- guardian.co.uk, Sunday May 11 2003 09.42 BST
Internal Department of Health documents reveal how hospitals pour scarce resources into A&E departments during a crucial seven-day period when performance tests are conducted.
Faced with the prospect of losing NHS funding if they failed to meet Government targets, health trusts went to astonishing lengths, spending hundreds of thousands of pounds drafting in extra doctors, nurses and radiographers for the week they were assessed. Some trusts went as far as cancelling dozens of operations to free up beds.
The documents show that NHS trusts achieved an extraordinary rise in the number of patients treated quickly in accident and emergency departments during one key week at the end of March.
Hospital bosses had been forewarned that this was the only week in the year when waiting times of patients would determine whether or not the hospitals hit their target, which in turn would determine their star-rating and their funding level for next year.
The target stipulates that 90 per cent of patients should either be discharged, transferred to another hospital or admitted within four hours of coming into A&E. It was devised by Health Secretary Alan Milburn, who pledged to end long trolley waits in casualty departments.
Two of the largest trusts, both of which hope to be granted foundation hospital status by Milburn, went so far as to cancel dozens of operations, freeing beds during the crucial week into which A&E patients could be admitted quickly.
The figures suggest that manipulation of the service by managers is becoming widespread in order to meet the Government's targets. Ministers have also warned that managers who failed to improve their ailing A&E departments would find themselves out of a job.
Dr Evan Harris, Lib Dem spokesmen on hospitals, called for the abolition of the target.
'The target culture can no longer be defended,' he said. 'This isn't a measure of performance - it's a measure of how the managers can try to fix it.
'What worries me is what happens in that week, if it encourages senior doctors to leave their sicker patients needing more care, and concentrate on pushing patients through as fast as possible.'
The internal document, measuring the weekly performances of casualty departments at 29 hospitals which were the first to become NHS trusts, shows some recorded 10 per cent rises in speedy treatment of patients within the space of a single week.
West Hertfordshire Hospitals NHS Trust, which includes Watford General Hospital, saw the number being treated within four hours leap from 80.5 per cent in the week ending 24 March, to 95.7 per cent the following week. However, by the end of April, that figure had gone back down to 83 per cent.
A similar feat was achieved by the Epsom and St Helier Trust in Surrey, which went from 84.1 per cent to 99 per cent between 24 March and 31 March. More than a quarter of the hospitals in the survey saw results improve by 10 per cent or more over the week as casualty departments were flooded with extra doctors and nurses.
The 29 hospitals reached an average of 93.7 per cent in the crucial week, but then fell back by 4 per cent three weeks later. From December until the last week of March, their weekly average had been under 90 per cent.
The two largest teaching hospital groups have admitted that they cancelled elective or non-urgent surgery in the week of the survey.
St Mary's Hospital in west London, and Guy's and St Thomas' Hospitals Trust, which are both rated as top-performing trusts and have both applied to be foundation hospitals, cancelled operations for patients, which freed up beds for quick use by casualty patients.
St Mary's has admitted that operations were cancelled specifically to hit the government target.
A spokeswoman said last night: 'We took a strategic view on this, that we were hitting nearly all the 90 targets we are set, but weren't doing so well against this one, and we wanted to maintain our three stars.
'We did probably what most other trusts did and brought in extra staff, and looked at the waiting lists [for surgery].' The patients who were cancelled had their operations 'put back by only a few weeks. Everyone went hell for leather to meet the target.'
Guy's and St Thomas' Trust, one of the favourites to be a foundation hospital, also cancelled patients' operations. However, they denied the cancellations were specifically done in order to hit the 90 per cent target.
'During March, we did see an increase in the number of elective patients who were cancelled as a result of high levels of bed occupancy,' a statement said. 'This pressure on beds was the result of several different factors, including an increase in the number of medical and surgical patients needing emergency admission.
'Achieving the A&E target may have contributed in small part to this pressure on beds, but was not the predominant factor.'
Sir George Alberti, the Government's NHS emergency tsar, said that the decision to base the target on one week at the end of March was a 'political decision'.
Commenting on the lengths staff went to, he said: 'It's called human nature. Everyone tried everything possible to hit the target. The good thing is the impact on morale in emergency departments was phenomenal. People hadn't believed they could do it.'
He added that there was evidence that some improvements were being sustained.
