Targets, targets

Quite the truth of this I\’m not sure:

Road traffic victims who have multiple injuries and fractures are not being transferred to specialist units for surgery fast enough because beds are full of routine cases, orthopaedic surgeons said.

Routine cases such as hip and knee replacements have to be carried out within Government waiting time targets meaning urgent trauma cases are delayed which can jeopardise their recovery.

At their Annual Congress this week, the British Orthopaedic Association heard that patients are being "systematically harmed" as managers try to hit waiting time targets and avoid cancelling operations.

Some patients with pelvic fractures are having surgery delayed by between 10 and 20 days even though this less than half of patients operated on ten days after their injury can expect to make a full recovery.

The resulting more complex surgery and longer rehabilitation is costing the NHS more money than if these trauma patients were operated on quickly, it was argued.

But the basic truth is obvious. If you set targets then people will strive to reach those targets in the easiest manner possible. And that easiest manner possible might not be quite what you actually want.

We see even the Guardianistas waking up to the principal agent problem when traders get bonuses for short term successs at the risk of long term blow up. It\’s not all that different here. Set a target and the health system will attempt to achieve it, but that may not be actually what you want…like people being dragged in from car crashes and not getting the treatment they need….and the treatment that of course we all desire they get.

Which leads on to an interesting and more subtle point. What is it that we actually want from a "national health service"? Is it health insurance? Or health assurance?

We know that we can\’t have the latter in totality. We all agree that most of us have to make some direct contribution, through prescription charges, paying for our own glasses, that sort of thing.

But health insurance is different, this is something that can be provided collectively and through the State. If some medical calamity befalls you, like said car smash, or a vile cancer, some chronic disability, then the NHS can and arguably should treat you at no direct cost.

Assurance here meaning, aswith life assurance, payment for something that will definitely happen. We\’ll all need some health care at some point. Insurance, again as with other insurances, is protection against those calamities which will happen to some percentage of us but not all. And the costs of it happening are simply not possible to cover directly (think fire insurance for a house) thus we pool the risks.

But if the NHS is not covering us for those insurable risks, and it cannot be a full system of assurance, then are we sure that we\’ve got the system we want?

Leave aside all the stuff about internal and external markets, methods of funding and so on, isn\’t it an insurance scheme that we want, first and foremost? And if it isn\’t that, then is it fit for function at all?

2 thoughts on “Targets, targets”

  1. As W.E. Deming said, targets are a bad thing. They are used because managers/ministers have a particular view of human nature and don’t know another way. They have to be given different information to change their management philosophy. John Seddon offers this in “Systems Thinking in the Public Sector” I’d be interested in the views of anyone who has read it, who works in the public sector.

  2. “I’ve paid taxes all my life, so I want a new hip when I need one. If they deliver some young oik who’s crashed his car and has yet to pay tuppence in tax, let him wait.” That seems a reasonable argument based on party politicals telling us that we’ve paid for our NHS and that we deserve xyz.

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