- How local is really central. Malcolm
Dean Guardian Wednesday November 7, 2001
- Heart league tables 'will lead to fewer operations'. Guardian
Society Friday February 1, 2002
- Hospitals siphon off cancer cash. NHS trusts are using extra
millions to meet targets on non-essential services, writes Anthony Browne.
Observer
Sunday March 17, 2002
- Scrap NHS targets, say doctors. John Carvel, social affairs editor
Guardian
Friday May 10, 2002
- Rogue trust mars waiting list success. Michael White, political
editor Guardian
Saturday May 11, 2002
- The government is shaking up the auditing of the health service, but
evidence is growing that too much targetry can be bad for you. David
Walker Guardian
Monday May 6, 2002
- Hospital administrator told to 'fiddle' waiting figures. Society
Tuesday May 14, 2002
- NHS 'hindered not helped' by targets. John Carvel, social affairs
editor Guardian
Monday May 20, 2002
- Targets 'hold back NHS improvements'. David Batty Society
Wednesday May 22, 2002
- Bristol Royal infirmary in waiting list scandal. A investigation has
found that an NHS hospital manipulated its waiting lists to meet government
targets - the latest in a series of similar scandals. Guardian
Wednesday June 26, 2002
- The figures are vast. But can they make them count? Hugo Young Guardian
Tuesday July 16, 2002
- A new target to reduce the waiting time for an NHS operation to a maximum of
three months by 2008 was set by the chancellor yesterday and will become the
acid test of whether the government's health reforms have worked. Guardian
Tuesday July 16, 2002
- NHS ambulance services are putting patients' lives at risk by fiddling the
records of emergency response times to gain a higher position in government
league tables, according to an investigation by the Consumer's
Association. Guardian
Tuesday July 16, 2002
- Government warned over service targets. David Walker Society
Thursday July 18, 2002
- NHS 'must drop targets obsession'. John Carvel Guardian
Wednesday July 24, 2002
- Ambulance services accused of fiddling 999 response times. James
Meikle, health correspondent Thursday
August 8, 2002 The Guardian
- Milburn retreats on care home standards. John Carvel, social affairs
editor
Tuesday August 20, 2002 The Guardian
- The chief executive of one of the fastest improving hospitals in the NHS was
suspended yesterday amid allegations that his achievement was based on
unorthodox manipulation of waiting lists. John Carvel, social affairs
editor
Wednesday August 21, 2002 The Guardian
- Public confidence in the NHS has been undermined by deliberate manipulation
of the waiting lists and distortion of clinical priorities, the cross-party
public accounts committee of MPs warns today. John Carvel, social affairs
editor
Wednesday September 18, 2002 The Guardian
- A top surgeon today said he had been ordered to stop operating on badly
injured patients to concentrate on patients waiting for routine treatment.
Tuesday October 22, 2002
- Specialist work put behind routine operations, says doctor. John
Carvel, social affairs editor
Wednesday October 23, 2002 The Guardian
- Top rated hospital faces performance review after sacking boss.
David Batty
Wednesday December 4, 2002
- The audit commission has played down claims that an investigation by its
officials has discovered that up to one in three NHS trusts in England are
"deliberately distorting" waiting list figures.
Patrick Butler Monday December 23, 2002
- An NHS "whistleblower", sacked after speaking out about an alleged
"fiddle" of statistics for cancelled operations is taking his case to an
employment tribunal.
BBC News Thursday, 9
January, 2003
- Tougher reporting standards for accident and emergency waiting times were
coming into force today following claims that patients were held in ambulances
to help meet government targets.
Monday January 13, 2003
- Whistleblower lifts lid on NHS culture of secrecy. A senior health
service official who was fired after revealing his hospital's financial
problems yesterday lifted the lid on what he claims is the culture of
deception now endemic in the NHS. Jo Revill, health editor
Sunday January 26, 2003 The Observer
- Online commentary: The Observer today reports on the case of NHS
whistleblower Ian Perkin. Here he says that managers must be able to talk
honestly about the problems which the service faces.
Sunday
January 26, 2003
- All patients in need of an operation will be able to choose when and where
they are treated, under radical plans to cut waiting lists announced by the
government today. David Batty
Tuesday February 11, 2003
- Trying to keep abreast of the latest set of targets. Benefits of
extra investment in buses, another blitz on abandoned cars and a satisfactory
school report - but an NHS drug overspend.
Monday
February 24, 2003 The Guardian
- Tony Blair has intervened directly to prevent the government missing
delivery targets in a range of key public services, it emerged yesterday.
Patrick Wintour, chief political correspondent
Friday February 28, 2003 The Guardian
- Spot check by auditors finds NHS waiting lists fiddled. John Carvel,
social affairs editor
Wednesday March 5, 2003 The Guardian
- A trust running two hospitals was severely criticised yesterday after an
investigation which revealed the systematic fiddling of patient waiting lists.
David Ward
Wednesday March 5, 2003 The Guardian
- A "command and control" culture at an ambulance trust led to bullying and
inaccurately recorded data on response times, according to NHS inspectors.
Tuesday March 18, 2003
- Public health must fight to stay on the political radar if it is not to be
marginalised by more pressing NHS concerns, the Chancellor's health policy
adviser Derek Wanless warned. Patrick Butler in Cardiff
Thursday March 20, 2003
- A one-week blitz by hospitals to cut A&E waiting times and meet four-hour
treatment deadlines for patients has sparked renewed criticism of the way
national figures are compiled and interpreted. James Meikle, health
correspondent
Saturday March 29, 2003 The Guardian
- The maximum wait for an operation on the NHS in England will fall from 12
to nine months by next March, the government said yesterday. John Carvel,
social affairs editor
Wednesday April 2, 2003 The Guardian
- The government has hit its four main targets for reducing waiting times in
NHS hospitals in England after a frantic scramble last month to meet a March
31 deadline. John Carvel, social affairs editor
Saturday April 5, 2003 The Guardian
- One of Britain's most famous teaching hospitals is in a state of
unprecedented crisis and riven by internal quarrels due to government pressure
to modernise, a Guardian investigation has discovered. A number of doctors and
administrators at St George's in London have been suspended or sacked by the
trust board after alleging mismanagement as the hospital struggles to achieve
government "star" ratings.
Sarah
Hall Saturday April 19, 2003 The Guardian
- Staff tell of cutbacks, quarrels and cover-ups. Sarah Hall
Saturday April 19, 2003 The Guardian
- Hospital doctors are being forced to slash the time they spend on
individual patients - sometimes to less than three minutes - as managers
resort to 'stopwatch' techniques to deliver the Government's stringent NHS
targets. Jo Revill, health editor
Sunday
April 20, 2003 The Observer
- NHS chiefs in Enfield hit the 2003 hospital waiting time targets with just
a few hours to spare before the government's deadline at the end of March.
John Carvel
Monday
April 21, 2003 The Guardian
- Ministers' understanding of the ambulance service was called into question
yesterday when health inspectors discovered serious defects in an ambulance
trust which was awarded top marks in the government's performance tables. John
Carvel, social affairs editor
Thursday
April 24, 2003 The Guardian
- Targets pile pressure on staff under siege. Nurses at one successful
hospital tell Anushka Asthana what it's really like on the NHS front line.
Sunday
May 11, 2003 The Observer
- 'All of a sudden, we had loads of helpers'.
Sunday
May 11, 2003 The Observer
- Hospitals faking cuts in casualty wait times. Operations axed to rig
targets, documents reveal. Jo Revill, health editor
Sunday
May 11, 2003 The Observer
- The real casualty. Cheating on targets shames the NHS. Leader
Sunday
May 11, 2003 The Observer
- Two-thirds of NHS accident and emergency departments in England faked
improvements in their waiting times during the week chosen by ministers to
measure their performance, a survey by the British Medical Association showed
yesterday. John Carvel
Tuesday
May 13, 2003 The Guardian
- No patient should have to wait more than three months for a cataract
operation from the end of 2004 under a £56m initiative announced today by the
health secretary, Alan Milburn.
Wednesday May 21, 2003
- Hospitals stopped meeting official targets for speeding up treatment in
accident and emergency departments as soon as the government completed an
assessment of their performance, doctors' leaders disclosed last night. John
Carvel, social affairs editor
Tuesday June 3, 2003 The Guardian
- NHS targets are a necessary discipline. Leader
Friday
June 6, 2003 The Guardian
- The government's claim to have hit its main political targets for reducing
NHS waiting times came under fire yesterday after the Department of Health said
the number queuing more than a year for a hospital operation in England nearly
doubled in April. John Carvel, social affairs editor
Saturday
June 7, 2003 The Guardian
- Taking aim at NHS targets.
Tuesday
June 10, 2003 The Guardian
- Twenty-five people in one city have lost their vision because of a Treasury
obsession with forcing unrealistic targets on the NHS without examining the
consequences, a committee of MPs reveals today. David Hencke, Westminster
correspondent
Tuesday July 22, 2003 The Guardian
- Doctors are to be freed from over-zealous Whitehall targets which risk
endangering patients' lives, amid government fears that 'management speak'
culture is damaging New Labour. Gaby Hinsliff, chief political correspondent
Sunday September 7, 2003 The Observer
- The best hospitals and councils should have more freedom to set their own
priorities instead of having performance targets dictated by central government,
the audit commission said today.
Monday September 15, 2003
- Ambulance queues highlight A&E crisis. Targets blamed as patients left
waiting hours for handover. Sarah Boseley, health editor
Tuesday
September 16, 2003 The Guardian
- Labour's regime of performance targets for improving hospitals, schools
and other public services has come under fire from the government's chief
statistician, who says targets are sometimes "naive" and impossible to
deliver. Tash Shifrin
Monday October 6, 2003
- Local authorities and the NHS will be set targets to reduce health
inequalities across England, the public health minister, Melanie Johnson has
announced. David Batty
Friday October 31, 2003
- Political interference and an obsession with targets are threatening to
derail the major improvements Tony Blair promised for hospitals, an
authoritative report will warn this week. Jo Revill, health editor
Sunday November 23, 2003 The Observer
- Excessive government targets and bureaucracy are preventing healthcare
professionals and NHS managers from running an effective health service, a
thinktank warned today.
Tuesday December 2, 2003
- Hospitals are to be given 'performance bonuses' of up to £500,000 for
hitting NHS targets in what will be seen as an attempt to bribe trusts into
improving treatment. Those hitting targets to reduce waits for casualty
treatment, or boost their 24-hour emergency service for psychiatric patients
in crisis, will be allowed to spend the windfall on whatever they like. Gaby
Hinsliff, chief political correspondent
Sunday February 1, 2004 The Observer
- NHS leaders have questioned plans to pay hospitals bonuses of up to
£500,000 for improvements in emergency care under a scheme announced by health
secretary John Reid today. Tash Shifrin
Monday February 2, 2004
- The government will today signal a change of direction ahead of a possible
third Labour term, promising to release the energies of state schools and
hospitals by lifting the dead hand of central control. John Carvel and
Rebecca Smithers
Tuesday February 10, 2004 The Guardian
- Fewer targets for NHS, announces Reid. Tash Shifrin
Tuesday February 10, 2004
- "PCTs desperately need some relief." Health agencies are drowning in a
tidal wave of inspection, says Geoffrey Hollis. They need to be liberated if
they are to get on with the job they are supposed to do.
Wednesday February 11, 2004
- John Reid, the health secretary, caused confusion in the NHS yesterday
when he announced new standards for hospitals to achieve after 2006 when the
current system of performance targets will be scrapped. John Carvel, social
affairs editor Wednesday
February 11, 2004 The Guardian
- The art of aiming high. Leader
Wednesday February 11, 2004 The Guardian
- The government distanced itself yesterday from an incentive scheme devised
by the Brent primary care trust in north London, which offers doctors and
other heathcare workers £100 for each smoker who claims to quit. James Meikle,
health correspondent
Monday March 29, 2004 The Guardian
- A director at one of London's top NHS hospitals was suspended yesterday
during an investigation into an alleged waiting list fiddle to reduce the
number of patients in the queue for treatment. The Royal National Orthopaedic
hospital in Stanmore, north-west London, said it had suspended Stuart Coalwood,
acting director of commissioning, pending the outcome of inquiries. John
Carvel
Wednesday June 16, 2004 The Guardian
- When health targets risk turning into a coconut shy. In our latest report
on provision in Enfield, the spotlight turns to hospital services and the
complex workings of bureaucracy. Sarah Boseley
Monday June 28, 2004 The Guardian
- The NHS chief executive, Sir Nigel Crisp, has claimed controversial
changes to the way NHS productivity is measured "do not go far enough", it
emerged today. Tash Shifrin
Friday July 2, 2004
- NHS targets disrupt war against superbugs. We are even told to economise
on handwash, say nurses. Nurses are warning that their attempts to rid
hospitals of superbugs such as MRSA are being undermined by managers and
doctors under pressure to treat as many patients as possible to meet waiting
list targets. Jo Revill
Sunday July 18, 2004 The Observer
- The health secretary, John Reid, will today announce a new set of NHS
targets and standards, focusing on a central pledge to cut total waiting times
to 18 weeks by 2008. The current NHS target regime has been widely criticised
for distorting clinical priorities in order to focus on headline-grabbing
areas such as waiting times. The number of targets has also come under fire.
Tash Shifrin
Wednesday July 21, 2004
- NHS star ratings are crude and need changing if they are to be credible,
says Sir Ian Kennedy.
Wednesday July 21, 2004 The Guardian
- The regulator that published them has cast doubt on their usefulness and
the consumers' watchdog has branded them meaningless, so what are NHS star
ratings for, asks Tash Shifrin.
Wednesday July 21, 2004
- A measurement of hospitals' success in reducing the number of MRSA
superbug infections was axed from the scoring system for this year's NHS star
ratings, only to reappear in new targets announced today. Some of the top
performing trusts have the worst rates of infection in the country, it has
emerged. Tash Shifrin and Hélène Mulholland
Wednesday July 21, 2004
- NHS support is failing hundreds of thousands of people in the UK each year
dying from chronic diseases, MPs warned today. As many as 300,000 people each
year are dying from diseases such as cancer without access to proper
palliative care, says the Commons health committee.
Thursday July 22, 2004
- Health chiefs rigged the rules so that government targets for patients to
see their GP in less than 48 hours could be met, according to a leaked memo
passed to The Observer. Ministers have trumpeted their success in slashing
waiting times for a GP appointment, with official figures now showing that 98
per cent of patients can see their family doctor within two working days of
telephoning. But serious questions emerge today with revelations that at least
one local health trust not only tipped off its doctors as to the exact timing
of the monthly survey of appointment availability, but also offered to draft
in extra temporary doctors for those likely to miss it. Gaby Hinsliff, chief
political correspondent
Sunday August 1, 2004 The Observer
- The number of patients waiting more than nine months to be admitted to NHS
hospitals has risen sharply for the second month in a row, figures out today
reveal. At the end of July, 281 people had been on the waiting list for nine
months or more; more than trebling from 80 the month before. The June figure
was itself double the number of people on the waiting list the previous two
months. The Department of Health said most of the increase was caused by
Brighton and Sussex University Hospitals NHS Trust, with 234 breaches
reflected in the 281 people waiting over nine months. John Martin
Friday September 3, 2004
- Tony Blair's opportunities for showcasing Labour's NHS achievements at the
party conference in Brighton this month were blighted yesterday when the local
hospitals were implicated in a waiting list fiasco. The Department of Health
said Brighton and Sussex University Hospitals NHS trust was under
investigation over irregularities in the recording of waiting times. The
official waiting list statistics for England, published yesterday, showed 281
patients had been waiting more than nine months for an operation - the maximum
allowed under government targets. The department said 234 of them were
Brighton patients absent from previous figures. John Carvel, social affairs
editor
Saturday September 4, 2004 The Guardian
- A government target for people to see their GP within 48 hours is
affecting patient care, doctors have warned. A compilation of research papers
published yesterday in a Royal College of General Practitioners report
concludes that the government target of a 48-hour wait means patients often
end up seeing a number of different doctors, rather than building up a
relationship with their registered GP. This will aversely affect patients with
multiple and compounding health problems, often those from disadvantaged
communities, the report warns. Hélène Mulholland
Friday September 24, 2004
- A leading London hospital fiddled data about cancelled operations as it
attempted to curry favour with the Department of Health to win a higher star
rating. Its chief executive also improperly charged £540 towards the cost of a
dinner at the Savoy to the hospital's credit card, an independent inquiry
found yesterday. Inspectors upheld two of six complaints by a whistleblower
against St George's hospital in Tooting, south London, concluding: "The
dysfunctional state of the senior management team was severe." But the inquiry
report, published by south west London strategic health authority, reserved
some of its sternest criticism for the whistleblower, Ian Perkin, the
hospital's former finance director, accusing him of "obsessive managerial
behaviour". John Carvel
Wednesday
October 20, 2004 The Guardian
- NHS leaders called yesterday for a government inquiry into whether
foundation hospitals are admitting thousands more A&E patients for further
treatment to increase their revenue under the new system of payment by
results. The NHS Confederation, representing managers and trusts, said
"perverse incentives" were being offered to hospitals to admit patients to a
ward instead of treating them promptly and sending them home within the
four-hour deadline set by ministers. Those admitted via A&E automatically
trigger a £1,200 invoice to be paid by the patient's primary care trust,
even if the patient is subsequently discharged in less than 12 hours. John
Carvel
Friday January 7, 2005 The Guardian
- You say that foundation hospitals are admitting "thousands more A&E
patients for further treatment to increase their revenue" (Foundation
hospitals challenged, January 7). In fact, foundation trusts' increase in
admissions is not out of line with the rise in England as a whole. The
reason is probably related to a very challenging target, which is intended
to ensure that patients don't spend more than four hours in A&E. The way the
payment- by-results system has been designed does create an incentive to
improve the recording of admissions in all hospitals and is recognised as
having some perverse incentives. But there is no evidence that this is a
problem unique to foundation trusts. The NHS Confederation has not called
for a government inquiry into foundation trusts' behaviour, but for a review
to ensure that incentives and targets for all NHS organisations support the
high-quality delivery of emergency care. Nigel Edwards NHS Confederation Sue
Slipman Foundation Trust Network Letter
Monday
January 10, 2005 The Guardian
- Patients are dying in hospital because of government targets, the
Conservative leader, Michael Howard, claimed today. Hélène Mulholland in St
Albans
Thursday February 3, 2005
- Doctors' leaders today blamed "crude" government targets for preventing
GPs from offering patients appointments more than 48 hours in advance. The
attack by the British Medical Association (BMA) came after the prime minister
declared last night that he was "astonished" to learn that the requirement on
GPs to see patients within two days was causing difficulties.
Friday April 29, 2005
- The health secretary, John Reid, today denied that a key government target
was preventing patients from seeing a GP on demand. Mr Reid admitted that
problems still remained around government efforts to guarantee patients a GP
appointment within 48 hours, but insisted these were being addressed with new
patient-GP contracts. Mr Reid's comments follow Tony Blair's appearance on
last night's BBC1 Question Time live election special, when audience members
complained they were unable to book GP appointments more than two days in
advance because of the 48-hour waiting time target. Hélène Mulholland and
agencies
Friday April 29, 2005
- Tony Blair yesterday signalled a review of the government's public service
reform programme when he promised to reduce the number of targets imposed in
schools and the NHS, as well as to make them more flexible and less centrally
driven. His remarks follow his admission that he was astonished that some
patients were being forced to accept a GP's appointment within 48 hours,
rather than being given the option of such an appointment in line with
Department of Health access targets. Patrick Wintour and John Carvel
Saturday April 30, 2005 The Guardian
- Diana Church has every right to feel annoyed. On BBC1's Question Time on
Thursday, she confronted Tony Blair with the frustrations of procedures at her
local GP surgery. Asked by her doctor, who had seen her son, to make a return
appointment the following week, she was told by the receptionist that the
booking could only be made 48 hours ahead. This seemed to undermine the
government's target - aimed at reducing waiting times - of requiring family
doctors to offer an appointment within 48 hours of a request. The chairman of
the British Medical Association's GP committee jumped in yesterday to condemn
the "crude target" that was distorting priorities. He declared his profession
had never liked it anyway. With an election just days away, Tory and Liberal
Democrat spokesmen followed suit, promising abolition of NHS targets. Leader
Saturday
April 30, 2005 The Guardian
- Hospitals in England will lose their licence to treat NHS patients if they
cannot meet government targets for controlling costs, improving quality and
cutting waiting times, a senior Department of Health official has told trust
managers. John Carvel, social affairs editor
Friday
June 17, 2005 The Guardian
- The health secretary, Patricia Hewitt, today told NHS bosses that "a great
deal more needs to be done" to reduce the time it takes to treat cancer
patients. Speaking in London to a national cancer taskforce made up of health
service chiefs, Mrs Hewitt cautioned not enough was being done to meet "tough"
targets set out five years ago. The organisation that represents the interests
of the health service's trusts, the NHS Confederation, said today that the
medical establishment faced a "major challenge". But, said its chief
executive, Gill Morgan, the health service must rise to the occasion by
finding "creative solutions" to problems such as equipment shortages by using
the private sector more often. Roxanne Escobales
Monday
June 27, 2005
- The government today announced sanctions to cut "intolerable" NHS waiting
lists in Northern Ireland, where hundreds of patients are waiting for more
than 18 months for treatment. Trusts unable to provide treatment within 12
months will be forced to offer patients a fully funded "second offer" at
another hospital, in line with a similar scheme in Wales. The move is part of
NHS reforms being planned for the province, where concerns are growing over
the wide variation in service delivery across the 19 Northern Ireland health
trusts. Hélène Mulholland
Monday July 4, 2005
- Ministers have backed off from a threat to prosecute hospital managers who
fail to ensure that staff follow a legally binding code designed to stop the
spread of superbugs. They said there would be false expectations about how and
when criminal sanctions could be applied, and a new criminal offence would
have to be created, accompanied by financial penalties that would take money
away from patient care. Hospitals might also be tempted not to disclose
relevant information to inspectors. James Meikle, health correspondent
Friday July 15, 2005 The Guardian
- Veteran health service manager Ken Jarrold retires at the end of December,
but he is not going meekly. His valedictory speech to the Institute of Health
Management last week was a powerful critique of the NHS under new Labour.
Jarrold skewered Labour's failings unerringly: policy incoherence, thoughtless
structural change, and no effective financial management. Most startling was
his assessment of the corrosive effect of targets: "There is bullying and
harassment at all levels. The drive to deliver has become, in some places, an
opportunity for inappropriate behaviour. Performance management is not a
value-free zone." Patrick Butler Wednesday
November 23, 2005 The Guardian
- There's no great mystery about cutting hospital death rates. All you need
do is keep the really sick people away. University College London Hospitals
trust is to attract patients by advertising itself as having the lowest death
rates in the National Health Service. Stuart Jeffries
Monday December 5, 2005 The Guardian
- Hospital
operating 'dual' lists Sunderland Royal Hospital put 5,000 urology
patients on a separate list while they waited for follow-up appointments. The
patients did not count as being on a waiting list, and were instead told they
were in a queue. North East Conservative Euro MP Martin Callanan said: "It
sounds suspiciously like a way to fiddle figures to me." The hospital denies
doing anything wrong and now allots each patient with an appointment. Summary by Keep our NHS Public
of BBC Online 3
February 2006
- Trusts will get
exemptions for key 18-week target. The government is to give trusts a
"level of tolerance" in achieving the target to treat all patients within 18
weeks of referral by 2008. Department of Health head of access and choice
Margaret Edwards said the DoH accepted that a "small proportion" of patients
who required a series of diagnostic tests before treatment might need to be
excluded from the national target. She also said the need for increased
diagnostic capacity meant that the next phase of procuring diagnostic services
from the independent sector was crucial. Summary by Keep our NHS Public
of Health Service Journal 9
February 2006
- PCT deficit
blamed on targets. An Audit Commission report says that Cheshire West PCT
is forecasting a massive debt of £17.6m because it implemented government
targets without considering the financial consequences. Jacqui Harvey, chief
executive of the trust, which has been allocated a turnaround team, said "we
must reduce our overall spending significantly," which means "reducing the
level of services we provide". Summary by Keep our NHS Public
of Health Service Journal 9
February 2006
- Bid to cut
waiting lists has pushed safety down NHS agenda. The chief executive for
Luton and Dunstable NHS Trust claims the government's focus on targets means
that few hospital trusts prioritise safety issues. At a National Patient
Safety Agency conference, which only five chief executives attended, Stephen
Ramsden addressed health minister Jane Kennedy, saying: "I'm not a big fan of
the target culture. If half the attention had been given to patient safety as
has been given to waiting times then more chief executives would be here and
more would have been done." His remarks were greeted with widespread applause
from around 900 delegates. Summary by Keep our NHS Public
of
British Medical Journal 10 February 2006
- Have targets
improved performance in the English NHS? The star rating system for
English NHS trusts seems to have improved performance, but systems need to be
put in place to minimise gaming and ensure targets are not causing problems
elsewhere. Professors Gwyn Bevan and Christopher Hood argue this could be
achieved by introducing more uncertainty in the way that performance is
assessed and better auditing of performance data. They also call for an
independent body to investigate the genuineness of reported improvements and
the costs to other services. The say the current combination of performance
measures that are highly predictable to managers and an audit system that is
poorly equipped to detect gaming risks losing credibility. Summary by Keep our NHS Public
of
British Medical Journal 17 February 2006
- The BBC has successfully defended a "no win no fee" libel action brought
by a senior manager in the National Health Service. A High Court judge today
rejected the libel claim by Marion Henry, an employee of the Weston General
Hospital in Somerset, against a BBC news programme that accused her of being
involved in the manipulation of hospital waiting lists in order to meet NHS
targets from 1999 to 2002. Ben Dowell
Thursday March 9, 2006
- Health chief
gets £475,000 pay-off. Chris Appleby, the chief executive of
Pennine Acute Hospitals Trust who has agreed to retire early after
conflicts with doctors, is to receive a payout of almost half a million
pounds. He had been under pressure to go since the trust's medics held a vote
of no confidence into his management last summer. Senior medical staff felt
patient care was suffering in the drive to meet targets.
Politicians who campaigned for Mr Appleby to go say they are "disgusted" by
his payout. David Heyes, MP for Ashton under Lyne, said: "The large sums
involved are a terrible contrast to the way other NHS employees are treated."
Summary by
Keep our NHS Public
of
Manchester Evening News 11 April 2006
- The neglect of the
elderly in the NHS will be targeted this week under new
guidelines forcing hospitals to respect patients'
dignity. Gaby Hinsliff, political editor
Sunday April 16, 2006 The Observer
- Blair: finance
no excuse. Tony Blair has said that financial pressures are not an excuse
to slow down on delivering the 2008 18-week waiting
target.
Summary by
Keep our NHS Public
of Health Service Journal 20 April 2006
- Missing the
targets. Out of 26 of the Government's key health
targets, 12 have been revealed as having little prospect of being met by
the intended date of 2008 unless urgent remedial action is taken. These are:
Improving diagnostics - choice of CT or MRI scan; waiting times for cancer
treatment; halving
MRSA rates; "Patient choice",
the promise of a choice of hospital, including the option of going private,
for certain procedures if waiting time targets are exceeded; choose-and-book
system in GPs surgeries for hospital appointments; reducing inequalities in
infant mortality rates; reducing inequalities in infant mortality rates;
[public health] cutting
smoking rates in poorer households; reducing inequalities in life expectancy;
cutting teenage pregnancy rates; cutting childhood obesity rates; improving
access to genito-urinary clinics; meeting the financial forecast -
spending targets.
Summary by
Keep our NHS Public
of Times 25 April 2006
- Creative
destruction in the NHS. Former government adviser Chris Ham writes that:
"When the prime minister makes two
major interventions
in the NHS in the space of a week, it is a sure sign that the problems of the
NHS have reached the top of the government's agenda… The crunch point has
arisen, in his words, as part of the transition from the application of
'necessarily crude and blunt instruments of centralised performance management
and targets' to the use of
market-like
incentives 'to make reform self sustaining.'" Summary by
Keep our NHS Public
of
British Medical Journal 28 April 2006
- Matrons scheme
unlikely to deliver cut in admissions. GPs should not expect the
government's community matrons scheme to reduce unplanned admissions or
hospital bed days, according to a review from the Health Services Management
Centre at the University of Birmingham. It suggests primary care will struggle
to hit the Government's key target of a 5% reduction
in unplanned bed days by 2008.
Summary by
Keep our NHS Public
of Pulse 28 April 2006
- Firm signal on health reforms. The Department of Health has issued
a message of "no surrender" as it reaffirmed
its strategy for reducing waiting times by 2008 while balancing the NHS's
books. Andy Burnham, the new health minister, said striving for financial
balance would lead to "some difficult decisions" but claimed there will be
funds available to meet the new
targets. £1.4bn, followed by £2.9bn, has been set
aside to meet the target of 18 weeks wait between referral and treatment over
the two years. Although figures are hazy, it is estimated that presently only
50% of patients are dealt with in this time frame, and average waiting times
are rising rather than falling.
Summary by
Keep our NHS Public
of
Financial Times 11 May 2006
- 18-week target: scale of challenge is huge. The challenge of
meeting the 2008 18-week referral to treatment target is '20 times bigger'
than that of cancer targets, according to the head of its delivery programme,
Philippa Robinson.
Summary by
Keep our NHS Public
of Health Service Journal 18 May 2006
- Consultants not to blame for
NHS debt. NHS
managers have admitted that an obsession with targets
is the root cause of the current financial deficits, rather than the
consultant contract. In evidence
to a Commons health select committee inquiry, the confederation said the
consultant contract and Agenda for Change were "only cited as contributory in
a handful of cases" of NHS organisations in debt. The evidence also criticises
the policy of hospital
building through PFI schemes, the DoH finance for which is "wholly
inadequate and requires a significant review".
Summary by
Keep our NHS Public
of Hospital
Doctor 22 June 2006
- Health targets attacked. The president of the Royal College of
Surgeons has attacked Government health targets. He says they have undermined
doctors' professionalism and destabilised and distorted clinical priorities.
Bernard Ribeiro, a surgeon in Essex, says targets have merely shunted the
problems elsewhere. He said: "The professionalism of doctors is being
undermined by a target-led culture. This extends its tentacles over every
aspect of our work. Many of the changes we have seen are based on insufficient
evidence and consumerist focus groups." Summary by
Keep our NHS Public
of Telegraph
19 July 2006
- Blair warned over 18-week target. The NHS will 'struggle' to meet
the 18-week waiting-time target without
extra cash, NHS
managers warned prime minister Tony Blair last week. At a Number 10 summit
convened by health minister Andy Burnham to brief Mr Blair on progress towards
the target, managers said that without a cash boost the service would be
unlikely to achieve it. Summary by
Keep our NHS Public
of Health
Service Journal 20 July 2006
-
Senior hospital managers were condemned today for failing to tackle repeat
outbreaks of a deadly stomach bug, that killed at least 65 people and
infected several hundred. The bosses of Stoke Mandeville Hospital in
Aylesbury,
Buckinghamshire, were censured by NHS inspectorate, the Healthcare
Commission, for prioritising political targets, such
as reducing waiting times over patient safety. There were 174 cases of the
potentially fatal bug Clostridium difficile in the first outbreak at the
hospital between October 2003 and June 2004, and another 160 cases in the
second between October 2004 and June 2005. Of the 38 patients who died in the
outbreaks, 33 definitely contracted the infection after being admitted to the
hospital. But the Healthcare Commission found that over three years a total of
65 deaths at the hospital were linked to the C-bug. In a damning report the
infection definitely or probably killed 41 patients and contributed to the
deaths of another 24. The report came as it emerged there was a 17.2% increase
in cases of Clostridium difficile in hospitals throughout England last year.
The Health Protection Agency, the national body responsible for tackling
infectious diseases, found there were 51,690 cases in 2005, up from 44,107 in
2004. David Batty
Monday
July 24, 2006 Guardian Unlimited
-
NHS targets blamed
as crowded wards increase risk of superbugs. An official report by the
Department of Health has shown a direct link between ward occupancy rates and
MRSA rates in a document so sensitive that access under the Freedom of
Information Act was twice refused. The report from the Health Care Commission,
commissioned by Patricia Hewitt, found an increase in the level of crowding
from 2001-02 to 2002-03 and concluded that "these increases…are sufficient to
explain the observed growth in MRSA between those two years". Ministers had
refuted earlier claims by the Public Accounts Committee that "conflicts with
other key targets and priorities" were harming NHS
efforts to tackle hospital infections. However the HCC's findings further
suggest that targets are pressuring hospitals into overcrowding and therefore
spreading MRSA. The report says that by restricting wards' bed occupancy to
85%, 1,000 cases of MRSA a year could be avoided.
Summary by
Keep our NHS Public
of Independent 24 July 2006
-
At least
41 pensioners were killed by a hospital
superbug in the squalid wards of
Stoke Mandeville because senior executives ignored the dangers and
concentrated on delivering the government's waiting time
targets, health inspectors warned yesterday. Even after a public outcry
prompted an investigation by the Healthcare Commission, the renowned hospital in
Aylesbury failed to introduce basic measures of infection control. Earlier this
year, when the NHS trust had supposedly corrected its mistakes, inspectors
witnessed "dirty wards, dirty toilets and commodes, bedding and equipment lying
on floors, faeces on bed rails, pubic hair in baths, mould and cobwebs in
showers".
John Carvel, social affairs editor
Tuesday
July 25, 2006 The Guardian
- Labour scheme "caused NHS cash crisis". Record financial
deficits in the
NHS can be largely traced to Labour's decision to award
hospitals stars for good performance, according to the National Institute
for Economic and Social Research. The study found that the scheme, which was
designed to improve hospital performance, actually encouraged profligacy.
Author Gwyn Bevan said: "Whatever the merits of the star rating system, it
does not provide an indicator of the performance of trusts in terms of their
productiveness in providing health care for patients."
Summary by
Keep our NHS Public
of Telegraph
27 July 2006
- Targets have failed the NHS. Last month's report by the Healthcare
Commission on the outbreaks of
infectious diarrhoea in
Stoke Mandeville hospital, in which 334 patients fell ill and at least 33
died, showed that managers overrode the advice of the expert clinicians on
their own staff and thus failed to isolate infected patients to control the
outbreak. This active mismanagement was driven by a need to meet
targets, in particular the requirement to clear
patients from the accident and emergency department within four hours.
Patients in A& E with infections
were admitted to open wards rather than isolation facilities, which were in
short supply. Almost equally disturbing is the sharp rise in hospital
readmission rates - by nearly a quarter since 2002, according to government
figures released this week. The most likely explanation is premature discharge
of patients by hospital trusts under pressure of targets.
Summary by
Keep our NHS Public
of Times
10 August 2006
-
The government today pledged to change ambulance control room systems after it
emerged that one-fifth of trusts had mis-reported their response times to
emergency calls. Emergency 999 calls for ambulances reached a ten-year high of
nearly 6m in England last year, with ambulance staff attending 4.8m emergency
incidents. But a Department of Health audit found that six out of 31 trusts
had failed to accurately record the actual response times to the most serious
life-threatening emergency calls. The irregularities picked up in the audit
included starting the clock later than the point defined by the Department of
Health, and "incorrect data management". The Department of Health today called
on trusts to discipline any individuals guilty of producing faulty figures.
The ambulance service has been under pressure to meet a government target
which requires 75% of such 'Category A' calls to be responded to within eight
minutes.
Hélène Mulholland
Monday
August 14, 2006 Guardian Unlimited
- The extra billions invested in
the NHS have been largely wasted, an independent thinktank claims today,
resulting in far less improvement in services than might have been expected. A
report from Civitas (the Institute for the Study of Civil Society) says that
while government spending on the NHS has doubled in cash terms from 2000 - an
increase of around a third in real terms - productivity has gone down.
"Service improvement has in too many areas resembled a country stroll, whereas
expenditure has increased at a sprint," says James Gubb, the author of The NHS
and the NHS Plan. The high-profile targets, such as
waiting times and cancer care, have all been met, the report concedes. But
this has sometimes been done through "gaming": in one trust, A&E patients were
kept in ambulances until staff were confident they could be treated within the
four-hour government target. But beyond the areas covered by such targets, the
improvements are slight, says the report. The
UK lags behind
in mental health and stroke care, it says, and it is the only Organisation for
Economic Cooperation and Development country to register virtually no
improvement in death rates from stroke between 1999 and 2003. Sarah Boseley,
health editor
Monday
August 14, 2006 The Guardian
-
One in five ambulance trusts systematically misreported response times, making
it look as if they reached serious life-threatening emergencies within
government targets, the Department of Health
disclosed yesterday. An audit of 31 ambulance services in England found six
did not follow official guidance about how response times should be recorded.
Some did not start the clock as soon as a 999 call was received. Others did
not synchronise the clocks on the emergency switchboard with those used by
paramedics. In some cases, ambulance trusts recategorised the urgency of the
call after the job was done to make it fit the response time achieved rather
than the priority given when the original call was made. This would have
allowed staff to downgrade an emergency if the ambulance arrived late. The
department said the six trusts were
West Yorkshire,
South Yorkshire,
Cumbria,
West Midlands,
Staffordshire and the
West Country ambulance service.
John Carvel, social affairs editor
Tuesday
August 15, 2006 The Guardian
- Monitor in target warning. The independent foundation trust
regulator has warned that progress towards the 18-week
target could be slowed down by primary care trusts attempting to cut
spending. summary of findings from foundation trusts' annual plans warns that
foundation trust financial and operational planning will become 'increasingly
uncertain' and that 'the progress towards 18-week waiting targets may be
slowed'. 'Operational and financial planning is complicated as foundation
trusts balance waiting list targets with commissioners' desire to minimise
activity,' it says. The regulator also says the 'priority to achieve financial
balance is leading some commissioners to demonstrate behaviour which conflicts
with payment by results reform'. Seven foundation trusts have forecast a
deficit for the end of the current financial year. University College
London Hospitals is predicting the biggest deficit - £10m by year-end.
Countess of
Chester Hospital,
Gloucestershire Hospitals,
Barnsley Hospital, Doncaster and
Bassetlaw Hospitals, City Hospitals
Sunderland, and Homerton University Hospital foundation trusts are
forecasting deficits ranging from £1m-£3m.
Summary by
Keep our NHS Public
of Health
Service Journal 31 August 2006
-
Doctors expose
'crisis' at TV hospital. Blunders by bosses have endangered lives at one
of Britain's busiest casualty departments, the hospital's own doctors claimed.
Six senior consultants at the Royal
London claimed management decisions at the hospital had led to
serious lapses in patient care. An orthopaedic surgeon said: "Specialists
from every department have written letters to management that we can't do
without certain services like radiology. But managers are deaf and are
obsessed with targets." Some of the doctors claimed that two patients died
because equipment that could have saved them was not ordered; patients with
minor injuries are treated before seriously ill ones just to keep government
waiting time targets; bosses refuse to provide cover for doctors who are on
holiday, ill or suspended, with serious consequences to treatment; 15,000
packets of X-rays were found lying in a corridor, meaning some serious illness
may not have been spotted. One orthopaedic surgeon was concerned that some
patients at
high risk of carrying MRSA were shuttled into general wards to fulfill
government four-hour waiting time targets. Senior
radiologist Dr Otto Chan was
suspended last
year. He was summarily dismissed despite an investigation panel recommending
his reinstatement. Astonishingly half the £1.5million legal costs of his
suspension and dismissal were taken from the £7million radiology budget. He
discovered the numbers used to identify files were being reused after three
months for different patients "to save a few hundred pounds". "It meant some
patients with life threatening conditions were given the all clear because
someone else's report found its way onto their file. I told managers it was
unsafe but they threatened to discipline me."
Summary by
Keep our NHS Public
of Mirror 1 September 2006
-
A&E targets manipulated - academics. Data is being manipulated by the
government in order to meet four-hour waiting time targets in A&
E, according to City University's Cass Business School. The current
target was described to the BBC as "simply not achievable without the employment
of dubious management tactics". Lead researcher Professor Les Mayhew said: "The
Government needs to revisit its targets and stop forcing hospitals into a
position where they look for ways to creatively report back, rather than
actually reducing waiting times for real people." The researchers used data from
170,000 patients and a recognized model of the movement of people - "queuing
theory" - to show that the level of improvement was not actually possible. While
the school was sure that waiting times had decreased, they suggested that
hospitals were using tactics to stop the clock.
Summary by
Keep our NHS Public of Chester
Chronicle 6 February 2007
-
Blair pledges to cut waiting times to 18 weeks.
Tony
Blair today pledged to cut hospital waiting times to a maximum of 18 weeks
before he steps down. The move came as the government's NHS reforms came under
renewed attack from doctors and health unions. But accompanied by the health
secretary, Patricia Hewitt, on a tour of King's College Hospital in south-east
London, Mr Blair stressed that the NHS had to carry on changing in order to cut
patients' waiting times.
Staff and agencies
Monday
February 19, 2007 Guardian Unlimited
- PM tells surgeons to work nights.
Tony
Blair will today call on hospitals to keep operating theatres open into the
evenings for non-emergency procedures to ensure that NHS patients on average
wait no more than seven to eight weeks. On a tour of a London hospital the
prime minister will hail late-night surgery as an example of the sort of
reform that will allow the government to meet its waiting time target. Labour
pledged in its manifesto for the last election that by the end of 2008 NHS
patients would wait a maximum of 18 weeks for surgery after referral from
their GP to a consultant.
Nicholas Watt
Monday
February 19, 2007 The Guardian
- Doctors attack Blair's waiting list pledge. Doctors have attacked a
new Government drive to tackle waiting lists by carrying out operations at
evenings and weekends. Tony Blair heralded the 18-week referral to treatment
target as part of his political legacy and said that in two years the average
wait could be as low as seven to eight weeks, leading to "an end to waiting as
we know it" in England's NHS. However doctors and opposition leaders said that
hospitals already facing financial problems could not afford to run theatres
"around the clock". James Johnson, the chairman of the British Medical
Association, said: "If primary care trusts have run out of money, they cannot
buy a lot more operations. This and the lack of staff have already prevented
extended working from happening in many parts of the NHS" He added that there
had been no adequate planning for extended surgery hours and currently health
professionals were moving overseas while nurses were finding it hard to find
work. Norman Lamb, the Liberal Democrat health spokesman, criticised Mr
Blair's claims as many hospitals were currently in deficit and cutting jobs
and services as a result. Health Minister Andy Burnham highlighted a scheme in
Yeovil where longer opening hours for diagnostic procedures and "one-stop
clinics" for cancer and orthopaedics were being operated successfully.
Thirteen areas in England have told the Government that they can meet the
18-week target a year early, gaining "early achiever" status from the
Department of Health. Downing Street has identified the 18-week target as one
of the areas in which Mr Blair wants to "finish what I have started". A
campaign is to be launched next month "to focus the activities of all NHS
staff" and patients on cutting waiting times. Hospital bosses will be
encouraged to send more patients abroad and make more use of the private
sector.
Summary by
Keep our NHS Public of Telegraph
20 February 2007
- Hospitals lead to way to Blair's 18-week goal. Hospital bosses at
Doncaster and
Chesterfield announced yesterday that they hope to hit the government's
18-week referral to treatment target up to twelve months early. The
announcement came as Tony Blair placed the target at the heart of his legacy.
Hospital bosses are considering round-the-clock surgery, sending more patients
abroad and greater use of private centres in order to bring down waiting
times. However Jonathan Fielden, deputy chairman of the British Medical
Association's consultants' committee, warned that the targets could provide
too narrow a focus, leaving out some such as those with long-term conditions
and mental health problems. He said: "The focus on surgery is only a
relatively small area of what healthcare delivers. If you just focus on
production lines and churning people through we won't look at the broader
picture and we need to do that."
Summary by
Keep our NHS Public of Yorkshire
Post 20 February 2007
- GP: Patients hidden in waiting lists. Patients were removed from
official waiting list figures because of staff shortages at a
Scottish
hospital, prompting accusations that the statistics were being manipulated.
People waiting for hip and knee replacements in one part of Glasgow were
excluded from the Scottish Executive's much-vaunted waiting times promise.
However, their counterparts on the other side of the city, where there were
more specialist surgeons, were guaranteed treatment in the target time. The
different application of waiting list guarantees in different parts of Glasgow
was exposed after a GP began to wonder why his own patients were not receiving
hip and knee replacements within the six-month target. Dr Jim Finlayson, who
works on the Mull of Kintyre, said: "Andy Kerr (the Health Minister) is always
appearing saying it is wonderful, no-one is waiting more than six months and I
have all these patients who are. It is an 11 to 12-month wait." Nicola
Sturgeon, Holyrood leader of the SNP, said: "If staff shortages are the
problem in south Glasgow then Andy Kerr should come clean on that and not hide
behind manipulated figures." The SNP is committed to giving every patient a
legally enforceable waiting time guarantee.
Summary by
Keep our NHS Public of Herald
27 February 2007
- Hearing tests waiting time to be slashed.
The maximum wait for NHS hearing tests is to be slashed from more than two
years to less than two months, as new technology is introduced to accelerate
fitting of digital aids for hundreds of thousands of older people, the
government said yesterday.
John Carvel, social affairs editor
Tuesday March 6, 2007 The Guardian
- 'Financial
rules led to NHS crisis'. DoH economists are blaming an accounting change,
and employing the wrong sort of staff, for the financial crisis in the NHS. In
a report, they say the increased income of GPs and other health workers is not
the cause of PCT deficits. The imposition of rules that blocked the power of
PCTs to move cash from capital to revenue accounts is 'the most important
explanation of the emergence of deficits'. If PCTs had been able to shuffle
the cash around as they had before, to the tune of £380m, no one would have
noticed the deficits, the report says. But they add that some PCTs also took
on too many extra staff who were 'unsuited to the pattern of clinical demand
pressures' that followed the extra cash that had flowed into the NHS. About
70% of the extra resources that went into the NHS was spent on the equivalent
of an additional 178,973 full-time employees. Another 16% was spent on
non-labour costs. The economists say that pressure to meet targets is behind
some of the deficits, and accounts for their concentration in the south and
east of England, where PCTs have had most ground to make up. They add that
more care should be taken when introducing targets. They ask, for example,
whether it is worth moving from seeing 98% to 100% of A&
E attenders within four hours. Summary by
Keep our NHS Public of Doctor
Update 6 March 2007
- NHS 'reforms' are not helping patients, say hospital doctors.
Senior hospital doctors believe that major NHS reforms, such as
payment by results
and Patient Choice, will fail to
improve the service patients receive, according to a British Medical
Association survey. The poll of 265 consultants in England will be worrying
for the government, coming at a time when ministers hoped to regain
clinicians' backing for their reform programme. The survey showed they have
much work to do to reduce doctors' scepticism - 53% said PBR would worsen or
considerably worsen patient care. Only 11% said choice would improve patient
care, while a third believed moving care out of hospitals and into the
community would result in better services.
Independent sector
provision would make patient care poorer, according to 72%, while 58% said
they had examples of patients being adversely affected by a national
initiative. More than half (56%) said they or their colleagues had experienced
problems because
clinically effective treatments or procedures were no longer available or
restricted. BMA consultants' leader Jonathan Fielden said senior doctors
were implementing better services for their patients - 81% of respondents had
initiated service improvements in the past year. However, their efforts were
being hampered by funding constraints and poorly thought through government
policies. 'The government is wasting millions of pounds on health reforms that
have not adequately involved senior doctors and consequently fail to benefit
patients,' he said. 'Consultants are going the extra mile to bring down
waiting lists only to be told to slow down and be less productive. Meanwhile,
work continues to be diverted away from NHS hospitals to under-performing
independent sector providers at greater cost. Plans to increase recruitment or
buy new, modern equipment are being put on hold or abandoned because of a lack
of money.' He added that many of the doctors who took part in this survey felt
unable to speak out openly. 'There is a
culture of fear in the
NHS and doctors are under severe pressure to meet
targets and keep their mouths shut. Doctors want to be at the forefront of
health reforms, both locally and nationally, to ensure government policy has
clear benefits for patients.'
Summary by
Keep our NHS Public of Public
Finance 9 March 2007
- NHS funding. In a letter to the Independent Jo Selwood writes: "It
is disgraceful that MPs on the Public Accounts Committee should seek to put
the blame for the current
NHS funding crisis
on the shoulders of doctors. What
about the millions of pounds the Government is forcing the NHS to
pay to private
companies to do operations that could be done better and more cheaply
in-house ? What about the money
being poured into the multi-million pound fiasco that is the
"Connecting for Health" IT project that very few health professionals
actually want ? What about the
ever-increasing number of "management consultants" being brought in to service
the ever-expanding numbers of "targets" and "initiatives'
pouring out from the Government ?
Doctors determine treatment based solely on what is best for the patient.
These decisions are based on clinical need and based on the years of training
and experience of doctors. To try and tell them that the decision should be
based instead on cost can only be detrimental to patients."
Summary by
Keep our NHS Public of Independent
21 March 2007
- NHS 'will continue to grow' at minimum 3% in real terms. The Health
Secretary, Patricia Hewitt, has given the assurance that the NHS "will
continue to grow, and grow faster than the rate of economic growth generally",
following Gordon Brown's budget last week. Although exact figures for the
NHS's financial future are not yet set, and won't be till august, she added
that: "I have no doubt that we will get a fair settlement both for health and
for social care." Her words are particularly significant given reports that
the Treasury has been trying to impose a spending freeze on social-care
spending. The Department of Health has been arguing that to do so would
undermine any settlement for health in general. The 3% figure is below the
4.4% predicted by the Wanless report in 2002 as the level required by the NHS
after 2008. However it is higher than some within the service had feared. Ms
Hewitt underlined the "scale of the turnaround" in the NHS. She said that the
service had dealt with a £625m overspend while still treating more patients,
keeping waiting times down and producing rising levels of satisfaction with
treatment, according to patient surveys. She went on to promise that, while
there were tough times ahead, "over the next twelve months we will see,
instead of constant financial problems, constant improvements". She added that
this, in particular the 18-week waiting time target, would be achieved by
staff reshaping the way services are provided instead of the "top-down,
performance-management target" approach which would draw on "real enthusiasm"
from staff. There were growing examples, she said, "of improved ways of
treating patients that are also less expensive for the NHS, where you really
do get better and cheaper". Admitting that the Department was "going to look
at" plans to draw up an entitlement list, seen as a step towards reducing NHS
care to 'core' services, she managed to imply that, with no timetable, it was
a highly unlikely development.
Summary by
Keep our NHS Public of Financial
Times 29 March 2007
- Workforce: SHAs'
failure to plan staff numbers has
been 'disastrous'. Workforce planning is at risk of being abandoned by NHS
chief executives burdened with 'excessive' Whitehall demands, a damning report
has found. The final report of the workforce planning inquiry carried out by the
Commons heath select committee condemns the government for failing to make
forecasting staff numbers a priority. Instead, continuing
government interference
has forced strategic health authorities to focus on
budget cuts,
structural changes and targets, with 'disastrous'
effects on staffing, says the committee. For example, from 1999-2004 nursing
numbers increased by 67,000 - some 340 per cent in excess of original targets
laid out in the NHS plan. Yet, at the same time, recruitment at many trusts was
frozen, making it difficult for newly trained staff to get jobs. The committee
urged the Department of Health to improve workforce planning 'without
interfering excessively with the autonomy of SHAs or pressurising them into
achieving specific numerical targets, as has been the case in the past.' It must
'stop micromanaging' and start trusting local managers, the report adds. Summary by
Keep our NHS Public of Health
Service Journal 29 March 2007
- Pay cuts urged for GPs who miss targets. GPs and consultants should
have their salaries cut if they fail to achieve targets or increase
productivity, an economist said. Alan Maynard, professor of health economics
at York University, argued that "demerit awards" do "concentrate people's
minds". Perhaps one per cent to two per cent of a GP's or consultant's annual
salary could be put at risk if they do not hit targets, he said. He added:
"The issue is whether this could be built into the GP and consultant contracts
in order to get them to do higher levels of activity or more evidence-based
levels of activity."
Summary by
Keep our NHS Public of Telegraph
30 March 2007
- Hospital's 1.4m 'fix' just to meet Whitehall targets
Reading's Royal Berkshire Hospital is being forced to find a "short term
fix" to meet the 18-week target for orthopedic operations. The hospital has
applied to build a temporary two story extension at a cost of 1.4m for just 19
months. It will house a 22-bed ward and two operating theatres and recpovery
rooms. Reading East MP Rob Wilson said: "This is another example of the crazy
world of health economics." Chris Covington, RBH divisional manager for
clinical support services, said: "For the first time the 18 week target
includes all stages leading up to treatment, including outpatient
consultations,diagnostic tests and procedures rather than focusing separately
on outpatient and in-patient stages of care. The Royal Berkshire NHS
Foundation Trust fully endorses and supports this improvement and has robust
plans in place to ensure that we will achieve this target by December 2008."
Tory MP Mr Wilson said: "If the government had funded these operations last
year they could have been done already, but because the trust wasn't given the
resources, a waiting list built up. Now, to meet government targets, they have
to spend a big sum of money to comply. The hospital and the PCT are doing a
good job, they're doing their best in difficult circumstances. It's down to
the way the government is incompetently handling the system, which ends up
costing the taxpayers even more, because it forces trusts to use short term
fixes like this. The trust is doing what it can to ensure it gets money in
future, because if it doesn't spend money on reducing waiting lists now, it
will get penalised for not hitting targets later on."
Summary by
Keep our NHS Public of Reading
Chronicle 6 April 2007
- Figures show Hewitt's birth care promise is unattainable.
Two-thirds of English regions do not have enough midwives to offer option of
home delivery Polly Curtis, health correspondent
Saturday April 7, 2007 The Guardian
- Anger over
'unnecessary treatment. A senior cancer specialist has come under fire
after he admitted giving patients unnecessary treatments to manipulate
hospital waiting lists. Chris Hamilton, consultant oncologist at
Hull's Princess Royal Hospital, said the problem was the government target
of all treatment beginning within 31 days of diagnosis. He said it meant some
low-risk patients were being treated before more urgent cases. "You're caught
in a bind. Either you give them unnecessary treatment with hormones and
reclassify them or you put them to the front of the queue where they shouldn't
really be," he said in an interview due to be broadcast on the Julian
Worricker programme on Radio Five Live. He added that he knew the practice was
being carried out at other hospitals and had informed the national cancer
director. S spokeswoman for the Department of Health said: "If there is a
clinical reason for not starting treatment within the four week guideline or
the patient does not want to start treatment immediately there is clear
provision within the guidance for the patient to be taken out of the list."
The Prostate Cancer Charity condemned Mr Hamilton's claims. Dr Chris Hiley,
the charity's head of policy and research, said: "It would be totally
unacceptable if hormone treatment were being prescribed for men with prostate
cancer simply in order to meet treatment target times - when it is not
required to treat their cancer. Exposing men to these risks to meet Government
targets would be deeply unethical and fly in the face of informed consent."
Summary by
Keep our NHS Public of Chester
Chronicle 7 April 2007
- Cancer target
'clutched from sky' claim. A top Tayside doctor criticised nationally set
health targets, describing a specific breast cancer target as "figures
clutched out of the sky." Dr Alistair Robertson reacted after local health
bosses received a number of reports on NHS Tayside's performance against
national targets for different health services and a colleague queried their
value to patients. Dr Andrew Russell, NHS Tayside's director of primary care
and a GP in Dundee, was clearly concerned that a lot of effort was going in to
measuring and monitoring, and he needed to be convinced that investment was
helping patients and not just creating more bureaucracy. He said a lot of NHS
resources went in to gathering the information and producing the reports
required by NHS Quality Improvement
Scotland (QIS),
the national body that monitors health authorities' performance against
targets. He said he would hope that people's energy was being directed in a
way that would make a difference to patients rather than "simply produce more
process." Dr Russell asked his colleagues at the meeting of NHS Tayside's
improvement and quality sub-committee if they had "a confidence" several
reports presented to them on a variety of local services and their performance
against national targets would make a difference to patients. Earlier the
committee discussed a report on the local breast screening service and several
areas where it failed to meet the national standards. One of the targets that
the East of Scotland Breast Screening Service based at Ninewells Hospital
failed to meet was the recommendation that all radiologists read 5000 films a
year. The idea would appear to be that those who search breast X-rays trying
to spot early warnings of tumours should have to examine a minimum number of
X-ray films to keep up their skills. But it was this target that was scorned
by Dr Robertson, who heads the clinical group that runs NHS Tayside's
laboratories and other clinical support services. He indicated that he had
been involved at a national level when targets were being set and was clearly
not wholly impressed by the process. "This issue about radiologists not
reading 5000 films, in reality that was just a figure clutched out of the sky
and, in an awful lot of instances (setting targets), that is what has
happened," said Dr Robertson. "The evidence base for a lot of these standards
is not always there."
Summary by
Keep our NHS Public of Dundee
Courier 1 May 2007
- 18-week target
hit by cuts. The scale of the Government's task in meeting its 18-week
referral-to-treatment target has been revealed, with orthopaedics identified
as the biggest area of concern. Health minister Andy Burnham said the
specialty remained 'the biggest challenge', as figures revealed far higher
than average waiting times for orthopaedic patients. Some claimed that the
financial crisis still faced by some PCTs was to blame, with hospitals alleged
to have slowed activity to save money. Niall Dickson, chief executive of the
King's Fund, said: 'The biggest threat to the 18-week target will come from
persistent and underlying financial deficits.' Speaking at the Department of
Health briefing, Mr Burnham said: 'We recognise the challenge and we have been
working extremely closely with doctors to provide beds.'
Summary by
Keep our NHS Public of Pulse
15 June 2007
- Target for
hospital waiting times to be cut to 18 weeks. A new target which would
slash waiting times for hospital treatment in
Scotland has been
announced. Health Secretary Nicola Sturgeon wants the NHS to cut the delay
between a GP referring a patient to hospital and treatment starting to 18
weeks. Patients can currently queue for six months for their first
consultation with a hospital doctor and another four-and-a-half months for any
procedure they may need. Ms Sturgeon admitted the target was ambitious, but
said the SNP would set out how it would be met by 2011 in their health action
plan which is expected by the end of this year. Tory health spokeswoman Mary
Scanlon tackled Ms Sturgeon's promise not to expand the use of private
medicine to treat NHS patients in Scotland. She said there were situations
where using private firms to look after NHS patients had been beneficial.
Summary by
Keep our NHS Public of Herald
29 June 2007
- Soothing treatment. The new
health secretary showed yesterday that he had rapidly understood the problems
of the patient he has been called on to heal. "On any objective measure," Alan
Johnson told the Commons, the NHS is performing well, with waiting lists down,
and with more operations being carried out than ever before. However, he went
on, there was a gloomy mood across the service, and a lack of confidence among
reform-weary staff that risks undermining the goodwill on which excellent care
depends. The rapid diagnosis is astute. The next question, though, is settling
on appropriate treatment. The first prescription is for a heavy dose of what
Whitehall wonks call "stakeholder management". Mr Johnson, however, is a
plain-speaking man, unlikely to lapse into the type of unworldly jargon that
has widened the gulf between the NHS headquarters and the medics it presides
over. His first move was to announce a review aimed at closing that gap. It
will make recommendations about the NHS's future only after taking soundings
from clinicians. Its credibility with doctors should be enhanced because it
will be headed up by one of their own - Professor Ara Darzi, a leading surgeon
who Gordon Brown last week appointed a minister. The trick, though, will be
ensuring that this new respect for the professions does not come at the
expense of the patient. While medics need to be listened to carefully when
they call for fewer and smarter targets, ministers
need to stand firm against calls simply to jettison the lot. Some targets have
helped bring down waiting times; similarly, the goal that by the end of next
year all patients should move from the GP's surgery to the operating theatre
within 18 weeks is galvanising new ways of working. The second, even more
difficult, task will be designing an NHS constitution, which the health
secretary suggested to the Commons he would like to see ready for its 60th
birthday next year. This needs to refine the strategy of the later Blair
years, which undermined service morale by making the expansion of private
provision of hospital services an end in itself. That was apparent when, for
example, contracts guaranteed
private treatment
centres payment even for work they did not carry out, and when such
centres were placed in places where they risked replacing, rather than adding
to, NHS provision. A cavalier approach to marketising healthcare was also been
seen in the rushed
introduction of a payment-by-results system which gave too much scope to
hospitals to cherry pick easier-to-treat cases. With experts warning that UK
healthcare is on the cusp of being treated as a
competitive sector by
the European courts - at which point political control would be permanently
surrendered - the new constitution needs to spell out the role and the limits
of private involvement. Doing that, though, need not mean unpicking all recent
reforms. Indeed, it is welcome that Gordon Brown has learned to live with
foundation hospitals,
which he was once less than keen on, for they have shown that they work well
in practice. And choice could be expanded in some areas, especially in primary
care, where patients are well-placed to evaluate the care they receive. But,
as Mr Brown has argued, there are powerful economic arguments - such as the
difficulty of writing a contract for good care, and the need for integration
between specialisms - for ensuring that the hospital system, in particular,
remains predominantly publicly owned. There is a political opportunity for
Labour here, too, when the Conservatives have recently committed themselves to
a more marketised system in which hospitals compete on cost, raising concerns
about maintaining standards. The health secretary rightly signalled yesterday
that further reorganisation is the last thing that a weary service needs.
There is no contradiction, though, between accepting that and making necessary
refinements to the strategy for reform for the future. Leader
Thursday July 5, 2007 The Guardian
- Public sector targets to be scrapped. New approach gives more power
to local councils and NHS trusts. A bonfire of government targets to ease red
tape affecting schools, hospitals and town halls will be ordered tomorrow as
part of a sweeping reform of public services, the Guardian can reveal. Most of
the 110 Whitehall-imposed priorities that have dominated the public sector for
the past nine years will be abandoned . Andy Burnham, the chief secretary to
the Treasury, is coordinating a move to end one of the defining
characteristics of the Blair years by scrapping all but 30 top-down targets
used to vet performance. The targets - from raising the GCSE pass rate to
reducing the fear of crime - helped to drive through the big pledges in
Labour's election manifestos. But they rankled with doctors, teachers and
other public servants who felt their professional discretion had been
curtailed. In an interview with the Guardian today, Mr Burnham set out a new
approach, making local service chiefs responsible for setting performance
objectives and answering to local communities if they are not ambitious
enough. He said: "This is the opening of a new chapter ... If we get this
right, the style of government will feel different. We want to give out a
message of more trust in public bodies." Under the system, there will be no
more than 30 public service agreements, committing Whitehall departments to
use their budgets over the three years to 2010/11 to achieve the government's
goals. The agreements will be monitored using indicators of national and local
performance. A few - such as progress towards meeting the pledge to cut
maximum hospital waiting times to 18 weeks by the end of 2008 - will remain as
nationally set priorities with clear measurable objectives. But most will
depend on local decisions by councils, NHS primary care trusts and other
service chiefs to set targets reflecting local needs and priorities. John
Carvel, social affairs editor
Wednesday July 18, 2007 The Guardian.
The existing public service targets.
The Treasury chief secretary on the new plans.
- NHS 'facing
flood of US-style lawsuits' over wait-time guarantee. Plans to bring in
legally binding waiting-time guarantees will lead to "American-style
litigation" as patients sue hospitals for delays, it was claimed. Nicol
Stephen, leader of the
Scottish Liberal
Democrats, said legally binding waiting-time guarantees, as proposed by the
Scottish Government as part of a patients' bill of rights, would cost the NHS
thousands of pounds in legal costs. "How much money will health boards have to
divert from the treatment of patients to prepare for this legal onslaught from
our First Minister ? Will final
decisions on treatments be taken out of the hands of doctors and will clinical
decisions by Scotland's doctors now be influenced by Scotland's lawyers
?" Mr Salmond said the planned measure was still out to consultation,
but he wanted waiting-list guarantees that were meaningful rather than
"meaningless" as, he claimed, happened under the previous administration.
Cathy Jamieson, the acting leader of the Scottish Labour Party, also attacked
Mr Salmond over promises made during the election campaign. She picked out the
abolition of public-private partnerships. He claimed all manifesto commitments
would be kept.
Summary by
Keep our NHS Public of Scotsman
7 September 2007
- NHS to miss
treatment wait targets. The National Health Service is set to fall well
short of its target of ensuring that no one waits more than 18 weeks from
seeing a family doctor to completion of treatment, latest official figures
suggest. Private sector contracts originally designed to deliver 1.5m extra
tests a year are still being held up by an ever lengthening review in the
Department of Health of whether they should go ahead. Negotiations on the
contracts, initially worth about £200m a year, began more than two and a half
years ago. Just two are operational. A review of the six remaining schemes was
meant to be completed by the end of August. But a health department spokesman
said at the weekend that they were still under review. Senior health
department sources insist some of the remaining deals will be approved. But
private sector suppliers are doubtful that many of them will be. Summary by
Keep our NHS Public of Financial
Times 10 September 2007
- Minister allows
'buffer zone' for hospitals to 18-week target. The Department of Health
has said that it expects the 18-week target for patients waiting for an
appointment after referral from a GP to cover only 90% of patients. Health
minister Ben Bradshaw said it would not be fair to expect hospitals to stick
to the time limit if patients postponed or missed appointments. It might also
not always be medically appropriate to adhere to a strict timeframe. Mr
Bradshaw said that hospitals would be required to treat 90% of patients
needing admission to hospital, and 95% of those not needing admission, within
18 weeks. "If there are delays, the patient will know. That will be the
ultimate test and the Healthcare Commission will be looking at this with an
eagle eye," he added. However opposition parties accused the government of
abandoning a manifesto pledge. Andrew Lansley, the shadow health secretary,
said: "By changing the goalposts the government has admitted that its
one-size-fits-all target doesn't work." Norman Lamb, the Liberal Democrat
health spokesman, said: "Ministers will struggle to convince a public already
sceptical about government statistics that this change isn't merely providing
political cover because of fears they will fail to achieve their target."The
change came as Mr Bradshaw released figures showing that 56% patients admitted
to hospital in August were treated within 18 weeks, but ten had waited longer
than a year. Among non admission patients the figure was 76% within 18 weeks.
Jonathan Fielden, chairman of the British Medical Association's consultants'
committee, said: "We have been calling for high quality and safe clinical care
to be put first for patients for some time. A possible 10% buffer zone will
allow trusts to move the focus from purely finance to quality, and ease some
of the pressure to meet the politically set 18-week target." Summary by
Keep our NHS Public of Guardian
9 November 2007
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