- guardian.co.uk, Sunday May 11 2003 09.42 BST
If you own a small hotel in Gloucestershire, you do not expect Egon Ronay's hotel inspectors to ring you up a month in advance to tell you the date they will be visiting your establishment. Yet that is effectively what the Government does each year, when it informs NHS chief executives of the exact week during which their casualty waiting times will be measured.
The current Government target stipulates that 90 per cent of all patients who are brought into Accident & Emergency departments should either be sent home or admitted within four hours. It means that a hospital trust could be treating only 50 per cent of its patients within four hours for 51 weeks of every year; yet if it spends hundreds of thousands of pounds on extra doctors and nurses over the right seven days and hits the target, that is all that matters. And meeting the target determines its future funding and stature within the health service.
As we report today, there is now widespread 'fixing' of this indicator. Sometimes operations are cancelled to ensure free beds for admission of A&E patients on the crucial days. Wanting patients to be seen within four hours is an admirable intention, but this is a ludicrous way of gauging whether it is really happening.
Politicians know that targets focus minds, and force NHS managers to think about how they can deliver services more efficiently. But there need to be fewer of them, and those that remain have to be set far more intelligently.
If Health Secretary Alan Milburn does not inject some realism into the process, the public will start to lose faith in these measurements. Moreover, they will doubt the assertions of hitherto reliable experts such as Sir George Alberti, the NHS emergency director, that the hospitals are improving. Our casualty departments are gradually stepping out of the Dark Ages of 15-hour trolley waits, but using targets which encourage blatant manipulation is no way to prove it.
