Editor—According to MPs, NHS staff are cheating to hit government targets.1 Many readers will not be surprised to read of stories of wheels being removed to rename a trolley as a bed, this problem has a more serious side. Through the use of punitive targets the government has tried to lead us from the gold standard of patient centred care to a new “target centred” brand of medicine.
The targets seem chosen for their ease of measurement rather than their clinical effectiveness. Where is the evidence base for these targets? Why is the same target used for a minor graze as for a polytrauma case? We have had numerous examples of patients being admitted purely to avoid breaching the four hour accident and emergency wait.
At best this has ended in an immediate discharge for an inappropriate admission, with all the attendant increase in costs and decrease in free beds. At worst the patient is transferred without the resuscitation and immediate treatment he or she needs. With such severe financial penalties associated with multiple breaches it is not surprising to hear these stories. As long waits in accident and emergency departments are due to understaffing, setting a magical four hour cut off will not improve patient care. We welcome MPs questioning the value of the targets. However, they should not accuse NHS staff of cheating to overcome the ludicrous targets they have set. The only people really being cheated are the patients.
Competing interests: None declared.
References
- 1.Gulland A. NHS staff cheat to hit government targets, MPs say. BMJ 2003;327: 179. (26 July.)12881236 [Google Scholar]