Concern about the efficiency and effect of targets in the National Health Service has been gathering for years, but the time has now come for a profound examination of their use. Targets do have their place in the NHS because the service patients receive must be measured, but a more mature, evidence-based use of targets is needed for the future.
The most recent figures on targets appear disquieting. From April to June, the health service failed to meet the 12-week guarantee for treatment delivered on an inpatient or day care basis. The latest figures for A&E waiting times also show the service falling short of the Scottish Government's target, with 94.2 per cent of patients being seen and subsequently admitted, transferred or discharged within four hours during the week ending August 16.
There is no question that the waiting times in A&E in particular are a symptom of a system that is struggling to cope with the ever-increasing demand from an ageing population. The NHS also has to use its limited resources as best it can as part of a system that brings together health and social care and if targets can help achieve that, they should be used.
But Holyrood's Health Committee is right to ask for the Scottish Government to ask for more information on how health boards are meeting, or failing to meet, the targets. In time, this might have to lead to some consideration of whether there should be more flexibility around some of the highest-profile targets such as the four-hour A&E waiting time.
The committee's concern centres on the way in which targets could be affecting how money is spent. During an examination of health board budgets, it heard that resources were often diverted if there was a risk a target would be missed, to the possible detriment of other projects. The committee's conclusion was that a focus on key targets could result in large sums of money being spent to achieve marginal improvements in performance. "The boards agreed that the focus on achieving high-profile target measures could lead to an inefficient allocation of resources," a committee report said.
This conclusion is in accordance with concern expressed recently by the Academy of Medical Royal Colleges and Faculties in Scotland and the Royal College of Nursing Scotland. Together, the organisations called the targets unsustainable and said they were often skewing clinical priorities and focusing energy on too man of the wrong things.
In the face of this criticism, the Scottish Government says it is committed to maintaining targets, but that should not preclude an investigation into the concerns of the health committee and many NHS staff. The service needs some way of measuring performance, but the Scottish Government should also determine to what extent targets are distorting the way staff behave and how health boards spend their money.
The specific problem the committee has identified is that the Government is not able to establish how much it is costing boards to meet the last percentage points of the targets and it has a question: how can ministers ensure that the drive to meet targets remains an efficient use of money for NHS boards when it is not able to establish how much it is costing boards to meet them? It is a fair question. The Scottish Government should now provide an answer.
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