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The great target fiasco

18th February 2008

Chris Hamnett explores the issue of government-set performance-related targets in The Guardian.

healthreport

Once the Labour government took control of the country, the new Prime Minister, Tony Blair, decided to focus on the modernisation of Britain's public services and to ensure they were driven by the requirements of the consumer or client.

Tony Blair and Gordon Brown wanted to improve the quality and standards of medical services. The question was how the government could gauge "the provision of non-market services?"

It is more difficult to measure performance in non-profit organisations in the public sector, such as the health service, than in the private market.

The government's answer was to set targets and measure performance using numbers, lists and "league tables". Their introduction meant that health boards now have to make certain that patients do not wait "more than a specified time" to be seen.

The idea behind the improvement of public sector services is excellent. However, "the problem is with the practice". When targets must be reached, the quality of the service and the satisfaction of those using it becomes less important.

This has resulted in some "perverse outcomes". For example, a target which was designed to make certain a patient could see a GP within 48 hours after they had booked in, caused many doctors to stop offering bookings more than 48 hours in advance.

Suggestions have been put forward that the focus on attaining these waiting time targets has led to less attention devoted to other important issues, such as superbugs.

The government's promise that a patient "should not have to wait more than four hours to be seen in accident and emergency departments" has also led to skewed results.

A BMA survey showed that 50% of hospitals has brought in extra staff during the time when measurements were made and 25% had "cancelled elective surgery to meet the targets".

The pressure on staff will mean that targets may be met, but at an overall cost to the standard of service.

The government must understand that by setting targets it is compromising service quality - "the reverse of what [it] wants to achieve".

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