Banging heads together… News and Comment from Roy Lilley

It seems the NHS has missed another target.

The news slipped out whilst The Maymite was hogging the headlines in Europe.  No one noticed.

The target itself is easy to game, so the fact it is dropping-out tells us something…

If Trusts miss the target it costs them £250 a day.  In the last year, it’s cost them £2.4m.  Across the NHS that’s about forty-three quid a day, for each acute Trust.

Hardly worth bothering with?  Well…

The target is a so-called quality measure and it is the number of breaches of same-sex accommodation policies.  Simple to say, not so simple to do.  

When the policy was introduced it involved redesign, building works and a lot of bish-bash-boshing-about.  By and large, as always, the NHS delivered.

It all works very well when bed occupancy is running at about eighty, or so percent.  When it gets really busy and occupancy gets into the high-nineties, someone somewhere will have to make the call; do we send Mr Lilley home because he is not Mrs Lilley, or do we stump up two hundred and fifty quid and keep him somewhere safe.

Between October 2016 and September 2017, the Trusts, between them, decided to opt for £250 on 9,741 occasions.  That is 3,525 more times than in the previous year and up by 7,401 on the same window in 2013-4.

Or, as the Daily Mirror delighted in reporting; up by 316%.

I’m going to start from the premise that mix-sex wards are not a good thing and the assumption that no one comes to work to see how many men and women they can get in the wrong place.

We all agree that…

Ok, so why is it happening?

It’s obvious, there are too many patients, not enough beds and on some occasions it it better to stump up a string-of-ponies and end up on the front-page of the Mirror, than send someone home, too early and end up on the front-page of the Mirror.

The single-sex accommodation penalty is what happens when you don’t hit the target.  There was a time when, if you didn’t hit a target, all hell would break loose. 

Not any more.  The DH press office, famous for being famous for something… look like they’ve thrown in the towel.  The best they could manage;

“Since 2010, mixed-sex accommodation breaches are down from almost 12,000 a month to less than 1,000 in September this year.”

So, that’s OK then.  The numbers are better than they were seven years ago but worse than they were a year ago.  Err… am I missing something?

If you are ever stuck for an example, or working on your MBA and need one… this is the best I can think of, to explain the futility of targets.

If targets do anything they encourage us to collect data.  The purpose of data is for someone to crunch it and make sense of it.  I don’t think we need The Big-Blue to tell us, the data says the target is on a dramatic decline. 

The DH appear not-bovered.  They know this target has become part of management-by-flogging-a-dead-horse.

There is absolutely no point in asking people to do something they simply cannot do and punish them for not doing it.  This is a whole system issue and out of their reach to resolve.  Trusts do not manage the whole system.  CCGs and STPs do.

If there are too few beds and a mixed-sex breach is inevitable, what is the most stupid thing you could do?  How about; taking £250 away from the organisation, when it might be able to use the £250 to pay for a solution?

data.Gov tells us an NHS bed costs £400 a day.  If we gave the £2.4m back to the hospitals they might be able to open some more beds.

Sometimes you have to stop banging your head against a brick wall and start banging heads together. 


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