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How 6 years spent attacking politically motivated targets finally missed its mark

Filed Under (Reform of the NHS, Secretary of State, Targets) by Paul on 22-11-2011

I crave a little self indulgence from the reader for the first half of this post since it covers an issue that stayed near the front of my mind every week for six years of my working life.

Last Friday saw several of the broadsheets rehearsing the history of the use of targets in the NHS over the last decade. They were doing so because the current Secretary of State, having spent 7 years railing against politically motivated targets, set his own last Thursday.

Since he earns his living as a politician (although many other politicians would question his skills and capabilities in that area) then we can assume that this target has been created by a politician.

From 2001-2007 I spent a lot of time trying to understand how the DH could help NHS organisations hit targets that the Government had set in their election manifestos of 2001 and 2005. The driving force behind the success of these targets was the certain knowledge that we had that these mattered enormously to the public. Time and again through quantitative and qualitative polling and through the elections themselves we knew that access in general, and waiting for a long time for hospital treatment in particular, was a very big deal to the public who paid for the NHS.

This was not just an abstract target set by the Secretary of State who then sat back and watched. Once a month there would be a stocktake between the Secretary of State for Health and the Prime Minister about how the NHS was doing in meeting maximum waiting targets and, one on side of the table or the other I was a part of that process for six years.

Last Friday Ruth Thorlby, a senior fellow at the Nuffield Trust, said that when in opposition the Conservatives had campaigned against targets,

“They said that targets were not the right way to get the health service to perform and distorted clinical priorities. But now they find themselves apparently imposing a target. It shows that targets have a place in health policy and the targets that Labour introduced worked.”

Good to know and thanks to the hard work of NHS staff including those managers that the current Government likes to attack.

Whenever a maximum waiting target was set, most people in the DH and at the top of the NHS felt that it was not possible to meet it, and this in part is where the politics of the current Secretary of State were formed.

Whilst in opposition he would have meeting after meeting with parts of the NHS who would use the opportunity to persuade him that they hated the Government setting targets and changing their work environment to meet them,. It interfered with their rights to operate in the way in which they wanted to – and when he came to power would he please stop it?

Andrew Lansley would have heard this on most days for 6 years and over all that period of time he would have come to believe that to be on the side of the NHS he would have to come out strongly against targets.

So when he came to power one of the first things he did was to try and stop targets. This proved harder than he had anticipated because they were a part of the NHS constitution – and he had voted for that during the previous year -but he managed to give the impression that he had abolished the targets.

His big short term political problem was that this failed to deliver a wave of gratitude from the NHS and thereby failed to provide cover for his top down reorganisation of the service.

His much bigger real world political problem was that maximum waiting times still mattered more than anything else to the public and if they were to drift upward it would be seen as the fault of the Government.

And indeed this is what happened. Every month, as maximum waiting times drifted higher, Andrew Lansley called public attention to the mean and the average which were not increasing. His line was that waiting times were ‘low and stable’. But the problem for the public was that some of them were waiting for a long time – and they didn’t really care much about the mean.

So last week’s figures showed that if you live in Telford and Wrekin a third of patients (32.9%) wait longer than 18 weeks. Just to the south, in Dudley, only 3.2% wait for more than 18 weeks.

The reality of long maximum waiting times is a long period of pain and distress for patients. It worries them and their relatives and friends and I suspect in the Telford area many people think the NHS has failed them.

Its good news for the public that the current Secretary of State has now recognised that long waits are bad for both the public and the NHS and has pledged to bring down the longer waits affecting patients.

I look forward to commenting on his progress in continuing the policy.

Comments:

2 Responses to “How 6 years spent attacking politically motivated targets finally missed its mark”


  1. To be accurate while many clinicians disliked targets generally they were often great fans of targets in their own areas as it gave them a lever with their managers. What they tended to object to was the very poor way that some middle managers implemented the targets and the heavy handed and rather crass approach to performance managament that was adopted by some parts of the system. The last 3-5% of the 4 hour target was probably a bit of a mistake but generally even that target came to be appreciated.

    The mistake that was made was to think that if 5 targets worked 50 would be 10 times better. The interaction of targets and the ability of organisations to focus on very many targets turned out to be an issue.


  2. We now need a targets regime for journalists – number of words per hour, satisfaction of readers, cost per word, topics covered, involvement of community – or is this nonsense only for poor saps managing public services ?

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