Hospital targets 'making patients suffer'

Doctors in one in four accident departments say the care of seriously ill and injured patients has suffered as a result of Government's waiting list targets, a report says today.

The damning British Medical Association report, based on information from 163 A&E departments in England, also suggests official figures cannot be trusted as waiting list data have been manipulated.
Scene from an A & E department
The target was for 94 per cent of patients to be seen within four hours; raised to 98 per cent in January

Half of the doctors who replied said patients were moved to inappropriate wards to get them out of the accident department and 40 per cent said patients were discharged before they were "adequately assessed or stabilised".

Twenty seven per cent said that "care of the seriously ill or injured was compromised because of the pressure to meet the four-hour target". More than a quarter also said that waiting list operations had been cancelled to make space in wards for emergency patients who needed to be admitted.

Almost half said extra agency staff were employed to speed the delivery of care in the three-month period when the average daily waiting times are measured in emergency departments. The survey showed 38 hospitals had not met any of the targets set since last March. These say no patient should wait more than four hours from arrival to being treated and discharged or admitted to a bed on a ward.

This followed government embarrassment over lengthy trolley waits and stories of patients waiting through the night for treatment. A target was set a year ago for 94 per cent of patients to be seen within four hours. That was increased to 98 per cent in January. Each time a hospital meets the target it is supposed to receive a £100,000 bonus to improve services even more.

But the survey showed that of 125 departments that had achieved one or more of the first three targets, only 53 per cent had seen the money. Many said their trust had absorbed it to meet deficits. Donald MacKechnie, the chairman of the BMA's A&E committee said staff had worked exceptionally hard to meet targets despite an increase in attendances.

"There have been tremendous improvements. Departments bear no resemblance to two years ago.

"But I am appalled to hear some A&E staff are being put under intolerable pressure, even bullied by trusts, as they attempt to treat and discharge patients within four hours.

"It is absolutely right that patients visiting A&E are seen and treated as quickly as possible but not if staff are forced to make inappropriate decisions and patient care is in any way compromised."

Mr MacKechnie said that manipulation of the figures was not as extreme as it had been in the past but included moving patients off the computer minutes before the four hours came up. As targets get tighter more departments are finding them harder to achieve. Almost half failed to meet the 97 per cent target last October.

Dr Martin Shalley, the president of the British Association of Accident Emergency Medicine, said that on average the workload had increased by nine per cent last year against just over two per cent increase normally seen.

"Quite a few colleagues are saying that they are not seeing the money from meeting the targets. Some of the money will be spent in other areas to relieve pressure on the A&E department.

"But we have heard anecdotally that some money has been used to meet a shortfall. I understand they can do this. What we need is for trusts to communicate where the money has gone."

Dr Shalley, an emergency consultant at Birmingham Heartlands Hospital, said that targets were good for patients and no one wanted to return to the "dark days" of five years ago. But there was concern about meeting the latest 98 per cent target.

"In my own department we were at 98.7 per cent when I looked last week. We need a more pragmatic approach."

John Hutton, the health minister, said: "This BMA survey gives a deliberately distorted picture of the changes that have taken place in A&E Departments. NHS patients tell us that A&E is better than ever.

"If any doctors have genuine concerns about patient care or fiddling of figures, they have a clinical duty to take them up with their medical director or chief executive.

"To date, we have received no formal complaints. If we were to receive specific concerns, we would investigate them immediately.

"We make no apology for doing what patients asked - taking steps to work with clinicians to improve A&E services. This has happened thanks to investment, reform and the hard work of staff.

"Our revolution in patient care means that, despite a significant increase in demand, 19 out of 20 people are now seen and treated in A&E in under four hours.

"We know there is further to go, but A&E is now unrecognisable from what it was just a few years ago."

Andrew Lansley, the shadow health secretary said: "Time and again we have warned the Government that waiting list targets would distort clinical judgments and put patients at risk."
Well its about time someone came out and said this! Waiting lists are being used to hide exactly what is going on in hospitals! Those on the inside need to make it clear exactly what IS going on.

Lies, dam lies and statistics!


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