Surgery targets endanger patient safety, poll suggests

By Adam Brimelow
Health Correspondent, BBC News


Pressures over hospital budgets and targets may be damaging safety in operating theatres, a survey suggests.

Image caption,
Nearly 600 surgeons responded to the questionnaire

About one in five of the nearly 600 surgeons questioned by Bournemouth University reported being involved in incidents, during a two-week period, where patients were harmed.

Many complained of having to operate on patients they had not seen before, or a lack of time for complex operations.

The government says "a culture of micromanagement" has endangered safety.

For many years the NHS has been told to make patient safety a top priority. But this survey suggests many surgeons are unhappy with the overall approach to safety.

Near misses

A total of 549 general surgeons responded to the online questionnaire - about one in four members of the Association of Surgeons of Great Britain and Ireland.

Of these 40% said they had been involved in an untoward event where a patient was nearly harmed, and a further 19% where there was actual harm, during the two-week period covered by the survey.

The authors of the paper, published in the Bulletin of the Royal College of Surgeons, estimate that the problems arose in about 3% of operations.

This is significantly higher than the figure cited by the National Patient Safety Agency, but lower than those from other studies in North America.

When asked about what gets in the way of patient safety, many said they did not feel in full clinical control, because of pressure from managers to get through operating lists.

One surgeon quoted in the paper warns against bowing to these pressures: "Don't be seduced by management into making do, thinking you are being heroic; you're not, you are being dangerous."

The lead author, Professor Colin Pritchard from the School of Health and Social Care at Bournemouth University, says surgeons often come under pressure to "slip in" extra patients on their lists.

"If anything goes wrong they're responsible but not in charge. The key is the influence - and often the malign influence - of managers who are concerned with meeting targets."

However, he says, the surgeons are "very understanding" of the pressures faced by managers, who he says are forced to look at patients as "numbers or nuts and bolts".

'Struck off'

Other concerns raised by the surgeons included poor staffing, the breaking up of clinical teams, and lack of equipment.

A spokesman for the Patients Association said the paper once again raised the spectre of a "production line" approach to NHS care.

"This study gives yet more weight to the idea that whilst the NHS may have been meeting its targets over the past few years, that doesn't mean those targets are always a benefit for patients," he said.

He also called for better regulation of health service managers, so they could be struck off in the same way as doctors if their decisions harmed patients unnecessarily.

In a statement the health secretary for England, Andrew Lansley, said the report highlighted a point he had made repeatedly.

"Patient safety must come first, that means allowing clinicians to focus on the outcome of a patient's treatment, rather than the diktats of managers. That's why we will abolish Labour's top-down process targets and replace them with outcome measures, which drive improvements in the quality of patient care."

A spokesman for the NHS Confederation, which represents health service managers in England, said the methodology used in the study was "unusual", but he added that patient safety was "of paramount importance to all NHS staff".

He cautioned against "a potentially fruitless debate" about who was in control.

"Ensuring patients are treated right first time, every time, is not only beneficial to the patient but is also the most efficient way of running any health service," he said.

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