Published: 04/08/2005, Volume II5, No. 5967 Page 7
The 18-week total waiting-time target may cause 'intolerable pressure' on managers, the government has been told.
A King's Fund paper published today warns that rigid targets can lead to a clash of priorities between managers and clinicians - for instance, 'in a complex diagnosis that may take some time and a number of consultants to resolve'.
And it says the government should learn from previous experience in setting targets, in which managers have sometimes been forced to 'literally run around to ensure that a small number of patients are treated on time'.
The War on Waiting for Hospital Treatment calls on the government to do more research on variations in clinical priorities and treatment thresholds 'as part of a more systematic programme of demand management'.
King's Fund chief economist Professor John Appleby, who coauthored the report, told HSJ: 'A single national target based on waiting time is a bit crude, ' he said. 'We could be looking at a scoring system to prioritise patients or reducing average waiting times, not maximum.' He suggested the service's efforts to hit the target to deal with 98 per cent of accident and emergency patients within four hours raised the question of whether the 'huge amount of money to hit the last few per cent was actually worth it'.
Professor Appleby added there was reason to be optimistic that the 2008 target of 18 weeks from initial GP consultation to treatment would be achieved, but warned the introduction of choice and payment by results would have unknown effects on performance. He said success on bringing down waits had so far been due to strong management and 'P45 targets', an environment he described as 'a million miles from markets, choice and payment systems'.
www. kingsfund. org. uk
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