Business as usual…


There are lots of reasons;

• Not enough beds

• Not enough nurses

• Finding a consultant

• Not enough doctors on the rota.

• Delayed discharge

Mainly it comes down to the people. Too many people waiting to be seen by too few people to do the seeing.

Everything points in the direction of a failed workforce policy, to find enough people and keep them. The upshot, delays.

Workforce and delays. The two are inextricably linked.

In this case workforce policy and missed A&E targets. Delays in A&E have become so persistent, departments have corroded up. There is no longer any hope that A&E targets will be met. Thus, they have been abandoned.

We’ve given up hope of staffing adequately for the foreseeable, so the targets are out of the window. Does it matter?

Why do we have targets?

The story starts in 1990 when the, then, Tory government introduced a 2yr wait target, for electives.

The incoming Blair government, 2004, managed waiting aggressively. Funding was improved and the target set for 100% through A&E in 4hrs. In the first year 48% failed to meet the target but by 2005-6 it was up to 98.2% success.

The targets were a political construct. Not medical. Indeed, it was pressure from the medics that reduced the target from 100% to 98%, to allow time for longer observations.

Lansley lowered it to 95%.

By December 2014 the number of patients being treated within four hours had fallen to 91.8%.

From December 2015, the 95% target, over England as a whole, was missed every month. Performance against the four-hour wait target, in the summer of 2018, was the worst second quarter performance recorded.

Only 88.9% of patients were seen in four hours, in September 2018. This January 84.4% were seen in time.

What do you do? If you can’t hit the targets… change the targets.

Does it matter if you wait a bit longer in A&E? Yes, if you’re having a heart attack, or bleeding to death. Probably not if you have a broken toe? Inconvenient, painful but not life threatening.

The news that A&E waiting times are to be recalibrated is not a big news day, or the end of an era. It is the confirmation of a reality. What A&Es have been doing for the last couple of years…. dealing with the sickest first.

Why are the targets changing? Because last year the Prime Minister asked NHSE bosses to look at the targets and their relevance and usefulness.

You see, its all about politics and the workforce.

Targets are a political construct and have morphed into management techniques, flow dynamics, pathway design, resource application and medical improvements… but they started with politics and will end with politics.

Targets have also delivered us regulation and regulators.

Missing targets has been career limiting. I wonder if the CQC will apologise and reinstate the people who, at their behest have lost their jobs missing unachievable targets.

The people who have been bullied into breakdowns trying to do the undoable.

I doubt it.

Does the recalibration of the targets matter?

It matters to managers and other staff who have prided themselves on achieving the works of Lazarus in three hours and fifty-one minutes.

To a lot of the public who cannot get to see a GP, turning up, getting seen, diagnosed and treated in four hours, waiting, using the free wi-fi, drinking a Costa… it’s better than hanging about for weeks, for a GP appointment, and then being sent to hospital anyway.

To the public, who are really sick, they will be moved to the front of the queue, without A&E staff looking over their shoulder for the woman with the clip-board.

For the staff, who take pride in their skills, they will still bust a gut to help everyone.

Business as usual.

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Reproduced at by kind permission of Roy Lilley.