Jeremy Laurance: No NHS targets means happy doctors – and neglected patients

Medical Life

The bonfire of NHS targets is blazing nicely. Cast into the flames are the 18-week limit on waiting times from GP referral to operation, the four-hour limit on A&E waits (relaxed before being scrapped next year), the 48-hour limit on appointments with GPs (though in reality this was never a formal target, and bonus payments for hitting it remain).

Does this matter? Andrew Lansley, health secretary, thinks not. In place of targets, backed by NHS enforcers, come "quality measures" covering, initially, stroke, dementia and thrombosis (blood clots). Details are still hazy but these are supposed to be a more gentlemanly way of doing business – setting aspirations rather than laying down rules which, when breached, attract instant penalties. The idea is that ministers indicate the direction of travel, and leave doctors to decide how to reach the destination.

This is music to the ears of the medical profession, which has protested at the perverse incentives created by targets for a decade. Yet anyone who doubts their importance should listen to former health secretary Alan Milburn on the subject of NHS waiting lists.

Polling that the Department of Health did in the run-up to the NHS Plan launch in 2000 showed waiting was the public's number one concern. But it was not the staff's – it ranked only seventh out of the 10 most important changes they wanted to see. Alan Milburn, speaking to the Financial Times, said: "What really struck me is that for the public, waiting was the thing. They were suffering it and wanted it changed. But when we polled the staff it wasn't. The [people working in the NHS] had just got used to it."

Milburn's phrase "The people working in the NHS had just got used to it" was striking. Waiting wasn't a problem for the doctors, only for the patients. It is common to every profession and trade – the more absorbed in it you become, the less you can see it as others do. The same was true of hospital infections such as MRSA and C Difficile – doctors did not rate them as significant threats because they had become used to seeing and treating them. In one sense, they were right – there are bigger problems and bigger killers. And as a senior Health Protection Agency scientist once ruefully admitted, doctors had underplayed the problem because "we had antibiotics."

But patients saw it differently. They understood there was a risk a treatment might not work, but they did not expect the hospital itself to make them sick. Hospitals were supposed to make you better, not worse. Targets helped redress this balance. They gave the patients' priorities prominence and reminded us that the medical perspective is not the only one. Their loss is a significant weakening of the patients' voice.

There is a further worry. Without the pressure to meet targets, standards may slip. There is no simpler way of saving cash than letting waiting times stretch. At times of pressure, as now, it is the rationing mechanism of first resort.

PROMOTED VIDEO
Life and Style
ebookNow available in paperback
ebooks
ebookPart of The Independent’s new eBook series The Great Composers
News
Rob Lowe
peopleRob Lowe hits out at Obama's snub of Benjamin Netanyahu
Sport
football
News
Davies (let) says: 'Everybody thought we were having an affair. It was never true!'
people'Our friendship flourished online. You can share some very revelatory moments at four in the morning…'
Arts and Entertainment
Over their 20 years, the band has built a community of dedicated followers the world over
music
News
Staff assemble outside the old City Road offices in London
mediaThe stories, the writers and the changes over the last quarter of a century at Britain's youngest paper
Latest stories from i100
Have you tried new the Independent Digital Edition apps?

ES Rentals

    Independent Dating
    and  

    By clicking 'Search' you
    are agreeing to our
    Terms of Use.

    iJobs Job Widget
    iJobs General

    Austen Lloyd: Private Client Solicitor - Oxford

    Excellent Salary : Austen Lloyd: OXFORD - REGIONAL FIRM - An excellent opportu...

    Austen Lloyd: Clinical Negligence Associate / Partner - Bristol

    Super Package: Austen Lloyd: BRISTOL - SENIOR CLINICAL NEGLIGENCE - An outstan...

    Recruitment Genius: Sales Consultant - Solar Energy - OTE £50,000

    £15000 - £50000 per annum: Recruitment Genius: Fantastic opportunities are ava...

    Recruitment Genius: Compute Engineer

    Negotiable: Recruitment Genius: A Compute Engineer is required to join a globa...

    Day In a Page

    Iraq invasion 2003: The bloody warnings six wise men gave to Tony Blair as he prepared to launch poorly planned campaign

    What the six wise men told Tony Blair

    Months before the invasion of Iraq in 2003, experts sought to warn the PM about his plans. Here, four of them recall that day
    25 years of The Independent on Sunday: The stories, the writers and the changes over the last quarter of a century

    25 years of The Independent on Sunday

    The stories, the writers and the changes over the last quarter of a century
    Homeless Veterans appeal: 'Really caring is a dangerous emotion in this kind of work'

    Homeless Veterans appeal

    As head of The Soldiers' Charity, Martin Rutledge has to temper compassion with realism. He tells Chris Green how his Army career prepared him
    Wu-Tang Clan and The Sexual Objects offer fans a chance to own the only copies of their latest albums

    Smash hit go under the hammer

    It's nice to pick up a new record once in a while, but the purchasers of two latest releases can go a step further - by buying the only copy
    Geeks who rocked the world: Documentary looks back at origins of the computer-games industry

    The geeks who rocked the world

    A new documentary looks back at origins of the computer-games industry
    Belle & Sebastian interview: Stuart Murdoch reveals how the band is taking a new direction

    Belle & Sebastian is taking a new direction

    Twenty years ago, Belle & Sebastian was a fey indie band from Glasgow. It still is – except today, as prime mover Stuart Murdoch admits, it has a global cult following, from Hollywood to South Korea
    America: Land of the free, home of the political dynasty

    America: Land of the free, home of the political dynasty

    These days in the US things are pretty much stuck where they are, both in politics and society at large, says Rupert Cornwell
    A graphic history of US civil rights – in comic book form

    A graphic history of US civil rights – in comic book form

    A veteran of the Fifties campaigns is inspiring a new generation of activists
    Winston Churchill: the enigma of a British hero

    Winston Churchill: the enigma of a British hero

    A C Benson called him 'a horrid little fellow', George Orwell would have shot him, but what a giant he seems now, says DJ Taylor
    Growing mussels: Precious freshwater shellfish are thriving in a unique green project

    Growing mussels

    Precious freshwater shellfish are thriving in a unique green project
    Diana Krall: The jazz singer on being friends with Elton John, outer space and skiing in Dubai

    Diana Krall interview

    The jazz singer on being friends with Elton John, outer space and skiing in Dubai
    Pinstriped for action: A glimpse of what the very rich man will be wearing this winter

    Pinstriped for action

    A glimpse of what the very rich man will be wearing this winter
    Russell T Davies & Ben Cook: 'Our friendship flourished online. You can share some very revelatory moments at four in the morning…'

    Russell T Davies & Ben Cook: How we met

    'Our friendship flourished online. You can share some very revelatory moments at four in the morning…'
    Bill Granger recipes: Our chef serves up his favourite Japanese dishes

    Bill Granger's Japanese recipes

    Stock up on mirin, soy and miso and you have the makings of everyday Japanese cuisine
    Michael Calvin: How we need more Eric Cantonas to knock some sense into us

    Michael Calvin's Last Word

    How we need more Eric Cantonas to knock some sense into us