From targets to results

HJ

Perhaps a good idea in principle, but just imagine how creative NHS hospitals will get at finding ways not to re-admit patients within 30 days, regardless of clinical need.

David Lindsay

Up to now, I have quite liked Andrew Lansley. He voted against the Iraq War. And simply by staying as it was, his party had, in line with public opinion, a more left-wing health policy than New Labour for as long as there was any New Labour.

But all that ended as a price of coalition with the Lib Dems, supposedly the party of Beveridge. Today, we see what that entails: charging hospitals if patients are readmitted "too soon" after having been discharged, or if they are kept in "too long" due to complications.

After my first my operation, I had been out for a week when I had to be rushed back in with a pulmonary embolism. No one's fault. One of those things. But how would my recovery have been assisted by the cuts that this proposal envisages?

mart

David:

"The emphasis is on results, not targets"

OK - but how does Mr L, as the "man in Whitehall" get the results, without first setting a target?

Why is this supposed new policy not simply a new target?

And as for fining hospitals... I give up.

Mr L said he would trust health professionals again. If this story is true, it is not exactly an indication of trust in health professionals.

Better to remove the targets that resulted in distorted decisions. And replace them with.. no targets.

Thank you

denis cooper

If poor performance by a hospital is going to result in fines then they should be personal fines imposed on the managers held responsible, not fines imposed on the hospital.

If the hospital was fined then conceivably the governing body might dock the fine off the pay of the managers, but more likely it would be patients who would suffer.

This shouldn't really need to be said, but it's always better to punish the guilty rather than punish the innocent and allow the guilty to go unscathed.

Grow Up Get Real

And who pays the fines? Johnny and Janet Taxpayer.
Why not just cut out the middle man (and the middle management) and rip up the wasteful, pointless "target" system.

Alex

"The emphasis is on results, not targets; transparency, not ruses; efficiency, not waste. Improving the quality of care is all that matters;.."

Like it..

When Labour came to power in 1997 the NHS was a mess. It was common to wait months to see a consultant and more months for an operation or suitable treatment.

Labour built more hospitals and employed more doctors and nurses and bought newer and better equipment and set targets for waiting lists and then waiting times and, eventually, with great effort and great vision, made great improvements.

So if now, "The emphasis is on results, not targets; ..... efficiency, not waste. Improving the quality of care is all that matters;.."

That's because the system has been fixed and the people will no longer accept Tory neglect of the NHS.

As for Mr Lansley's latest announcement: at best a gimmick, at worst a pointless gimmick. If that's his big idea, gawd'elp us when he reveals his small ideas...

Chuck Unsworth

Lansley will have to establish a system for examination of the causes of re-admittance. That's going to be quite difficult, given the medical profession's reluctance to commit to any firm diagnosis of anything at all. My guess is that 90% and more of the 'causes' will be deemed unrelated or sent for second or third opinion.

BrianSJ

He should go and read John Seddon's stuff. This centralised target-setting has to stop now now now.

Blofeld's Cat

So Chuck, would you rather the medical profession committed wholeheartedly to a diagnosis that was wrong?

So much of the problem stems from the parcelling of clinical conditions into time-limited packages - 3 days for an appendix, 5 days for a hip and so forth. So much better to return to a more holistic view - is the patient fit enough to be discharged home (and is 'home' ready)? Trouble is, the managers insist on virtually 100% bed occupancy, so emergencies will soon swamp out routine care because bed numbers have shrunk so much that managers outnumber beds.

This oil tanker ain't going to turn round quickly.

Naomi Muse

Different targets, really. Focusing on the patient is the only way and should never have changed.

toni

"is the patient fit enough to be discharged home (and is 'home' ready)?"
As managers and doctor's nervously attempt to make this important assessment, back we go to bed-blocking.

mongoose

re Grow Up Get Real @ 2:32pm, BrianSJ @ 3:43pm, Naomi Muse @
6:40pm
Totally agree - the Government must stop setting targets, and indeed do away with most of them. This idea of Lansley's is yet more micro management.

nonny mouse

The problem with targets is that they cause hospitals to make bad decisions.

In the name of efficiency hospitals were asked to reduce the time patients spend in hospital. The idea behind it was good, as hospitals tended to keep people in for longer than is needed. The problem is they set a numerical target, so patients who needed more time in hospital were turfed out early so that the hospital could meet an arbitary target.

What Lansley has done is remove the target and make an incentive for hospitals to keep patients in until they are healthy enough to leave.

The NHS is still funded by the tax payer, with (presumably) the funds following the patient. The 'fines' just mean that the hospital gets less money if it releases patients too early. It also gets less money if it keeps patients in too long (because it has to spend more).

Hopefully the end result is better decision making by the hospital for individual patients - releasing them as early as possible, but not so early that they need to be re-admitted.

Kate Denham

How is 'no readmittances for related conditions within one month of discharge' not a target?

This isn't about the distinction between targets and results (which are essentially the same thing), it's about the distinction between targets and outcomes - and I'm sad to say I think this demonstrates the new government failing to grasp that concept.

Of course, service delivery isn't designed to deliver perfect scores against targets, it's designed to deliver positive outcomes for the patients. Unfortunately, it's very hard to measure outcomes (How can I measure whether patients are treated with dignity and respect, for example?) but we can measure some things which are likely to impact on that outcome (like the number of nurses they have to explain their condition to before they see a doctor, the time lag between appointments with consultants for serious conditions when they are likely to be worrying, and the time you have to stay in hospital which is not normally a very pleasant experience), which brings us straight back to those seemingly useless targets...

Martwc

Just what is the point of the state fining a state agency? Money-go-round = futile.
A better strategy would be:
1. If a person is re-admitted for a cause that is clinically related to their early discharge, then the hospital is awarded a 'black mark'.
2. Black marks will be awarded for other reasons too, like the hospital's incidence of MRSA-related disease.
3. Each year, the management of the 10 worst-performing hospitals will be dismissed from post without compensation, for incompetence.