The Big Issues: 'Labour has to get over its obsession with NHS targets'

In the third of a series of personal articles on the key election topics, Baroness Julia Neuberger goes to casualty to give an expert diagnosis of the health service - and offers her own cures for its ills
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I'm sitting in the A&E department of a London teaching hospital. It's rather impressive. It is a great deal cleaner than I remember when I last spent time in Accident and Emergency as a patient and as a mother. The cleaner has just wiped the door handle, which is one of the most important ways of preventing MRSA, a cause of immense problems throughout hospitals. One of the things we should do to fight MRSA is to get rid of the NHS targets that encourage a high turn-over of beds, and recognise that we will have to use our beds slightly less intensively, and wash them down between patients.

I'm sitting in the A&E department of a London teaching hospital. It's rather impressive. It is a great deal cleaner than I remember when I last spent time in Accident and Emergency as a patient and as a mother. The cleaner has just wiped the door handle, which is one of the most important ways of preventing MRSA, a cause of immense problems throughout hospitals. One of the things we should do to fight MRSA is to get rid of the NHS targets that encourage a high turn-over of beds, and recognise that we will have to use our beds slightly less intensively, and wash them down between patients.

I believe that Labour is too obsessed with targets. Some of these have brought great benefits - some relating to waiting times have concentrated the minds of hospital management beautifully - but others have created perverse incentives. Hospitals can be so desperate to get people seen in A&E or given a bed within four hours, that the patient may go into the wrong kind of bed or one that hasn't been washed down adequately. We need to have fewer targets, and those there are ought to be very carefully targeted.

Some of the people around me here in A&E may well need a bed. Labour has increased numbers of beds available and that has been a great improvement. The Government has also achieved quite a lot of transformation in the actual physical environment. But there is a downside to that. Some of the funding, particularly of new hospitals, has been done through the private finance initiative which has brought money into the system, but most of the deals are 30 years long and often don't have proper break clauses. As a result, if healthcare needs change we can't change the hospitals and have to continue to buy the same services from the private sector. This leaves most of the risk with the public sector.

Looking around here, I can see surprising numbers of staff. The Labour Government promised to get us 10,000 more doctors, 20,000 more nurses and 6,500 more therapists. It now says it has met that target. That is true if you judge the result as a head count, but not true if you count it by whole-time equivalent. More and more people are working part-time.

We do need more doctors and nurses. In general practice, ministers claim to have recruited the desired numbers of staff, but added into their head count are lots of GP assistants and also doctors who have some kind of restriction on their practice. In terms of traditional GPs being recruited, the results are not very good at all.

The waiting time to be seen by a consultant has improved dramatically. If you really want to reduce waiting times, though, then measurement of them should include the process from seeing the GP to having whatever interventions you need, and any diagnostic tests in between.

Labour has put an unprecedented amount of money into the NHS. Some of this has been spent well, and some of it less well. Even with all that money there are quite a lot of deficits and overspends in acute trusts, and they are finding it hard to make ends meet. A lot of the new money has gone on staff salaries, which is understandable. It's been well spent on recruiting nurses and doctors, although I don't think the Government has done as well as it says. I think recruiting surgeons from abroad to cut down some of the operations for which there has been a long waiting list has been very good indeed.

But I think the Government is to be criticised for not putting enough money into the mental health services. It has been too worried about the very few people who might be dangerous to the wider public and not worried enough about the sheer bloody misery experienced by others who have mental illness, both those patients within the system and those who can't get access to it.

In terms of the treatment of people with cancer and with coronary heart disease - the UK's two biggest killers - much more is being done. The Government has done brilliantly at getting the cancer doctors on its side. There are cancer collaboratives where all the various cancer doctors have come together to discuss how best to treat patients. Mortality rates are down for both diseases, and the Government is going to hit its own targets by 2010. But how much of that is do with the fact that the mortality rate was falling anyway is impossible to tell.

There is a lot of discontent among NHS staff in general, and a lot of doctors who supported Blair and the Labour Government are much less keen on them now. There are two reasons for that. Although doctors have seen a lot of money coming into the service, they haven't necessarily seen it coming into the things that they want and mind about. They don't feel that they have the kind of control they would like. There has been much too much central fiat from the Department of Health and not enough consultation of the staff who make it work. The other thing a lot of doctors don't like is this patient choice mantra that is being trotted out, which is going to allow much more use of the private sector. Many doctors don't approve of that.

When Labour came to power we had a minister for public health, Tessa Jowell, and there were great promises about making a huge difference to the nation's health. That's where we have had the biggest letdown. With smoking cessation, ministers say they have more or less hit their targets because they are counting anyone who has stopped for four weeks. That doesn't really tell you anything. If I were serious about getting people to stop smoking I would ban it in public places. They also get a black mark on their attempt to change the diet of the nation. The five-a-day campaign to encourage people to eat fruit and vegetables has been much less successful here than it has in the US.

Labour has delivered to some extent. Has it delivered as well as it could have done with that amount of money? No. I would give the Government 65-70 marks out of 100.

Baroness Julia Neuberger DBE is a writer, broadcaster, former chief executive of the King's Fund and a Liberal Democrat peer

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