Comment: National efficiency measures are ignored in the need to deliver healthcare

Published: 13/06/2002, Volume II2, No.5809 Page 17

If government still needs a lesson in the futility of trying to micro-manage the NHS then the report on hospital efficiency targets from York University's Centre for Health Economics provides it (see news, pages 6-7). The report contains myriad significant messages for policy planners, but among the starkest is that complex national efficiency measures are simply ignored in the rush to deliver healthcare.

Press any health service manager hard enough and they will admit that the only targets that matter are those attached to waiting lists, winter pressures and coming in on budget. You would expect finance directors, of all NHS staff, to love efficiency targets - only one of those questioned by CHE fully understood them.

Everywhere the report's authors looked, they saw the same thing happening: trusts responding to local, not national, efficiency needs by trimming this budget and boosting that one. As long as break-even was achieved and waiting-list targets met, the centre was considered to be getting all that it was asking for.

'Superfluous' is the word used by CHE for the hospital efficiency targets, but it cautions that 'there is still an important role for the centre to produce comparative cost information...but that role is to improve the information base at the local level, not to replace local judgement on how best to use the information'. This conclusion was reached before the announcement of patient choice - a system that will be based on nationally comparable tariffs - and therefore now has even greater resonance.