Dear Mr Lansley,
Yesterday at 4pm I had cause to attend the A&E department at a local hospital. Due to the nature of the symptoms I was experiencing, the medical staff needed to undertake a complex and comprehensive initial investigation. As this was almost at a conclusion (shortly before 8pm) I was informed that in order to meet Government targets I would need to be moved out of A&E and be admitted to a ward. I was also told that it was likely that I would be discharged within an hour, subject to the results of the tests.
At this time the department was relatively quiet - there appeared to be sufficient staff on duty in A&E, cubicles were available and the waiting room was practically empty. In other words, there was no medical reason for me to have to move location at that time; neither did another patient require my cubicle. A short time after being admitted to the ward, the Doctor in charge of my case visited me and confirmed that I could be discharged.
I appreciate that Government NHS targets were probably introduced with the good intention of improving clinical care for patients, but I am troubled by the actual effects that they cause at ground level. In this case, I was left in no doubt that my medical well being was at the forefront of A&E staff members’ concerns, yet they were obviously hampered by these arbitrary numerical targets, which do little for clinical care and actually impede the efforts of front line professionals.
The effect of moving me out of a department that had sufficient capacity to treat me placed unnecessary strain on a ward that ultimately did not need to become involved in my treatment. Had the four-hour admittance time target not been in place, then my treatment would have run its course within A&E with minimum impact on that department’s operational capacity, and no impact on the ward at all. As it happened, the target generated additional administrative activity for staff from both departments that was ultimately unnecessary. It also caused the Doctor in charge of my treatment to become abstracted from his core function in order to brief ward staff and visit me in another part of the hospital to explain aspects of forthcoming outpatients treatment and inform me I was being discharged. This could have been quite easily achieved in my original location, and I am left in no doubt whatsoever that the remainder of my treatment would have been carried out in A&E had that department not been under pressure to meet the time-based target.
Had the target not been in place I am also certain that the ultimate outcome of my hospital visit would have been the same, as well as being a quicker and smoother experience. I am also convinced that unnecessary handover procedures, delays and administrative functions would have been avoided, thereby releasing capacity to attend to other patients. Other than exceeding the target time, there would have been no adverse impact had I been permitted to remain in the A&E department pending the results of the tests. I have no doubt that the A&E staff felt compelled to comply with the admission time target by ensuring that I was ‘off their books’ within the specified time period. This is despite the obvious ability and professionalism of those who attended to me. The problem here is not a ‘people problem’ – it is a system problem caused by inappropriate external pressures and perverse incentives.
Taking into account my experience, I would be grateful if you could demystify exactly how my NHS experience has been enhanced by the existence of Government targets, and explain how this particular target has contributed to improving clinical care at this hospital? I am also keen to understand why, in the event that I had ‘overstayed’ in A&E, it is appropriate that the hospital should subsequently be penalised for failing to meet that target?
I ask that you consider your answers carefully as I am not prepared to accept that this is an isolated case of bad individuals behaving inappropriately – it is an inevitable consequence of the inappropriate pressure associated with target-driven performance management.