On the hook…

Primary Care Training_NHS General Practice on the hook...

“We thought that we had the answers; it was the questions we had wrong.” 

Nice little quote from that great, global philosopher and thinker… Bono.  His song; Eleven O’clock, Tic, Toc.

Once again the NHS, faced with a problem, is just about to dig up the foundations, in search of the wrong answer.

Once again our erstwhile secretary of state, Number 18, is about to knee-jerk his way into the record books of all time bad decisions.  If he’s not fax-hunting, he’s log-in-jammed.  I just wish he would stop and think.

It looks like he’s about to dump A&E targets.  Wrong, wrong, wrong.

I am no fan of targets.  You know what they say, ‘hit the target and miss the point’.

Targets were a political construct.  Invented by the Tories in the 1990’s and built on by the Blair government.  They were blamed for ‘distorting clinical priorities‘… but they worked.  

In 2005/6, 98.2% of patients were seen, diagnosed and treated within four hours, the first full financial-year in which this has happened.

The original A&E target was 100% seen in four hours.  By 2004 it was lowered to 98%.  The coalition-lot lowered it to 95%.  In 2018 only 77.1% were sorted in four hours.

Targets produced cheating on a grand scale.  Medical assessment units were invented.  Running alongside A&E but outside it for statistical purposes.  So we have no real idea what’s what.

Targets produce distortion.  A patient coming up to four hours will get all the attention the department has.  Once the four hours is breached, it is of no further import.  The average time spent in A&E by a ‘breached’ patient is eight hours.

Here’s an interesting factoid

A&E visits per 1,000 population Netherlands 119, and England 345.  

It would be nice to know why?

Number 18 wants to scrap targets.  Why?  

Because the NHS’ persistent failure to meet targets means a monthly embarrassment for ministers who have to find new ways of saying; the NHS is very busy and all the familiar tropes about more nurses, more doctors, more money and more more… more of everything, including waiting.

He is proposing to dump the target on the grounds that it ‘distorts clinical priorities’… where have I heard that before… err, it’s what the Tories said about the Blair targets.

Dumping the target is bonkers.  Number 18 is making a basic management error.  Failing to ask; what is the root-cause of his problem?  He is ignoring management lesson one, page one; Sakichi Toyoda’s, ‘Five Why’ test.

5Why is an iterative, interrogative technique used to explore cause and effect relationships.  The ‘five’ is based on the general observation that ask ‘why’ five times and you’ll get somewhere near to a root-cause and a solution. 

Here’s how it works.

  1. A&E is failing to hit targets – why?
  2. Because it is very busy and we can’t get people through the system fast enough – why?
  3. We can’t admit people as the wards have no beds, they are full of people we can’t send home – why?
  4. Because social services don’t have the resources to put care packages together – why?
  5. Because their budgets have been hammered and there is no plan to fix it… 

Put that lot together and you will see, dumping the targets in A&E will fix nothing but might help with political embarrassment.

However, prepare for headlines that scream; 

‘War hero left in A&E for a fortnight…’

Dumping the targets, however you make the clinical argument, is the wrong decision because it lets No18 and BoJo off the hook to go and do what they are paid for, dig into the ‘too-difficult-tray’ and find a solution to funding social care.

Whatever side of the argument you may be on; target fiddling, fixing or finessing, one thing is for sure.  You’re being conned. Stick with the targets, keep Number 18 on the hook.

News and Comment from Roy Lilley

Contact Roy – please use this e-address roy.lilley@nhsmanagers.net

Reproduced at TrainingPrimaryCare.com by kind permission of Roy Lilley.