Hospitals-Hippocratic or Hypocritic

1.15.00pm BST (GMT +0100) Mon 10th Aug 2009

Were you taught not to cheat as a child? I was. So why does almost everything we do in life involve some kind of cheating? For instance, why to hospitals cheat on waiting time rules? Last January, when I checked myself into A&E after prolapsing a disc and paralysing my legs, why did they move me from A&E to an almost identical department called Rapid Reaction something-or-other? Was it because they wanted to beat the 4 hour government limit on waiting times in Accident and Emergency?

It would make sense if it was, because I spent over 5 hours in that mysterious department while they tried to find me a bed in an orthopaedic ward. Indeed, having chatted with Norman Lamb, the Lib Dem Shadow Health Secretary, it appears that many hospitals are cheating on this particular target. In a survey across the country a massive spike occurs in discharges from A&E only minutes before the 4 hour limit is hit, implying a mad dash to clear the books.

An acquaintance in the NHS in Walsall argues that this is because serious emergencies are prioritised and less critical cases are likely to be bumped back, leading to lots of quick cases occurring at the end of the four hours. This suggests that the target actually works, because had it not been there, there would have been no compunction for the hospital to treat the minor cases, at all. What it doesn't point to is a responsible attitude from the hospital administrators, rather than a mad dash to please their Whitehall masters.

The problem is that with so much effort going into meeting this target, treatments without such targets are being swept under the carpet. No government can legislate for everything, however much Labour might try, and so those expected to meet specific targets are naturally tempted to sacrifice treatments without targets to avoid sanctions.

This begs a wider question about what motivates the management of some hospitals? My January experience in hospital was not a happy one but I cannot fault the efforts of anyone who treated me clinically or surgically. I can only confirm that I never heard a kind word said by the nurses and doctors about the management of the hospital and I never heard a compassionate word spoken to me from the managers I encountered.

Perhaps the tail is wagging the dog here. Target obsession becomes a race to please the press rather than a genuine effort to raise standards of care. Of course, it would be easier to ditch all these targets if it wasn't for the fact that cheating is the accepted practice.

Neville Farmer

Parliamentary Spokesman