On the face of it, the government set itself a target and achieved it: the reduction of waiting times and lists may be one of the more significant achievements in the NHS since its inception almost sixty years ago. By the end of this year, according to Niall Dickson in a recent article for the Sunday Times, nobody should wait more than six months for anything. Mr Dickson, chief executive of the King’s Fund, an independent charitable foundation, did point out, however, that these figures disguise ‘hidden waits, because the NHS does not measure the gap between a first outpatient appointment and being put on the inpatient list for treatment.’ The fact is that the NHS has a distinguished history of fiddling waiting list figures, and investigations such as those by the National Audit Office, the Audit Commission and the King’s Fund, testify that confidence in current waiting list figures may well be misplaced. Nevertheless, everyone, and not least Mr Dickson, who’s foundation has just produced a highly positive Audit of the NHS, seems to believe NHS waiting has remarkably improved.
What if, just for the sake of argument, we consider the possible negative consequences of reducing waiting lists in such a target obsessed way? A&E departments have reached a stage, hospitals say, where 96% of patients are dealt with in four hours. But at what cost?
Firstly, it seems logical that reducing waiting times must result in less attentive patient care. This is not to attack hard working and conscientious medical staff, but rather to say that in a target driven environment time has to be economised. Which means less time for each patient, and this means less time to be nice to them. Obviously, this is difficult to gauge, since kindness is a largely unquantifiable commodity. Public satisfaction goes up and down (and the media has an enormous impact on public perceptions), so individual experiences mean something. Again, many are good, reporting smiling nurses and professional doctors, while others, such as David Conway, have reported altogether less savoury experiences.
Secondly, in order to ensure that A&E patients do not wait more than four hours between arriving and being treated, more are being admitted straight to hospital, which in turn leads to an increase in cancellations for planned operations because of a shortage of bed space. The Department of Health figures indicate that cancellations have been rising steadily from 50,505 in 1997-98 when the present government started its tenure to 66,303 in 2003-04, an increase of 15,798 cancellations – or 31.2 per cent. Figures to Q3 in 2003-04 (46,238) and 2004-05 (47,010) suggest that the numbers are still rising. These figures are only for cancellations within 24-hours of the operation, and it is unclear – because there are no national data – how many more the NHS may be cancelling outside the 24-hour boundary but still at short notice. Earlier this month, The Times estimated that the figure of 66,000 would rise to at least 132,000. As Jonathan Fielden, vice-chairman of the BMA’s consultants’ committee, has said: ‘When managers are faced with losing their jobs if they miss a target they will find any way to get round that target.’
Thirdly, there may well be a link between busy hospital wards and the rising problem of bugs such as MRSA, which can lead to permanent disability and even death. It is well known that the UK has one of the worst records for Hospital Acquired Infection in Europe and a number of recent reports, such as that by the NAO, have mentioned this as a key concern. A major obstacle to tackling the spread of antibiotic resistant bugs is that while patients and staff prefer hospitals which are visually clean, this will only have a minimal impact on the spread of MRSA. According to the King’s Fund, even the Department of Health’s Patient Environment Action Teams (PEATs) only assess cleanliness on visual criteria. Many more hospitals are now rated ‘good’ by the PEATs, but over the same period (2001-o2 to 2002-03) rates of MRSA (0.17 per 1000 bed days) have not changed, according to the MRSA surveillance scheme, and between 1993-2002 the number of deaths increased fifteen-fold. The fundamental issue is that many of the reductions in waiting times have only been possible by running a tight ship with little space for fluctuations in demand. It might well be that using beds less intensively would reduce infection rates, but this would be far less financially attractive.
Under New Labour, healthcare spending has doubled. There have been significant improvements, but they are not yet proportionate to the money invested. It’s possible that in due course, the gains will gather momentum, and that spending on salaries and training will start to yield returns, but the key point is that nothing can be treated in isolation and there needs to be a greater understanding of the interconnectedness of the challenges.
Comments (4)
StarDasher,
The difference in the misdiagnosis was that someone actually said to the doctor: "Do you think it could be pneumonia? Perhaps he should be in hospital rather than in the care home for this?"
The doctor ruled pneumonia out completely (probably because the suggestion came from a layman).
To tell you the truth, the only other place where I saw similar complacency by doctors (and I'm not talking about just this incident when I talk about complacency), was in US military hospitals. I think the job comes a bit differently when one doesn't run the risk of getting fired except for truly negligent/criminal behaviour.
I have had or been involved with four incidents that required something more than a visit to a GP. Every single one of them has had some major problem... Eight-month wait to see a neurologist after a rather nasty bang on the head, a wife going through several hours of unnecessary pain during childbirth, and two incidents with my daughter in nasty hospitals. I wasn't around for what happened to my grandfather.
I am not enamoured of the NHS. And no amount of funding or reform is going to make it even come close to the quality of most medical systems in the rest of the developed world.
Regards,
James
Posted by James | March 30, 2005 8:24 PM
Posted on March 30, 2005 20:24
The 'improvements' will never be 'proportionate' to the extra resource input. Most of it goes on wages and salaries, and 'medical' inflation.
Pneumonia is commonly misdiagnosed worldwide. Nothing special about that.
The NHS includes the GP primary care element.
No excuse for lack of cleanliness, though. Bosses not doing their job properly. Just like so many pub landlords, restaurant and store owners.
Posted by StarDasher | March 28, 2005 12:12 PM
Posted on March 28, 2005 12:12
James, I'll second your comments. The NHS will never be able to produce the standards that can and usually are achieved by private enterprise and I'm not convinced that private enterprise would be any more expensive.
Posted by Henry Kaye | March 25, 2005 9:50 PM
Posted on March 25, 2005 21:50
The whole point should be, why are we waiting at all? There is going to be waiting in a nationalised system due to the rationing nature of care. The only way to pay for a National Health Service without waiting lists would be to tax everything and everyone that moves. So we will all have good free health care, but we'll all be broke.
Scrap the system altogether...
When I first moved to the UK, eight years ago, I thought the NHS was a good thing... Until I actually had to use it for more than a GP's visit. Since then, every interaction with the NHS I and my family have had has been negative. Whether it was my misdiagnosed grandfather who died from pneumonia a few days after the doctors said he didn't have it, to the filthy state of the ward my daughter stayed in for tonsillitis. I never saw anything like it in the worst state-funded hospitals in the US.
Posted by James | March 25, 2005 11:25 AM
Posted on March 25, 2005 11:25