Targets slashed in DoH's 3-year plans

A vision for a locally driven NHS has been set out in the Department of Health's threeyear planning framework published this week.

In a drive to promote 'local autonomy', the number of national targets has been cut from 62 to just 20. They include eight in the DoH's public service agreements (news, page 4, 15 July), 11 existing commitments, including headline waiting-list targets, and a new one.

NHS chief executive Sir Nigel Crisp told HSJ that around one third of the previous 62 targets had been 'inputs' - concerning issues such as staffing. All the targets were now based on 'outputs'.

The new national target is the much-trailed commitment to achieve 'year on year reductions in MRSA [Methicillin-resistant Staphylococcus aureus] levels'. The framework reveals that the target will be extended to other infections, such as post-surgical infections in orthopaedics, as the relevant data becomes available from 2005.

The framework also reveals that PSA targets on improving life expectancy, tackling heart disease, cancer, suicide and fighting smoking, obesity and under-18 conception rates may be changed 'in the light of the outcome of the public health white paper later this year.'

The PSA on patient experience has been tweaked already. The framework states that 'the experience of black and minority ethnic groups will be specifically monitored' as part of patient surveys.

Speaking to HSJ, Sir Nigel said the move was a recognition that the NHS had 'under-emphasised the importance of catering' for the BME population, something reflected in research that showed 'black people rate the NHS lower' (than white people).

'We are not meeting their expectations', he claimed.

The tweak to the patient experience target reflects one of the five criteria the DoH includes for setting local targets.All primary care trusts will be required to carry out 'equity audits' of their population to identify inequalities in service provision.

Again, the framework requires that a specific audit must be carried out into the health needs of a PCT's BME population.

The four other criteria are the that the targets:

nshould reflect the needs of the local population;

n address obvious service gaps revealed by benchmarking against national standards;

n be evidence based;

nwherever possible, be shared with local authorities.

Sir Nigel stresses this last point in his foreword to the plan, writing: 'Health organisations and local authorities [need] to work even more closely together and pay attention to the whole range of health and social care services.'

He told HSJ that the NHS had much to learn from local authorities in three areas: the tackling of inequalities, working with local people to improve responsiveness and, specifically, case management, which was well established in some social service departments.

PCTs will be expected to develop local development plans in line with the national target and local criteria which will then be scrutinised and signed off by the DoH.

The planning framework also sets out how the national and local targets relate to the new national standards on which the Healthcare Commission will base its inspection regime, the payment by results reform and the need for the DoH and NHS to deliver£6.5bn in efficiency savings per year by 2007-08.