Leading article: Targets have no place in matters of life and death

Box-ticking can be no substitute for judgement, least of all in the NHS

Share
Related Topics

The NHS watchdog, the Healthcare Commission, has found that managers at Stafford Hospital pursued targets to the detriment of patients. One result was disgracefully substandard care; another, more shocking, was a sharply increased death rate. The chairman and chief executive of Mid Staffordshire Foundation Trust have resigned; the Health Secretary Alan Johnson has apologised.

We should, perhaps, be thankful for small mercies. The top trust officials did the decent thing and did not wait to be pushed. The Health Secretary said "sorry". Neither, regrettably, can be taken for granted in this age of buck-passing and self-justification. But this is where even the faintest positives stop.

In its damning report, the commission identified a whole chain of problems, from low staffing levels, through poor training, to inadequate follow-up procedures when things went wrong. The difficulties were particularly acute in the accident and emergency department, where unqualified staff made initial assessments and heart monitors were switched off because no one knew how to use them. You could not ask for a clearer example of waste – expensive machines lying idle for want of trained staff – in a service that repeatedly pleads penury.

One of the most galling aspects of the case is that patients and relatives could see clearly what was happening, and often why, but could not get their complaints taken seriously – although they assumed a consistent pattern early on. Such high-handed treatment of the people it is supposed to serve is all too typical of parts of the public sector, but seems especially ingrained in the NHS, where lay opinion is readily dismissed as ill-informed.

It could be argued that such complaints have, to an extent, always been levelled against hospital management. What sets this report apart, however, is its conclusion that meeting government targets took precedence over patients' welfare. So fixated were managers on the penalties that would apply to the trust if it missed targets – and, might we also suggest, on the financial and prestige rewards for exceeding them – that everything else took second place. This included patients' lives.

And while blame undoubtedly attaches to weak managers at every level, and to medical staff who lacked common humanity, those who set the targets also bear some responsibility. Scarcely a target has been set in any organisation that does not eventually have some unintended consequence. Organisations are notoriously adept at re-orientating their paper priorities to fit the criteria required.

Not so long ago, the manipulation of waiting lists was found to be almost endemic across the NHS. Mixed wards were "abolished" by the fiction of curtained partitions. In local government we have seen how Haringey social services contrived to tick all the Government's boxes, while grievously mishandling the case of Baby P. The performance of others, including Doncaster, is now being reassessed.

The revelations about Stafford Hospital are likely to fuel the growing backlash against the so-called target culture. Not that targets are intrinsically bad: a government service, like a business, needs to track how costs relate to results; it needs a gauge for improvement. But they are no substitute for either humanity or common sense, and no excuse for failing to exercise judgement. Once targets take precedence over decisions of life and death, it should be obvious that they have got out of hand.

React Now

Latest stories from i100
iJobs Job Widget
iJobs General

SThree: Trainee Recruitment Consultant - Dublin

£13676.46 - £16411.61 per annum + OTE: SThree: SThree Trainee Recruitment Cons...

Ashdown Group: Marketing or Business Graduate Opportunity - Norwich - £22,000

£18000 - £22000 per annum + training: Ashdown Group: Business and Marketing Gr...

SThree: Trainee Recruitment Consultant

£20000 - £25000 per annum + Commission: SThree: Are you great at building rela...

Ashdown Group: Database Analyst - Birmingham - £22,000 plus benefits

£20000 - £22000 per annum + excellent benefits: Ashdown Group: Application Sup...

Day In a Page

Read Next
Labour leader Ed Miliband unveils Labour's pledges carved into a stone plinth in Hastings  

Election 2015: Smash the two-party system! Smash the voting system!

Armando Iannucci
Tactical voting is a necessary evil of the current first-past-the-post system, where voters vote against what they do not want rather than in favour of what they do  

Election 2015: Voting tactically has become more fraught in new political order

Michael Ashcroft
General Election 2015: Ed Miliband's unlikely journey from hapless geek to heart-throb

Miliband's unlikely journey from hapless geek to heart-throb

He was meant to be Labour's biggest handicap - but has become almost an asset
General Election 2015: A guide to the smaller parties, from the the National Health Action Party to the Church of the Militant Elvis Party

On the margins

From Militant Elvis to Women's Equality: a guide to the underdogs standing in the election
Amr Darrag: Ex-Muslim Brotherhood minister in exile still believes Egypt's military regime can be replaced with 'moderate' Islamic rule

'This is the battle of young Egypt for the future of our country'

Ex-Muslim Brotherhood minister Amr Darrag still believes the opposition can rid Egypt of its military regime and replace it with 'moderate' Islamic rule, he tells Robert Fisk
Why patients must rely less on doctors: Improving our own health is the 'blockbuster drug of the century'

Why patients must rely less on doctors

Improving our own health is the 'blockbuster drug of the century'
Sarah Lucas is the perfect artist to represent Britain at the Venice Biennale

Flesh in Venice

Sarah Lucas has filled the British pavilion at the Venice Biennale with slinky cats and casts of her female friends' private parts. It makes you proud to be a woman, says Karen Wright
11 best anti-ageing day creams

11 best anti-ageing day creams

Slow down the ageing process with one of these high-performance, hardworking anti-agers
Juventus 2 Real Madrid 1: Five things we learnt, including Iker Casillas is past it and Carlos Tevez remains effective

Juventus vs Real Madrid

Five things we learnt from the Italian's Champions League first leg win over the Spanish giants
Ashes 2015: Test series looks a lost cause for England... whoever takes over as ECB director of cricket

Ashes series looks a lost cause for England...

Whoever takes over as ECB director of cricket, says Stephen Brenkley
Fishing for votes with Nigel Farage: The Ukip leader shows how he can work an audience as he casts his line to the disaffected of Grimsby

Fishing is on Nigel Farage's mind

Ukip leader casts a line to the disaffected
Who is bombing whom in the Middle East? It's amazing they don't all hit each other

Who is bombing whom in the Middle East?

Robert Fisk untangles the countries and factions
China's influence on fashion: At the top of the game both creatively and commercially

China's influence on fashion

At the top of the game both creatively and commercially
Lord O’Donnell: Former cabinet secretary on the election and life away from the levers of power

The man known as GOD has a reputation for getting the job done

Lord O'Donnell's three principles of rule
Rainbow shades: It's all bright on the night

Rainbow shades

It's all bright on the night
'It was first time I had ever tasted chocolate. I kept a piece, and when Amsterdam was liberated, I gave it to the first Allied soldier I saw'

Bread from heaven

Dutch survivors thank RAF for World War II drop that saved millions
Britain will be 'run for the wealthy and powerful' if Tories retain power - Labour

How 'the Axe' helped Labour

UK will be 'run for the wealthy and powerful' if Tories retain power