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Target culture in NHS
The recent report on my hospital, Stafford, has blamed target culture for the poor care provided. Do you agree.
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No, it's bad management.
Targets are supposed to give you an aim, a measure. If they are working to the targets it is a manageriak issue.
From what I understand they made cuts in order to gain foundation status.
I've been in and out of hospital all my life, the N.H.S has improved immeasurably over the last 10 years.
Targets are supposed to give you an aim, a measure. If they are working to the targets it is a manageriak issue.
From what I understand they made cuts in order to gain foundation status.
I've been in and out of hospital all my life, the N.H.S has improved immeasurably over the last 10 years.
To a certain extent, yes. When you put targets and league tables in place everything tends to focus on achieving the targets or moving up the league table rather than treating the sick, educating the children or investigating the crime.
Consequently you get strange practices like improving your cancer recovery rates by referring people who look like they're not going to recover to somewhere else, or improving your crime crime clearup statistics by only bothering to investigate those crimes which are easy to clearup like speeding or littering.
Obviously it's not quite that simple, but there's a certain amount of truth in it. It's alright blaming bad management, but it's a culture that encourages bad management.
Consequently you get strange practices like improving your cancer recovery rates by referring people who look like they're not going to recover to somewhere else, or improving your crime crime clearup statistics by only bothering to investigate those crimes which are easy to clearup like speeding or littering.
Obviously it's not quite that simple, but there's a certain amount of truth in it. It's alright blaming bad management, but it's a culture that encourages bad management.
I disagree, good chefs tend to make bad business men (or reatauranteurs if you prefer) so Drs similarly which ever proceedure they espouse they feel is right, Drs never admit to being wrong, you can't run a business like that.
I've seen the N.H.S at first hand over the years, targets is about identifying problems and formulating answers, if trusts are massaging the figures then that most definitely is a managerial problem.
I've seen the N.H.S at first hand over the years, targets is about identifying problems and formulating answers, if trusts are massaging the figures then that most definitely is a managerial problem.
Everton, you are right about it being a management issue, and yes the NHS has improved in part. However, the priorities and status is set by the govt and if too much emphasis is placed on one thing, eg Foundation Status, the focus switches to this to the detriment of other issues.
Ludwig, yes it is complicated and I would also tend to give a well maybe answer. Targets can skew service deivery. They are a bit of the curate's egg. Some have definitely improved matters, but when focus moves away from clinical need to finances care is bound to suffer
Ludwig, yes it is complicated and I would also tend to give a well maybe answer. Targets can skew service deivery. They are a bit of the curate's egg. Some have definitely improved matters, but when focus moves away from clinical need to finances care is bound to suffer
Doctors do not run the NHS. Consultants have far too much power but if there's a bed crisis or a target to be met then this is invaribly set by middle and top end management who are rarely clinically trained, (and if they are have long since abandoned clinical practice). So it is a pretty poor arguement to blame it on them.
I agree mostly with bednobs in the sense that there is a target culture in the NHS which as far as I'm concerned is a pain in the proverbial. We had a bed crisis lasting nearly three months in the Trust I work for because of A&E bed targets and also the novo virus which bu88ered (for want of a more appropriate word) up my targets and is continueing to do so still.
There is also the problem of increasing targets such as eighteen weeks which means that if you have a poor performing department (say Imaging) then you will fail to meet them because of that department.
However on the plus side, those targets are set to meet patient care and because for the majority of the time we have to abide by them the I guess patients (like it or not) are probably reaping the benefit so it's swings and roundabouts.
Personally my opinion is that the sooner the goverment stops trying to run the NHS like a business the better, it is not a business, it was not set up to make money and as such will always be something of a black hole as far as finance is concerned. It can be managed to an extent but it is not the same (and never will be) as a private company.
I agree mostly with bednobs in the sense that there is a target culture in the NHS which as far as I'm concerned is a pain in the proverbial. We had a bed crisis lasting nearly three months in the Trust I work for because of A&E bed targets and also the novo virus which bu88ered (for want of a more appropriate word) up my targets and is continueing to do so still.
There is also the problem of increasing targets such as eighteen weeks which means that if you have a poor performing department (say Imaging) then you will fail to meet them because of that department.
However on the plus side, those targets are set to meet patient care and because for the majority of the time we have to abide by them the I guess patients (like it or not) are probably reaping the benefit so it's swings and roundabouts.
Personally my opinion is that the sooner the goverment stops trying to run the NHS like a business the better, it is not a business, it was not set up to make money and as such will always be something of a black hole as far as finance is concerned. It can be managed to an extent but it is not the same (and never will be) as a private company.
China, I totally agree. The business model for the Nhs is grafted on, its not natural. Some bright spark who thought that the purchaser /provider split was good actually only built in another layer of bureaucracy. The govt have fallen into the trap that things have to be proven statistically. Whilst there is some merit in this, it takes no account of the complexity or qualitative nature of the NHS.
Years of cuts have left no slack in the system and govts have to be responsible for that
Years of cuts have left no slack in the system and govts have to be responsible for that
thankfully the Irish health care system is not run like this. Mind you it has its own difficulties. If health care staff believe any policy or practice impinges on good patient/client care and that it is in the public interest they should report it. A law has been introduced in Ireland to that effect the whistleblower protection. Too often those working in health care spend too much energy criticising practice without taken any action. I know I have sent several correspondane up the line about matters affecting the welfare of clients.
Pink, the whistleblower policy is great, but sometimes the problem is systemic. My mum was in this hospital for about 8months and by and large the staff were wonderful. They were just massively understaffed, and again that is a political and managerial cause. The care at times was *****, but I don't blame the individual medical and nursing staff entirely as they mostly did their best.
After that long you do get a true picture
After that long you do get a true picture
If this were so why would 95% of trusts be rated excellent?
No, there are issues with targets but this hospital is a case of catastrophic failure and the people in it are desperately looking for something, anything else to blame.
My father was ambulanced to A&E in a London Hospital 10 days ago. The ambulance was there in 8 minutes. He was in Emergency for more than 4 hours but the wait was comfortable, clean and everybody was great - This was on a Friday night.
He was in a week got excellent care and saw brilliant doctors - He even liked the food.
They could do this with targets why couldn't Staffordshire?
No, there are issues with targets but this hospital is a case of catastrophic failure and the people in it are desperately looking for something, anything else to blame.
My father was ambulanced to A&E in a London Hospital 10 days ago. The ambulance was there in 8 minutes. He was in Emergency for more than 4 hours but the wait was comfortable, clean and everybody was great - This was on a Friday night.
He was in a week got excellent care and saw brilliant doctors - He even liked the food.
They could do this with targets why couldn't Staffordshire?
Anyone involved in the poor care of these unfortunate patients must take a share of the blame. Yes, it may well be target culture, poor management, etc., but if anybody at all that was aware of what was going on did nothing about it or turned a blind eye, then they are all just as much to blame, whether they be a senior manager or a cleaner.
Doesn't help I know, but an interesting story that Rosetta will comment upon.
There was a system called the Three Wise Men, consultant status of some standing,who were appointed to deal with complaints against their colleagues or junior doctors. My junior came to me with a complaint that he felt that my colleague was unfit to operate because of a drink problem.....a serious acusation.
I tried to find out who the 3 Wise Men were and found out that nobody knew. However finally I went to the Chief Executive who informed me that I was one of the Three Wise men and I didn't know.
Stafford....believe me not an isolated case, a combination of bad management and emphasis on targets which bare a very mixed blessing.
There was a system called the Three Wise Men, consultant status of some standing,who were appointed to deal with complaints against their colleagues or junior doctors. My junior came to me with a complaint that he felt that my colleague was unfit to operate because of a drink problem.....a serious acusation.
I tried to find out who the 3 Wise Men were and found out that nobody knew. However finally I went to the Chief Executive who informed me that I was one of the Three Wise men and I didn't know.
Stafford....believe me not an isolated case, a combination of bad management and emphasis on targets which bare a very mixed blessing.
When I say business what I mean is that we make an investment and expect to see a return (service).
Before targets were set the money seemed to just disappear into a void.
Targets are'nt perfect but the N.H.S is a huge business and at board (government) level it can't do too much detail.
Micro management of that sort is down to the individual trusts and the individual teams working at the coal face.
Drs themselves disagree on the best courses of treatment, to pander to each ones preference would cost astronomical sums of money.
If targets get scrapped, mark my words, 5 years later someone will be on tele or on here (although that could be me) saying that "if we still had targets this would'nt happen."
Consultants don't always know best either, last year I was in hospital the consultant took me off the drip and onto tablets even though I told him I could'nt swallow anything, I spent the whole day without antibiotics and without fluids, I was quietly put back on the drip that evening, and then onto fluid medicine the next day which was still a struggle.
Before targets were set the money seemed to just disappear into a void.
Targets are'nt perfect but the N.H.S is a huge business and at board (government) level it can't do too much detail.
Micro management of that sort is down to the individual trusts and the individual teams working at the coal face.
Drs themselves disagree on the best courses of treatment, to pander to each ones preference would cost astronomical sums of money.
If targets get scrapped, mark my words, 5 years later someone will be on tele or on here (although that could be me) saying that "if we still had targets this would'nt happen."
Consultants don't always know best either, last year I was in hospital the consultant took me off the drip and onto tablets even though I told him I could'nt swallow anything, I spent the whole day without antibiotics and without fluids, I was quietly put back on the drip that evening, and then onto fluid medicine the next day which was still a struggle.
Sounds fairly typical that one hand doesn't know what the other is doing in NHS Sqad, and I agree that targets are a mixed blessing.
I dont think the current system is the best but I am blowed if I can come up with a better one. Dont get we wrong, I think the NHS is wonderful, despite some of the problems and I know how hard staff work. Whenmy mum was in there it was patently obvious that there were far too few nurses, particularly as C Diff was rife at the time. When I mentioned it to one of the Matrons she wittered on about something entirely inconsequential. Hows that for supporting your own staff?
Everton, of course they don't get it right all the time. With an organisation that big there are bound to be some mistakes. Things have improved here though, Mr R went through A&E recently and they were extremely thorough.
I dont think the current system is the best but I am blowed if I can come up with a better one. Dont get we wrong, I think the NHS is wonderful, despite some of the problems and I know how hard staff work. Whenmy mum was in there it was patently obvious that there were far too few nurses, particularly as C Diff was rife at the time. When I mentioned it to one of the Matrons she wittered on about something entirely inconsequential. Hows that for supporting your own staff?
Everton, of course they don't get it right all the time. With an organisation that big there are bound to be some mistakes. Things have improved here though, Mr R went through A&E recently and they were extremely thorough.
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