NHS England has largely given up and across the globe health targets are regarded quite differently but in Scotland they remain highly politicised and simplistic, even moronic. Despite well-known problems with target-setting including both failure to improve services and even a tendency to worsen them (below), the opposition parties and their lackeys in the MSM (above) leap gleefully, as they have done today, on ‘missed targets’, demanding improvements in the name of the people and either directly or by implication, condemning the ‘SNP Government.’
Where targets are hit or even surpassed, as with IVF, drug and alcohol treatment, they are ignored. Where they are approached despite pressure from soaring demand, as in A&E and in cancer treatment, it is never enough for commentators.
[What follows has mostly been presented here before]
Nearly all of the NHS Scotland targets are for treatment within a period of time for between 90% and 95% of patients. Anything below that is described as a failure to meet the targets and is the trigger for ministerial apologies, opposition attacks and miserable patient interviews but this is not helpful in improving services nor is it the case in other places.
The European Observatory on Health Systems and Policies, in 2008, concluded:
Despite the scale of this activity, there is scant evidence of the effectiveness of health targets. The process of establishing targets may have little linkage with mechanisms for governing, financing and delivering health services (Wismar and Busse 2002)…..Health targets may even be counterproductive – the current debate on their use is dominated by examples from the English National Health Service (NHS) in which the use of numerous extremely detailed targets, backed by incentives and sanctions, has led to widespread opportunistic behaviour. Distortion and even misreporting of data, accompanied by adoption of dysfunctional actions, achieve the targets but worsen patients’ situations (Wismar et al. 2006). (p3-4)
From an international study in 2014:
‘Most countries are following the UK 4-hour target [A&E] as it is recognised that there is a benefit to adding in a time constraint. Victoria and Ontario [Canada] both have set the achievement target lower, at 75% and 90% respectively, compared to 95% in England [and Scotland]. Moreover, neither system actually meets their target, and especially in Victoria there are few consequences to this. In Stockholm [Sweden] the county monitors performance on the 4-hour target but this is not nationally mandated.’
In a 2015 report for the Health Foundation (p5) the following reservations about an obsessive focus on targets were made:
- There have been instances where reported performance has improved without services improving for patients: ‘hitting the target but missing the point’.
Example: Cancelling procedures along parts of the pathway not covered by the target (for instance aftercare) in an attempt to direct resource towards the targeted area of referral to treatment, even though overall patient outcomes could be negatively affected.
- [Targets] may lead to a disproportionate focus on areas which are measured at the expense of those which aren’t.
Example: Reports that the Quality and Outcomes Framework (QOF) had a negative impact on holistic care in general practice, with the targets skewing focus towards single-conditions or issues.
- There have been reports of gaming and manipulation of data.
Example: Some ambulance trusts reported reaching patients in less than one minute (a near impossible time), suggesting manipulation of the data to meet the target.
Research from business schools, reported in Forbes magazine in 2013, suggests a wider and deeper problem with the whole idea of target-setting, arguing that they tend to do more harm than good and that they often cause real damage to organisations and to the people who work in, or who use, them:
‘We argue that the beneficial effects of goal setting have been overstated and that systematic harm caused by goal setting has been largely ignored,” the researchers conclude. Bad “side effects” produced by goal-setting programs include a rise in unethical behaviour, over-focus on one area while neglecting other parts of the business, distorted risk preferences, corrosion of organizational culture, and reduced intrinsic motivation.’
Where intensive national broadcast media attention to failures to meet targets is added to the above consequences, the effects must surely be even greater. During a recent one-month stay in hospital while at the same time writing this blog, I was able to ask 24 health practitioners about their reactions to the negativity commonly broadcast about NHS Scotland’s performance by BBC Scotland and STV. I had been especially interested in how their morale might have been affected but not one of the 24 reported watching or listening to Scottish news broadcasts other than by accident.
Scottish MSM weaponizing of the NHS, while potentially quite effective in scaring older and more vulnerable Scots into conservative mindsets conducive to voting against change, surely risks conflict with those professional groups working in it and often otherwise aligned with their Loyalist mission.