Knocking NHS targets has become the norm. It’s often the first thing people tell me socially when the NHS comes up in conversation – admittedly with people who haven’t used it much recently.
Of course there are occasions when targets are just tick boxes, such as some asthma reviews, or where they have distorted clinical priorities, such as the target for a maximum four hours wait in A&E. There are undoubtedly instances where targets have led to ‘gaming’ the system with little or no benefit to patients.
But there is a positive story to tell about targets too. This came across in the Nuffield Trust survey of Health Services across the UK, which was published last week.
It said that ‘by 2006 virtually no patients in England waited more than three months for an outpatient appointment, whereas 44% of patients in Wales and 61% in Northern Ireland waited more than three months.’
Health systems have gone in different directions in our devolved nations. The Welsh system has placed a strong emphasis on equality – witness its lead in ending prescription charges (which was soon followed by Scotland and Northern Ireland). Scotland started with a stronger emphasis on standards – they have had children’s asthma standards for some time, and are only now being followed by England. But Wales and Northern Ireland have made less progress than England in reducing waiting times (the Scots measure those in a different way which makes comparison difficult). NHS managers in England argue that targets were necessary to drive that huge improvement in average waiting times we now take for granted.
Although all main political parties argue that the need for targets is in the past, I hope that some of the best targets are retained as standards the health service should always meet. Interestingly, the Conservatives have nuanced their pledge on targets in recent weeks. They now promise to end ‘politically motivated process targets’ which implies that they will keep some which are supported by patients and clinicians.
I hope this happens. None of us want to see a return to waits of over a year for medical treatment. And consistent standards are needed to make sure we chip away at the postcode lottery that sees some asthma patients receive a very different standard of care from others, simply depending on where they live.
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