Scotland’s doctors have warned ministers in a bleak festive message that the target-driven “blame” culture in the “over-stretched and under-funded” NHS must end.
The British Medical Association said too much emphasis was being placed on targets that revealed little about the overall quality of care.
Dr Peter Bennie, chairman of the association’s Scottish council, admitted there was a place for timescales in which patients should be treated or discharged, but said they should not be “the only way of judging how the health service is performing”.
He added that against a backdrop of insufficient funding, increasing vacancies and rising demand, the expectation put on doctors and the rest of the healthcare workfare to meet targets was “simply not sustainable”.
His warning coincided with new figures revealing that waiting times in the country’s hard-pressed accident and emergency units have hit record levels.
The latest statistics show that just 81 per cent of A&E patients were seen within four hours – well below the official target of 95 per cent, and the worst total since weekly figures were first disclosed in February 2015.
Health officials said icy weather was to blame for the “exceptional” demand on the units while Labour claimed A&E services were in “meltdown” under the SNP.
At the Royal Infirmary of Edinburgh, almost half the accident and emergency patients waited longer than four hours.
However, the BMA said that many targets did not focus on the patient’s best interests and created a culture of blame when they were missed.
Dr Bennie, who paid tribute to the staff providing a “first class service” over Christmas and New Year, added: ”Multiple targets, an ageing population and the funding gap are creating a vicious circle, stretching the system and the workforce beyond their means.
“The current culture of using crude measures, often taken in isolation, to judge the complexities of the whole healthcare system, and to apportion blame, must end.
“I believe that there will always be a need to set standards for patient care, and for these to be monitored.
“Indeed, proper use of these figures can provide indications of where improvements in funding or service design are needed, and where the system is under most pressure.
“However, saying that a patient moved out of A&E, perhaps to an inappropriate ward, simply to meet the four hour target, is somehow a success, when it may well have been better for the patient to stay in the emergency department, indicates the faults with the current over-reliance on targets and the pressure they place on healthcare staff.
“In our view, we need a fundamental shift to a more mature way of dealing with the data we have on our health service, which places more emphasis on doing the right things for patients, and trusting doctors and healthcare staff to use their skills and judgment.
“We must focus more on whether we have delivered the best possible care for the people who rely on our health service, not simply how long they wait to get treated.”
A recent Audit Scotland report on the NHS in 2016/17 found seven out of eight key performance targets had been missed.
Shona Robison, the Health Minister, said she agreed there should be a balanced approach, including “targets and indicators” to give people clarity on what to expect from health and social care services.
She added: ”But they can never be an end in themselves. Our ambition must be to not only improve the care of individuals needing treatment, but to utilise the information from improved systems to enhance the health of Scotland as a whole.”
She said A&E units had been overwhelmed by an “unprecedented” combination of orthopaedic trauma cases caused by ice and snow and patients seeking treatment for flu.
Anas Sarwar, Labour’s health spokesman, said the SNP had left NHS staff “over-worked, under-valued and under-resourced”.
He added: ”Standards are important, but it is essential the NHS and wider care sector has the resources they need to realistically meet those standards and deliver the quality of care that patients require.”
Article Source : http://www.telegraph.co.uk/news/2017/12/28/doctors-call-end-target-driven-blame-culture-nhs/