Published: 07/11/2002, Volume II2, No. 5830 Page 8 9
British Medical Association chair Ian Bogle has called on the government to scrap the majority of specific NHS targets and allow primary care trusts to decide local priorities within broad national targets.
Appearing at the Commons public administration committee hearing on target-setting and performance measurement last week, Dr Bogle said consultants and managers were forced to collude to meet targets that did not match clinical priorities.
Admitting his evidence was only anecdotal, he said: 'I am sure some doctors collude because they want to assist managers in achieving targets.My colleagues tell me they have to hit waiting time targets for a whole raft of simple procedures, rather than carry out operations with higher clinical priority.
And he said an ongoing BMA survey revealed that three out of four doctors questioned said they were not seeing any benefit from the extra millions being pumped into the NHS because the money was being used to hit targets.
'It is the government insistence that these targets be met that is causing problems. There are over 400 targets in the NHS plan. That is what is causing a distortion of clinical priorities. I want more time with my patients and I want to see fewer, clearer targets that are of direct benefit to patient care.'
Dr Bogle said top-down pressure from the government to meet targets was resulting in the inefficient use of funds and prevented the movement of clinical decision making to local level. 'Managers are being told to meet targets at all costs and as a result are taking measures that are unacceptable, such as creating hidden waiting lists, downgrading clinical conditions that have not reached targets and redefining trolleys as beds.'
And Mid Dorset and North Poole Liberal Democrat MP Annette Brooke asked how decision making devolved to a local level would be monitored.
Dr Bogle said he wanted to see PCTs, the public and other NHS professionals produce a business plan for the area that incorporated national targets and local priorities. 'The plan would be submitted to the relevant special health authority which would carry out the monitoring.'
Cardiff West Labour MP Kevin Brennan asked Dr Bogle for examples of what he considered to be bad targets.
Dr Bogle said: 'Waiting lists per se are a lousy target because they take no note of patients' clinical needs. There is a temptation to do the easy work to meet the list and that way you get close to cheating because it is taking the easy way out.'
Committee chair Tony Wright asked why the medical profession was against the publication of performance data by named clinician. 'Patients want to know which doctor will kill them and which doctor will not. They just want to know as users of the service. Why are the professional groups having such difficulty with the concept. Are you happy with league tables?'
But Dr Bogle said the medical profession supported the publication of mortality and mobility data, so long as it was presented in context of case load. 'I support the provision of information on the performance of individual units in hospitals so long as it is based on good solid data on the performance of individual clinicians.
'And even if we and the government do not like the idea of league tables, if the data is out there league tables will be produced. It is just that performance must be presented in context of workload and all other factors.'