Editor—Concerns about waiting lists and targets in the NHS are not new. They have been central to the experience and perception of our health care since its inception.1 Nevertheless, Bogle's comments about the lengths to which some hospitals appear to go to meet targets should be taken seriously.2 That targets and personal incentives influence managerial practices is not in doubt.
We observe that patients may be admitted to a medical ward for a few hours to wait for results of investigations. Such admissions certainly help throughput in accident and emergency departments. But they also increase paperwork and add to nursing workloads. It is perhaps ironic that such admissions may reduce average lengths of stay, another management benchmark.
Recent evidence has supported the view that a focus on particular targets may make clinical services worse. Harrad estimated that to meet waiting time targets for new patients, 25 patients with diabetes or glaucoma may have lost their vision due to a delay in their follow up appointments.3 An analysis comparing the government's top performing hospitals with Dr Foster's research into death rates showed these hospitals to have higher than average death rates.4
We appreciate that it is easiest to manage measurable inputs and outputs. But when managing by target in a complex organisation such as the NHS, we think that greater care could perhaps be exercised in defining those few patient centred targets that unequivocally will make a difference for the better.
Competing interests: None declared.
References
- 1.Frankel S. The origins of waiting lists. In: Frankel S, West R, eds. Rationing and rationality in the National Health Service. London: Macmillan, 1993.
- 2.Beecham L. BMA chairman criticises erosion of clinical autonomy BMJ 2003;327: 8. [Google Scholar]
- 3.Gulland A. NHS staff cheat to hit government targets, MPs say. BMJ 2003;327: 179. (26 July.)12881236 [Google Scholar]
- 4.Wright O. “Best” hospitals have the worst death rates. Times 2003, May 12.