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

Teaching Assistant

£12024: Randstad Education Leeds: Teaching Assistant September 2014 start - te...

Physics Teacher

£130 - £162 per day + UPS: Randstad Education Hull: Physics Teacher Long Term ...

IT Technician (1st/2nd line support) - Leatherhead, Surrey

£23000 - £25000 per annum: Ashdown Group: IT Technician (1st/2nd line support)...

Primary Teacher EYFS, KS1 and KS2

£85 - £130 per day: Randstad Education Preston: Randstad Education are urgentl...

Day In a Page

Read Next
 

i Editor's letter: Summer holidays are here... so what to do with the children?

Oliver Duff Oliver Duff
 

The daily catch-up: knitting, why Ed wants to be PM and a colloquium of Indy-pedants

John Rentoul
Noel Fielding's 'Luxury Comedy': A land of the outright bizarre

Noel Fielding's 'Luxury Comedy'

A land of the outright bizarre
What are the worst 'Word Crimes'?

What are the worst 'Word Crimes'?

‘Weird Al’ Yankovic's latest video is an ode to good grammar. But what do The Independent’s experts think he’s missed out?
Can Secret Cinema sell 80,000 'Back to the Future' tickets?

The worst kept secret in cinema

A cult movie event aims to immerse audiences of 80,000 in ‘Back to the Future’. But has it lost its magic?
Facebook: The new hatched, matched and dispatched

The new hatched, matched and dispatched

Family events used to be marked in the personal columns. But now Facebook has usurped the ‘Births, Deaths and Marriages’ announcements
Why do we have blood types?

Are you my type?

All of us have one but probably never wondered why. Yet even now, a century after blood types were discovered, it’s a matter of debate what they’re for
Honesty box hotels: You decide how much you pay

Honesty box hotels

Five hotels in Paris now allow guests to pay only what they think their stay was worth. It seems fraught with financial risk, but the honesty policy has its benefit
Commonwealth Games 2014: Why weight of pressure rests easy on Michael Jamieson’s shoulders

Michael Jamieson: Why weight of pressure rests easy on his shoulders

The Scottish swimmer is ready for ‘the biggest race of my life’ at the Commonwealth Games
Some are reformed drug addicts. Some are single mums. All are on benefits. But now these so-called 'scroungers’ are fighting back

The 'scroungers’ fight back

The welfare claimants battling to alter stereotypes
Amazing video shows Nasa 'flame extinguishment experiment' in action

Fireballs in space

Amazing video shows Nasa's 'flame extinguishment experiment' in action
A Bible for billionaires

A Bible for billionaires

Find out why America's richest men are reading John Brookes
Paranoid parenting is on the rise - and our children are suffering because of it

Paranoid parenting is on the rise

And our children are suffering because of it
For sale: Island where the Magna Carta was sealed

Magna Carta Island goes on sale

Yours for a cool £4m
Phone hacking scandal special report: The slide into crime at the 'News of the World'

The hacker's tale: the slide into crime at the 'News of the World'

Glenn Mulcaire was jailed for six months for intercepting phone messages. James Hanning tells his story in a new book. This is an extract
We flinch, but there are degrees of paedophilia

We flinch, but there are degrees of paedophilia

Child abusers are not all the same, yet the idea of treating them differently in relation to the severity of their crimes has somehow become controversial
The truth about conspiracy theories is that some require considering

The truth about conspiracy theories is that some require considering

For instance, did Isis kill the Israeli teenagers to trigger a war, asks Patrick Cockburn