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Published: 17/04/2003, Volume II3, No. 5851 Page 12 13

Everyone knows that the 'target culture'has damaged relations between medics and managers - or has it? Trusts which hit last month's goals say clinician engagement was key to their success.Mark Gould reports When they cracked open the Veuve Clicquot after hitting end-of-year targets at the Whittington Hospital, managers were not just celebrating because they had achieved a government objective.

They were marking a united effort from managers and doctors, belying the supposed antagonism between the two parties.

Whittington Hospital trust medical director for surgery Celia Ingham Clark says: 'We wanted to meet the targets for the hospital and for local people who were happy to get their operations quickly. It matters to all of us, whether clinical or managerial, how the trust appears to the outside world.'

The Whittington was well on track to meet all its targets at the end of March, and, following a national injection of£883,000 in February, was able to treat an extra 376 of its patients to bring down total numbers of waiters, assisting the national picture.

The size of its total treatment waiting list dropped by a third over the year, and waiting times are now at an all-time low, with 90 per cent of patients waiting under six months for surgery.

Operations director Tara Donnelly says the trust concentrated on day and shortstay cases, using additional weekend lists in all the major surgical specialties to minimise impact on the rest of the hospital.

'There is not really a feeling of managers and clinicians being on different sides of a divide at the Whittington; we work collectively on problems.

'There needs to be a longstanding trust between the two professional groups so that when we need to respond to a challenge like this, relationships are such that people want to work together'.

One consultant urologist even came in several times during a fortnight's leave to do extra lists.

Ms Ingham Clark admits that the late arrival of national waiting list money made things 'a bit difficult'.

'I can't say It is a model for normal procedure because we didn't do any teaching [during the extra sessions], but that way we could get on very quickly.'

Luckily, Lewisham Hospital trust won its bid for£700,000 in waiting-list cash last autumn so managers were able to plan how to tackle knotty problems such as having a 400-patient gap between inhouse capacity and the target in orthopaedics alone.

Theatre surgery general manager Deborah Hallas says: 'We did a lot of talking with consultants from the start.We were very open about what we wanted to achieve, what money we had to pay for extra work, such as weekend rotas, and how consultants could relate to it.We are a three-star trust and and we want to stay that way because it benefits the whole community.'

The trust decided to treat the majority of patients inhouse 'as a matter of personal pride'. And as we had the money to pay surgeons and anaesthetists, they could see it was realistic too - so we were all happy, Ms Hallas says.

Aria Daneshfar, a consultant orthopaedic surgeon at Lewisham, has been doing Saturday minor ops rotas since October to free-up space for major work on the weekday lists.

'This worked perfectly because there was a bit of a beds crisis last year so we could get people in as day cases and free up space. I think we were even more efficient as a theatre team because people wanted to get the job done and get people home.'

Mr Daneshfar says the national mood of anger over the stalled consultant contract did not cause problems. 'Though the targets are arbitrary, they do make us think about the most efficient ways of getting the job done. Personally, I think a lot of the division and discontent about the contract comes from consultants with a lot of private work who do not have a lot of time for the extra NHS target work.'

Ms Hallas says there was a feeling of exhilaration when the trust chief executive announced that they had met their targets by 'a handful of patients'.

'It almost hasn't sunk in because we are already starting work on next year's targets.We want to get waiting-list work started by May and out of the way before winter.'

Innovation and some unconventional techniques helped zero-star Royal United Hospitals Bath trust achieve great improvements - despite a massive outbreak of the Norwalk-like diarrhoea and vomiting virus. In March last year, there were 223 patients waiting over 15 months for an operation.

Now there are no patients waiting more than 12 months.

Director of service renewal Paula Friend says extra bed capacity was used at the neighbouring Royal National Hospital for Rheumatic Diseases and the trust also worked with local primary care trusts to identify social care places to prevent delayed discharge. Extra occupational and physiotherapy staff were used to mobilise patients and free beds. 'We managed to cut one day each from the stay of about 60 patients, which made a big difference.'

Ms Friend admits that despite the efforts made to hit this year's targets, some things such as transferring cases to the day surgery unit and giving consultants extra sessions are 'not sustainable'.

But she says long-term improvements will come from changes like the introduction of one of the country's first sevenday imaging departments and a Sunday ward round so people can be discharged at weekends.

'It is a fantastic hospital and everyone did their bit to meet the targets - even the cleaners were coming in at all hours. It was a great team effort.'