DOCTORS and nurses find the culture of getting “patients out the door” to reach turnover targets hugely demoralising, Scotland's former chief medical officer has said as he claimed introducing “legal” waiting times had been a mistake.
Professor Sir Harry Burns said the four-hour A&E target and cancer treatment timescales have helped in some cases but that care is fragmented and should be changed to suit individual patients' needs and hospitals’ wider care performance with a “different approach to targets necessary” if patients are to receive the right care.
Sir Harry, above, launching a review of waiting times target policy, said that when wrongly implemented such policies “divert medical staff away from doing what patients need”.
Herald View: Care must not take second place to NHS targets
The director of global public health at Strathclyde University said that making the 18-week timeframe referral to treatment guarantee for patients with cancer law was "heavy handed" and should be reconsidered.
However, Scottish Health Secretary Shona Robison, below, said the targets will stay.
Sir Harry said it has been established there are “unintended consequences of targets” adding that "people begin to do things to fix the target at the expense of other aspects of care".
He said: “What we’ve got across health and social care are people who really want to do the job, they are doing a job that makes them feel valued and they want the ability to innovate and improve things.
"And where we are constraining them to do certain things, where they have to achieve a four-hour waiting time and all his kind of stuff it diverts them away from doing what patients need because they have to get them out the door.
Herald View: Care must not take second place to NHS targets
“So I can see how staff can be unhappy at being forced to do this.”
Sir Harry continued: "The 18-week target is a referral to treatment and what it doesn’t recognise is that some people who are referred to hospital for investigation might take a bit of time to think about and may have complex investigations that are necessary and so on.
"It is conflicting and unnecessary and can lead to confused discussions with patients."
Sir Harry went on: "If someone is trying to hasten you through a complex diagnostic process in order to meet a target that does not seem to me to be good patient management.
Herald View: Care must not take second place to NHS targets
"There’s no question that we need indicators that say people are moving along to get treatment that is appropriate to the urgency of their case, but I’m just not sure that we should be squeezing people into a target.
"Imposing a target, whether it be 90 per cent or 100 per cent or whatever, especially when targets are enshrined in law, it just feels to me to be a bit heavy handed."
Herald View: Care must not take second place to NHS targets
Sir Harry said it is essential to try to tackle health problems across the social sector, for example linking helping people suffering from mental health issues through debt problems could he helped by wither social or healthcare workers.
He emphasised research showing children living in chaotic families are far more likely suffer chronic ill health in later life as another example where health and social care should dovetail.
Herald View: Care must not take second place to NHS targets
He said: "One of the points I have emphasised is the need to do more to support families in difficulty, to identify children experiencing adversity and to build systems that will help them develop intellectually so that they do succeed in school and they do remain engaged with society.
"To me that is the biggest element of this, being able to reach out to support families."
Dr Peter Bennie, chair of BMA Scotland, said it has "warned for some time of the risk that inappropriate targets can skew clinical priorities and those concerns are reflected in this report".
“Decisions over the treatment of patients should always be based solely upon clinical need.
“This report gives us an important opportunity to develop new approaches to improving the quality of our health services. It is essential that we use it.”
Professor Derek Bell, president of the Royal College of Physicians of Edinburgh, above, said: “We must ensure that any new approach to targets and indicators focuses on patient outcomes across the whole system of care making the best use of our resources."
The Health Secretary said the current targets, such as for cancer treatment, A&E, and the treatment time guarantee, will remain but be built upon.
She said: "To be clear, the targets will remain in place, but Sir Harry’s report is absolutely right that we must shift the emphasis to ensure we have a more sophisticated approach which helps drive improvements in health across the population.
“His comprehensive review and findings enable us to start the process of devising new methods to more deeply understand people experience whilst using health and social care services."
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