NHS targets18th November 2008
Dr John Coakley, medical director of Homerton University Hospitals foundation trust, on NHS targets
While targets are not popular with clinicians, they do seem to have worked.
In the example of cardiac bypass grafts and angioplasties, waiting times have come down considerably since 2001 as the number of procedures and the age of patients has increased.
A major criticism of targets is that they encourage "hitting the target but missing the point" and in some cases lead to fabrication. However, we are now in position – particularly with percentage change targets for infection control – of hitting the point but missing the target.
Between 2004 and 2006, our hospital's annual C diff rates quadrupled from 50 to 194. A restrictive antibiotic policy introduced October 2006 led to an almost immediate reduction back to the 2004 baseline, running between 50 and 60 cases per year.
But then a new target was introduced to reduce C diff rates by 10-30% per hospital each year.
With 3-5% carriage in the population, a hospital such as ours would expect to have roughly five to 10 cases per month, which means we would possibly miss our target of 60, despite a good C diff reduction rate the year before.
Looking at cases per 1,000 bed days allows a standardised benchmark across the NHS but we do need to move to "a more sophisticated method of measuring these vital healthcare-associated infection targets."
We need to move away from a situation in which organisations that have independently set and met challenging targets, seem to fail.
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