the UK spends 8.4% of GDP on health and is 18th in WHO ranking the US spends 15.4% of GDP and does not figure in the top 20. The US spends 87% more on health and yet overall has a worse performance. Why should we want to change. The problem with targets is that people try to meet the paper targets but ignore the overall impact of what that can mean to the total picture. But without targets what will motivate staff? Removal of targets will mean no measure of service or performance. Do we really want that?

  • Comment number 40.

    If targets to receive treatment at A&E are to be scrapped, are parking fees also to be scrapped? After all, if one has no idea how long it will take to be treated one can have no idea how much time to pay for parking!

  • Comment number 41.

    Targets in any area of human endeavour are without value unless 1) measurable 2) Meaningful and relevant. Ask any private sector manager. Target setting for target setting sake is simple posturing and a complete waste of time - even for spin doctors. The Ambulance Service should be left alone to decide.

  • Comment number 42.

    If they spent less time working out targets, ambulances would get to patients quicker, more patients would be treated and less money would be spent.

  • Comment number 43.

    Are health targets necessary?

    No. Without stating the bleeding obvious, it is essential that injuries are prioritised - life threatening injuries should be treated first.

    Only Labour, with its determination that as many people as possible should be dependent of the nanny state, could produce the crass stupidy we now have in meeting targets.

  • Comment number 44.

    There WILL be deaths because of these cut backs. First life boats now ambulances, what next?? Are we going to go back to the 80's with people waiting months even years for operations? The previous government may have gone on target overload with the NHS, but that's because people were literally dying to get in to hospital because of the time between diagnosis & treatment.

  • Comment number 45.

    Is this another case of some (Andrew Lansley) who knows nothing about patient care trying "help" make things better?

  • Comment number 46.

    Who are the targets for? I suspect the origin idea was that the Minister in charge would have easy accessible facts and figures to hand for questions in the House. I have always worked in industry, if a DEPT IS RUNNING BADLY, tackle the manager, if it doesn't imporove remove the manager, not possible in Government areas.
    Most people who work in the NHS Know what is wrong,let them get on with it, most people in industry endeavour to do a good job, people are people, you get good and bad, I value meritocracies.

  • Comment number 47.

    I don't work in the Health Service so I don't know the benefits of targets.

    However stories are reported of people not getting the best treatment as its too expensive or people are too old for treatment.

    Surely people's health is far more important than balancing targets or budgets - enough Tax is paid by the majority in this country for people to be entitled to the best the NHS can give.

  • Comment number 48.

    They'd be better to spend this money on improving patient care and testing literacy skills amongst nursing staff (and I mean the British *educated* ones, not those from overseas)

  • Comment number 49.

    If a service is up to muster, it shouldn't have to set or meet targets.

  • Comment number 50.

    I only hope that the moaners in our society who go on about targets not being good for people will not need a ambulance quickly in an emergency.
    Remember, you will be the one's who complained about targets when it rolls up 30 or 40 minutes late because their will now be no control and a cut back in ambulances because their will be no need for so many.Any thing by this Lib/Tory goverment to save money,even putting peoples lives at risk means nothing to them in their pursuit of their ideaology.Remeber,when it happens,'we are all in this together'.

  • Comment number 51.

    39. At 11:51am on 17 Dec 2010, North Briton wrote:

    The advocates of moving to a US type health system..."

    I've not heard anyone advocate moving to a US type health system.

    Worshippers of the NHS like to make out that are two possible ways of running a health service, the NHS way and the US way.

    They conveniently ignore all the other ways of doing it, which are more efficient, more accountable, and can cost the tax payer less while still covering the important stuff.

    There are state run health insurance schemes, you could have free essential care, and charged optional/elective treatments etc etc etc etc

    The country cannot afford to have any desired health treatment available for 'free'.

    (PS the WHO ranking is 10 years old - so that's just shortly after the last Conservative government left it)

  • Comment number 52.

    This is one among many pointless performance measures designed solely for the benefit of the kind of middle managers whose jobs rely on paper-shuffling.

    I lived in mid-Wales, where there was no chance of an ambulance reaching me within the prescribed time limit - 11 miles from the nearest ambulance station, half a mile from the nearest village, and the same distance up a very narrow track. Placing such time pressures on an already-overloaded ambulance team does not help them one iota.

    The Minister should focus his attention on the type of call-outs instead; sending ambulances to incidents of a trivial nature constitutes a waste of taxpayers' money, as does attendances in most cities on Friday nights to deal with mindless, drunken yobs who deserve to be left where they are.

    Oh no, I forgot. As the yobs (women included) are legless and quite incapable of looking after themselves, they are classified as vulnerable and even disadvantaged, so will therefore be eligible to sue the NHS under human rights legislation.

  • Comment number 53.

    I see this sort of target as a good thing. Waiting for an ambulance is no fun.

    I expect ambulance arrivals will take longer. People will die as a result.

  • Comment number 54.

    5. At 10:27am on 17 Dec 2010, SaveourCountry wrote:
    it takes as long as it takes. I try to tell my own boss this when he puts to me ridiculous unacheivable targets. Must admit to being abit worried as in the report it says that they are making a "shocking scaling back" of ambulances. I was sort of under the impression he was going to make cuts of jobs that are not needed. The lifeboats yesterday, the ambulances today. People will die because of these 2 particular cuts. Get rid of the unecessary managers in the public sector, I know we have a massive debt that has to be paid but Im getting really worried about the changes call me Dave is making.

    I agree Camerons incompetence knows no bounds cut ambulances and life boats and things that are essential and as usual halfwit mps will argue in defence of keeping paper shuffling administrators and managers on incredulous salaries because they are needed to identify where the cuts can be made, who cares if old or vulnerable people die, they don't work pay tax or vote conservative anyway!

  • Comment number 55.

    The Government cuts with one hand then removes targets which measure performance with the other. Do they expect us to believe they are unrelated?

  • Comment number 56.

    Concentrating on target setting and achieving these targets has one major drawback. It requires a whole industry to collect said data and to process it all which drains massive amounts of money from the NHS. It creates 'jobs' for legions of people who have nothing to do with patient care. We can measure our success or failure by the feedback we get from the media and public and, direct resources accordingly. Why continue to waste millions on 'audits', 'studies' and 'statistics creation' merely to publish what we have already seen or been told? Too many chiefs, not enough Indians, too many cooks spoil the broth? You can prove anything using statistics, 87% of people know that. Take your pick!

  • Comment number 57.

    29. At 11:32am on 17 Dec 2010, Roger Smith wrote:
    I don't want a health service driven by targets, I want one driven by compassion!!


    Hear hear.

  • Comment number 58.

    As a tax payer I want to now where every penny goes, audits are essential to clarify patient quality care, targets if used appropriately can reduce costs.

  • Comment number 59.

    Customer service is what matters the most.

  • Comment number 60.

    39. At 11:51am on 17 Dec 2010, North Briton wrote:

    The advocates of moving to a US type health system..."

    I've not heard anyone advocate moving to a US type health system.

    Worshippers of the NHS like to make out that are two possible ways of running a health service, the NHS way and the US way.

    They conveniently ignore all the other ways of doing it, which are more efficient, more accountable, and can cost the tax payer less while still covering the important stuff.

    There are state run health insurance schemes, you could have free essential care, and charged optional/elective treatments etc etc etc etc

    The country cannot afford to have any desired health treatment available for 'free'.

    (PS the WHO ranking is 10 years old - so that's just shortly after the last Conservative government left it)


    ----------Fist regarding you PS Yes you are correct the most recent international survey in 2010 by the Commonwealth Foundation places the UK in First or Second Place depending on the criteria used. Considerably advanced on the WHO survey.
    ---------
    Incidentally what more efficient systems are you referring too?

    The insurance based system used in much of Europe produces outcomes comparable with the NHS (One or Two are better most slightly worse) however it costs around 30% more in terms of share of GDP to run.

    Whether this is in the form of tax or personal spend it is still more than the cost of the NHS!

  • Comment number 61.

    Post Code Lottery?

    This is an extremely sensitive subject to me personally.
    A hospital not too far away from me was in the headlines recently. I suggest someone investigates the other one in Staffordshire!

    Why? Here is a quote from Nick Triggle's (BBC News Health reporter) report on the above subject.

    A spokeswoman for the Patients Association said:

    "We do not want to go back to a situation where people are left on trolleys in A&E for days on end."

    In my neck of the woods this has been going on for years! Just the other day the local paper reported a woman left on a trolley for 25 hours!

    People given wrong medication, catching infections, attending hospital for one thing and returning home with another! etc etc...

    This hospital's record is diabolical! There may be occasions when patients have received the correct treatment and care but there are too many when they have not.

    If this hospital's rate of care is bad now, what will it be its rate be once all the changes come into force????

    As to the Ambulance service and the Paramedics connected to this hospital, in my experience, I find no fault whatsoever, they are brilliant!

    I'd also like to comment on what Monogram said post 32

    I don't know how old you are but any problems with NHS hospitals go way back to the Thatcher regime.
    Mrs T and her party, are the ones that turned hospitals into bureaucratic institutions and installed managers and the like taking away the proper patient care replacing it with bureaucracy.

    Also one of the consequences of her reign was, there used to be a thing called 'vocation' jobs such as those within the NHS, Police were classed as such.
    Once she had dismantled industry (over 3 million unemployed btw) people had to find jobs in other sections of society.
    'Vocational' disappeared from the Engish language to be replaced with?

    Ah yes, a young nurse plonking herself down in front of Tony Blair (this was televised) and asking him if 'he' would wipe someones backside for £5 an hour!

    Now then, what does that tell you?
    If this is the sort of person who is responsible for care in the NHS we need help not cuts!

    The truth is, cuts we will get, it's what the Tory's do and then disguise it with all sorts of reasons and excuses....the mind boggles at the time they must spend finding justification for their actions!

    I suggest they spend an equal amount of time thinking through their policies!

    Not surprising we saw smug expressions on their faces when they won the election, the deficit has given them a 'Licence to Kill'.
    To Kill the spirit of the people of this country!

    One good thing is emerging though (they don't think things through, remember?) these kids in office are so impatient to get their way, all the years this country has spent divided (caused in many cases and exacerbated by past governments) in their impetuosity they are now causing unity but not in the way they are planning! Great stuff!

    Remember DC & NC what goes around comes around to bite you on the butt!

    I'll be watching.

  • Comment number 62.

    Targets, as set up by the Government, are there for the wrong reasons. They allow statistical analysis, but do not add value.

    As an example, a hospital that deals with surgical procedures might have a target for patient after care, say 5 days on average. They are encouraged to send people home, even it means a return due to complications, because that then flags up a different target.

    We should have a service that is based on need. If we need a certain number of nurses then we should employ them. If we need to provide certain drugs then they should be available. If we elect to have cosmetic surgery then the individual should pay. And taxation for the service should be a living thing. We want a top-class health service so we must pay for one. Setting targets simply creates jobs for back-room staff, not the front-line nurses and doctors we need.

  • Comment number 63.

    I am an NHS professional and also heavily involved in 'targets' in the NHS (what do I mean ? - my work involves this http://www.advancingqualityalliance.nhs.uk/ organisation and integrating it into the hospital where I work).

    There is a need within the NHS for 'targets', as with any other government body where performance is not as simple to measure as a private sector company - the NHS does not make a profit so how can we rate it's effectiveness ? We must have performance measures in some form or another.

    The problem with 'targets' is that the eventual 'target' is usually a greatly simplified version of the performance goal that is originally identified. Managers in the NHS are then judged on their ability to meet these simplified targets which often leads to processes being put in place to meet the target rather than benefit the patient.

    For example -

    The 4 hour A&E waiting time target was originally brought about because patients had told the NHS that they did not want to wait for hours in A&E before seeing a doctor and being treated.

    So the government tell the NHS that no patient will be permitted to wait in A&E for more than 4 hours.

    So now we can guarantee that within 4 hours of arriving in A&E you will see someone. It may be a doctor but more likely will be a porter who will take you to a 'Clinical Decicion Unit' or 'Medical Assesment Unit' where you will then wait (usually even longer than you would have waited in A&E before the target was introduced) to see a doctor, be diagnosed or receive treatment.

    End result ? The patient still waits far too long to see a doctor and be treated but the hospital looks like it's performing really well because no-one waits in A&E for more than 4 hours.

    At the risk of evangelising (and getting a bit technical), the newer framework of the type I am working with has the great benefit of being driven by research based practice (i.e. our performance 'targets' are based on what medical research tells us will actually improve patient outcomes, not on politically motivated public opinion surveys) and rated not only on the completeness and correctness of the treatment which people receive but also on their actual outcomes (in other words, did we (a) give them the correct treatment and (b) did they actually get better).

    The greatest downside of this is that it requires a great deal of manpower to extract the level of detailed information that is required to tell us whether these 'targets' are met. It is simple to measure how long someone spends in A&E direct from computerised records of arrival and discharge/transfer times. It is much harder to gather data on whether they were diagnosed quickly and correctly, given the right treatment and then, after they go home, are actually better than when they arrived.

    Although I am a practising nurse, the majority of this manpower consists of back office staff - the ones that everyone always wants to cut from NHS bureaucracy to reduce costs.

    So you have a choice:

    If you want 'targets' then they need to be measuring and enforcing the actual performance improvements that benefit patients, not be a number chasing excercise designed to provide nice statistics on improvement come election time. This, however, costs money and entails lots of non-clinical staff to monitor and interpret.

    If you don't want 'targets', then you have to take it on trust that the NHS is doing the best job it can with no real way of measuring it. This is cheap but, I suspect, not a good system for promoting excellence.


    (P.S. Why do I keep putting inverted commas around the word 'targets' ? Because 'targets' is a rude word in the NHS now, they are always referred to as 'performance objectives' or 'improvement goals' - it amounts to the same thing but 'targets' sounds a bit old fashioned now).

  • Comment number 64.

    Are health targets necessary ??

    Not really, if you've got a good team you know are doing their best, target practice is just another cost in time and money.
    Unfortunately,in the way many work,targets do inform,and are therefore useful,of the competence of the workforce.

    E.G. I overheard a ''conversation'' today.

    person 1:There's no gritters or street pavement clearers out today.
    person 2:They can't be everywhere.

    (person 2 btw,used to work for the council)

    most probably, there are gritters out somewhere, just not in person 1's vicinity.
    whereas person 2's comment doesn't preclude the possibility that there is actually noone out.

    ...and so life goes on in the foolocracy.

    [what year is this again ??
    and Herr G.W.F.Hegel,why do we care ??

  • Comment number 65.

    lansleys said,the doctors and nurses requested these changes.it as nothing to do with cuts or saving money.on the word of the medics,not lansleys we oght to go along with it.i hope there is not an hidden agenda if there is heads should roll.

  • Comment number 66.

    Before we get bogged down with how good/bad a thing this is. Ask yourself this, WHAT IS A CAT B CALL? how about someone fitting, or a car crash, or indeed a person under a bus?

    I am a Paramedic responder in a very big service, we struggle. Most people who get who ring for a ambulance get one but dont need one, and most people then get taken to hospital who do not need to go.

    The service needs changing NOW from top to bottom.

  • Comment number 67.

    They have to scrap the targets in order to cut the budget. The service simply cannot meet what seem reasonable targets with significantly less staff and vehicles......simples!
    We have had targets overload but to say you can expect an ambulance in an emergency within X number of minutes doesn't seem a bad idea.
    Why train to be a doctor when a call centre operative will tell you if a medical need is urgent or not?

  • Comment number 68.

    This is a CUT to NHS budgets, even though the Tories claimed they were going to ringfence NHS spending.

    More lies from this terrible coalition of bankers' friends.

  • Comment number 69.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • Comment number 70.

    Once again we have another tory decision that will disadvantage the poorest and most needy in society.

    These targets show the public how well the NHS is performing and the tories are worried that when the cuts are made to the NHS we will be able to see how damage the tories are doing to the NHS.

    The tories do not care about the NHS as they and their supporters have private helthcare.

  • Comment number 71.

    Government targets have been a disaster. They have distorted the way institutions like the NHS operate so that "targets" are seen to be achieved rather than a good service provided.

    Targets have been extensively tried and failed in the former Soviet Union. It's a tragedy that we had a government for thirteen years that did not understand this elementary lesson from economic history.

  • Comment number 72.

    @56 "We can measure our success or failure by the feedback we get from the media and public"

    Oh yes, the oh-so-reliable media...! The media distort the truth to whatever position brings in the most income while the general public, with no real stats to base an opinion on, operate on rumour and beliefs that are often completely wrong!

  • Comment number 73.

    18. At 11:10am on 17 Dec 2010, Lucy Clake wrote:
    "....We are financially in a better position than nearly all other EU countries and our unemployment figures were reasonable. This fact was published last week but of course didn't get reported by our drama loving media or the Govt. as it didn't fit in with their plans."

    We really aren't you know.
    It goes something like this.
    UK tax receipts : £548bn.
    UK public spending: £697bn.
    The difference covered by the bond markets, for as long as they feel like lending to us. (And I can think of many better places to put money that UK debt right now.)
    And those 35,000 added to the unemployment count in recent times to make up circa 2.5 million won't thank you for calling the unemployment figures 'reasonable'.

    "...If we collected all the unpaid taxes of the wealthy tax dodgers in the Tory party many of these cuts would be unnecessary.."

    Sounds like you have clear evidence of wrongdoing.
    I suggest you pass on this 'inside knowledge' of the tax affairs of these reprobates to HMRC, who will doubtless prosecute it with great vigour.
    Or, you could be simply parroting the blather spouted by certain trade union leaders and left wing journalists. Which means HMRC won't be getting that call on the tax evaders hotline.
    But who am I to judge which you are?

  • Comment number 74.

    63. At 12:24pm on 17 Dec 2010, Simon Hill wrote:
    I am an NHS professional and also heavily involved in 'targets' in the NHS (what do I mean ? - my work involves this http://www.advancingqualityalliance.nhs.uk/ organisation and integrating it into the hospital where I work).

    There is a need within the NHS for 'targets', as with any other government body where performance is not as simple to measure as a private sector company - the NHS does not make a profit so how can we rate it's effectiveness ? We must have performance measures in some form or another.

    The problem with 'targets' is that the eventual 'target' is usually a greatly simplified version of the performance goal that is originally identified. Managers in the NHS are then judged on their ability to meet these simplified targets which often leads to processes being put in place to meet the target rather than benefit the patient.

    For example -

    The 4 hour A&E waiting time target was originally brought about because patients had told the NHS that they did not want to wait for hours in A&E before seeing a doctor and being treated.

    So the government tell the NHS that no patient will be permitted to wait in A&E for more than 4 hours.

    So now we can guarantee that within 4 hours of arriving in A&E you will see someone. It may be a doctor but more likely will be a porter who will take you to a 'Clinical Decicion Unit' or 'Medical Assesment Unit' where you will then wait (usually even longer than you would have waited in A&E before the target was introduced) to see a doctor, be diagnosed or receive treatment.

    End result ? The patient still waits far too long to see a doctor and be treated but the hospital looks like it's performing really well because no-one waits in A&E for more than 4 hours.

    At the risk of evangelising (and getting a bit technical), the newer framework of the type I am working with has the great benefit of being driven by research based practice (i.e. our performance 'targets' are based on what medical research tells us will actually improve patient outcomes, not on politically motivated public opinion surveys) and rated not only on the completeness and correctness of the treatment which people receive but also on their actual outcomes (in other words, did we (a) give them the correct treatment and (b) did they actually get better).

    The greatest downside of this is that it requires a great deal of manpower to extract the level of detailed information that is required to tell us whether these 'targets' are met. It is simple to measure how long someone spends in A&E direct from computerised records of arrival and discharge/transfer times. It is much harder to gather data on whether they were diagnosed quickly and correctly, given the right treatment and then, after they go home, are actually better than when they arrived.

    Although I am a practising nurse, the majority of this manpower consists of back office staff - the ones that everyone always wants to cut from NHS bureaucracy to reduce costs.

    So you have a choice:

    If you want 'targets' then they need to be measuring and enforcing the actual performance improvements that benefit patients, not be a number chasing excercise designed to provide nice statistics on improvement come election time. This, however, costs money and entails lots of non-clinical staff to monitor and interpret.

    If you don't want 'targets', then you have to take it on trust that the NHS is doing the best job it can with no real way of measuring it. This is cheap but, I suspect, not a good system for promoting excellence.


    (P.S. Why do I keep putting inverted commas around the word 'targets' ? Because 'targets' is a rude word in the NHS now, they are always referred to as 'performance objectives' or 'improvement goals' - it amounts to the same thing but 'targets' sounds a bit old fashioned now).

    ==============================================================
    Interesting take on the situation from someone in the know. If I were you I would go for the first available early retirement option. Trust me, the overall impact is the same and at least your sanity is preserved.

  • Comment number 75.

    Re 19

    The setting of targets.

    Targets are usually set by chiefs, without reference to the workforce, who do not have a clue as to whether they are achieveable or not. Most targets are completely unrealistic and do not have a snowball's hope in hell of being met. The only people who are able to set targets are the indians who actually do the work.

    In the case of the sacred-cow/political football status of the NHS, the targets in question were set by politicians grubbing for votes. They were designed to shut up the ignorant media who were bleating on about the time it took for patients to be seen.

  • Comment number 76.

    64. At 12:26pm on 17 Dec 2010, SSnotbanned wrote:
    Are health targets necessary ??

    Not really, if you've got a good team you know are doing their best, target practice is just another cost in time and money.
    Unfortunately,in the way many work,targets do inform,and are therefore useful,of the competence of the workforce.

    E.G. I overheard a ''conversation'' today.

    person 1:There's no gritters or street pavement clearers out today.
    person 2:They can't be everywhere.

    (person 2 btw,used to work for the council)

    most probably, there are gritters out somewhere, just not in person 1's vicinity.
    whereas person 2's comment doesn't preclude the possibility that there is actually noone out.

    ...and so life goes on in the foolocracy.

    [what year is this again ??
    and Herr G.W.F.Hegel,why do we care ??
    ================================================
    Too many targets can be a bad thing as it skews the behaviour of an organisation which become target-obsessed.
    Having said that, some targets are essential in order to set a quality objective and to ensure sufficient resource and priority is applied.
    Ambulance response time is clearly a very important measure of the ambulance service and should not be abolished. Failure to meet this target should not be a stick to beat the service with, but rather an indication to the money-men/women to allocate suffucuent funds and resource.
    Cutting this target smells strongly of running down the service and not wanting some nasty statistics to emerge down the line. So, we end up with a poorer service and no accountability - not good news.

  • Comment number 77.

    53. At 12:06pm on 17 Dec 2010, potatolord wrote:

    I see this sort of target as a good thing. Waiting for an ambulance is no fun.

    I expect ambulance arrivals will take longer. People will die as a result.


    Why would people die as a result? The only targets that are changing are for non-life threatening calls.

  • Comment number 78.

    I have a solution to all our problems, it can even solves the problem of the deficit! And...and it doesn't affect the bankers!

    How about the Government sets up its own medical drugs unit...instead of paying the astronomical drug prices companies charge...think of the money generated back into the economy...billions! We would be in credit instead of debit!

    Oops forgot this government supports privatisation...just a thought.

  • Comment number 79.

    38. At 11:50am on 17 Dec 2010, Daisy Chained wrote:

    A revelation? We have targets that are pretty pointless.

    What next? League tables are pointless? Targets are pointless? Private contracts are pointless? Thatcher was pointless? Tories are pointless?

    Is the Coalition disappearing up its own exhaust pipe?


    Your posting was pointless!

  • Comment number 80.

    In 1996 I was in a bar watching England v Italy. A girl in front of me turned around and stuck her cigarette in my eye. I sat in casualty for 11 and half hours without any pain relief and unable to even rinse my eye (I'd been told not to by the nurse in case I caused more damage). Anyone who thinks the '4 hour A+E' target should be abolished has never sat from 7:30pm till 6:45am in a Newcastle casualty unit on Sat night with a burnt cornea!

  • Comment number 81.

    @63 - Excellent post Simon!

    There are some very odd points of view out there, as indicated on this board. Many seem to think that the NHS just dreams up targets and jobs for the sake of it. As Simon says, YOU, the people demanded that patients don't wait too long in A&E (for example) and so a target was set. If you don't set a target and measure compliance with it how will you know? Some here seem to think you just throw £40 billion at healthcare and then hope for the best, as "we will know if people are doing a good job". It beggars belief!

    Triaging is perfectly reasonable but so is a reasonable target. 19 minutes for non-urgent cases was unreasonable and so scrapping this target is the right thing to do. But there needs to be some targetting and please, don;t keep going on about the extra pressure on individual crews, targets have zero effect on the crews themselves but on the management of services. No one gives the crew a stop-watch and says get to your destination in X amount of time. The target is the average for the service and it is for the service as a whole to use its resources in a way that meets the target. Of course, it isn't always possible if the funding isn't made available from central government.

  • Comment number 82.

    60. At 12:22pm on 17 Dec 2010, steve wrote:
    39. At 11:51am on 17 Dec 2010, North Briton wrote:

    The advocates of moving to a US type health system..."

    I've not heard anyone advocate moving to a US type health system.

    Worshippers of the NHS like to make out that are two possible ways of running a health service, the NHS way and the US way. They conveniently ignore all the other ways of doing it, which are more efficient, more accountable, and can cost the tax payer less while still covering the important stuff.

    There are state run health insurance schemes, you could have free essential care, and charged optional/elective treatments etc etc etc etc The country cannot afford to have any desired health treatment available for 'free'."



    According to this months pay slip I paid £432.00 income tax and £244.53 NI. If I require any NHS treatment it certainly isn't 'free'. Nor do I see how continuing to take £432.00 income tax and £244.53 NI a month off me in income tax (because I haven't heard any suggestion of tax cuts) then expecting me to sign up for additional health insurance will cost this particular tax payer less. It sounds like I'll be paying twice while those who earn less simply go without treatment at all unless they're spraying blood from open wounds.

    I'll add this promise to 'ring fence NHS spending' to all the other promises like Cables pledge to abolish university fee's and Cameron's pledge to supply our troops in Afghanistan with more helicopters. Funny how when he in opposition Cameron opposed bailing out UK banks but is now bailing out Irish ones too!

  • Comment number 83.

    Post 26 @ 11:22am on 17 Dec - 'Paul'.

    Well done 'Paul' for taking selected bits out of my whole post, completely out of context, for the benefit of your shabby rant.

  • Comment number 84.

    Who instilled us with this target culture in the first place? Let we take a wild guess... er, wasn't it NuLabour? This goes for all political parties. Take a tip from the London Borough Greenwich's motto: We Govern by Serving

  • Comment number 85.

    75. At 12:41pm on 17 Dec 2010, Dave wrote:
    Re 19

    The setting of targets.

    Targets are usually set by chiefs, without reference to the workforce, who do not have a clue as to whether they are achieveable or not. Most targets are completely unrealistic and do not have a snowball's hope in hell of being met. The only people who are able to set targets are the indians who actually do the work.
    __________________________________________________________

    Unfortunately the only change in immigration laws Cameron could manage was making it more difficult for Indians to come here and do the work.

  • Comment number 86.

    Targetting are a very good management tool, provided it's used sensibly.

    Far too many of the (last) Government's targets were aimed at things that could be easily measured. Good targets are for things which really make a difference.

    For example, the waiting time for GP referral to consultant is very easy to measure, but meaningless. What really matters is the time between referral and treatment, but that is very difficult to measure, and very difficult to report in any meaningful way.

    Pointless targetting just adds to the need for managers and administrators, without adding anything to patient care.

    Scrap all pointless targets!!!

  • Comment number 87.

    Cars, vans and motorcycles blasting through the traffic at dangerous speeds because a little old lady forgot to take her pills and is feeling dizzy?

    Intelligence tells you that each incident should be treated individually on it's own merits - it was Labour that forced us to take on a 'one size fits all' socialist mentality. Labour said that we were not allowed to assess a situation. We had to follow a communist instruction manual...

    I'm glad that this policy is changing but it's odd how the headline is 'scrapped' when it should be 'changed'.

  • Comment number 88.

    Its probably quite simple, they have introduced a target for target cutting so as to justify np scathing cuts in MP's and their staff.Which really would benefit us all.

  • Comment number 89.

    70. At 12:39pm on 17 Dec 2010, thelevellers wrote:

    Once again we have another tory decision that will disadvantage the poorest and most needy in society.
    ?

    How would this disadvantage the poorest and most needy in society?

  • Comment number 90.

    Less targets, less managers would both make the health service better. you only have to look at Stafford hospital to what happens when managers are more interested in targets than patients.

  • Comment number 91.

    77. At 12:42pm on 17 Dec 2010, Red Robbo wrote:
    53. At 12:06pm on 17 Dec 2010, potatolord wrote:

    I see this sort of target as a good thing. Waiting for an ambulance is no fun.

    I expect ambulance arrivals will take longer. People will die as a result.

    Why would people die as a result? The only targets that are changing are for non-life threatening calls.
    ____________________________________________________________

    Who decides what is & isn't life threatening? Diagnosis of stroke/migraine and meningitis/flu or heart attack/angina attack is tricky at the best of times. Internal injuries after a car crash may not be obvious... the perfectly lucid patient who isn't in much pain suddenly passes out 15 mins after the ambulance is called because they've been quietly bleeding internally (I've seen that happen first hand)

    An hours delay if its actually meningitis and not bad flu could well be fatal. Based on my experience of NHS direct I agree with potatolord. Its enevitable that ambulance despatch teams will mis-prioritise every now and then and there will be deaths.

  • Comment number 92.

    There is no need for a target when the majority of ambulances arrive within 19 minutes anyway.

  • Comment number 93.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • Comment number 94.

    78. At 12:42pm on 17 Dec 2010, Naomi wrote:
    I have a solution to all our problems, it can even solves the problem of the deficit! And...and it doesn't affect the bankers!

    How about the Government sets up its own medical drugs unit...instead of paying the astronomical drug prices companies charge...think of the money generated back into the economy...billions! We would be in credit instead of debit!

    Oops forgot this government supports privatisation...just a thought.
    ==================================
    I actually like this idea.
    We have many skilled researchers/chemists operating in our Universities who constantly develop new life enhancing drugs. Lets have a publicaly owned manufacturer of spin-off drugs who can supply directly to the NHS. More jobs for people in the UK - and cut out the profiteering leeches in the drug industry. Would save a stack of cash.

  • Comment number 95.

    80. At 12:45pm on 17 Dec 2010, Peter_Sym wrote:

    In 1996 I was in a bar watching England v Italy. A girl in front of me turned around and stuck her cigarette in my eye. I sat in casualty for 11 and half hours without any pain relief and unable to even rinse my eye (I'd been told not to by the nurse in case I caused more damage). Anyone who thinks the '4 hour A+E' target should be abolished has never sat from 7:30pm till 6:45am in a Newcastle casualty unit on Sat night with a burnt cornea!


    I'm sorry to here about your eye but doctors think the A&E targets compromise care and patient safety.

    http://news.bbc.co.uk/1/hi/health/8580761.stm

  • Comment number 96.

    Why is this bunch of liquidators now interfering with the NHS?
    The last time the Tories were in power the NHS was run down (not surprising as they don't use it), almost beyond repair, patients could not get operations as they wanted everyone to go private/BUPA. I guess this new attack on the NHS coincides with the appointment of the head of BUPA on a consulting basis. What a nasty and useless bunch these Tory Big Business lackeys are. The Great Con continues....

  • Comment number 97.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • Comment number 98.

    The thing I have never understood about targets is that they appear to be based on the assumption that people wouldn't try as hard if they didn't have targets.

    If there is a problem with work ethic it can be solved by good recruitment practices, allowing supervisors to supervise (instead of filling in diversity partnership risk assessments) and sacking people who are no good.

    The public sector is filled with hardworking people who are good at their jobs, but it is let down by the fact that it is almost impossible to fire the few bad apples. If the NHS could get rid of bad employees more easily they wouldn't need targets.

  • Comment number 99.

    These cuts are fine until you or your family need an ambulance that is not there. You can rest assured that there will always be one available for ministers and their families.

  • Comment number 100.

    The Labour target culture meant that although I was seen by a consultant quite quickly after my referral she didn't have time to talk to me in detail or ask the probing questions that might have solved the problem of someone with a much more complex condition. I saw her every fortnight for a couple of months but she still didn't remember my name, recognise my husband (who came to virtually every appointment) or any details of my condition. That's the result of numbers being the only target that counts. But if those targets hadn't been there I might not have been seen until it was too late and that would have been more disastrous than poor quality care. I guess the NHS really is between a rock and a hard place.

    As for emergency targets being scrapped, I find that more worrying. My friend had to call 999 when her dad collapsed. She's not medically trained and didn't know the signs to look out for and the operator on the other end of the line obviously didn't ask the right questions as my friend's dad was classed as non-urgent. Fortunately there was an ambulance nearby and it was a quiet day so the ambulance got there well within 10 minutes and it saved his life. The paramedics said that he wouldn't have survived if they hadn't been there with all their equipment when his heart stopped beating.

 

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