Sunday, June 10, 2007

Good news on waiting lists - but lets not forget the flaws of targets in the NHS, housing, etc

It was welcome to read some good news about the NHS on Friday.

The NHS is on target to achieve the "historic goal" of eliminating long waits for treatment. By the end of 2008, no patient will have to wait more than 18 weeks from GP referral to hospital admission.

The chief executive of the King's Fund observed that the NHS had made "huge strides" forward. (Of course, it should do given the huge injection of resources.)

The Health Minister Andy Burnham was quoted by the Independent as saying: “I don't believe there should be further national targets for the NHS." (And certainly No 10 was thinking in terms of shifting the balance of public sector reform away from over-reliance on central targets.)

Let hope this is so. Targets have perhaps been a necessary evil – but they have harmful effects. They focus on what is measurable to the detriment of others concerns; they have unforeseen consequences (as with GP appointments); they encourage can encourage manipulation of data; they often centralise power in the hands of the target-setters rather than the customers etc.

One effect that I believe is often overlooked is a threshold effect. Where targets are set in terms of triggers or thresholds – as in waiting times less than 18 weeks – there is effort to get cases just over (or under) the threshold with cases failing the target getting relegated on To Do lists.

The classic case for me is responsive repairs waiting times for housing association. Generally emergency repairs are completed within 24 hours, urgent repairs one week and routine repairs one month. The average repairs times will be just inside the thresholds for the later categories. For the repairs that miss the target, the completion times will often be very long. If you are a housing association board member and don’t believe me – ask the managers at your housing association for the data.

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