BMA warns against target-driven NHS culture

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A doctors’ union has warned the target-driven “blame” culture in Scotland’s NHS must end.

Peter Bennie, chairman of the British Medical Association’s Scottish Council, used a festive message to warn that many healthcare targets do not focus on the patient’s best interests and create a culture of blame when they are missed.

He called for a “fundamental shift” in the use of data in the health service towards enabling staff to use their skills and judgment.

Mr Bennie paid tribute to staff working over Christmas and new year and said they were providing a “first-class service”.

He added: ” Against a background of insufficient funding, increasing vacancies and rising demand, the expectation put on hard-pressed doctors and the whole healthcare workforce to meet the various targets currently in place is simply not sustainable.

“Multiple targets, an ageing population and the funding gap are creating a vicious circle, stretching the system and the workforce beyond their means.

“The current culture of using crude measures, often taken in isolation, to judge the complexities of the whole healthcare system, and to apportion blame, must end.

“I believe that there will always be a need to set standards for patient care, and for these to be monitored.

“Indeed, proper use of these figures can provide indications of where improvements in funding or service design are needed, and where the system is under most pressure.

“However, saying that a patient moved out of A&E, perhaps to an inappropriate ward, simply to meet the four hour target, is somehow a success, when it may well have been better for the patient to stay in the emergency department, indicates the faults with the current over-reliance on targets and the pressure they place on healthcare staff.

“In our view, we need a fundamental shift to a more mature way of dealing with the data we have on our health service, which places more emphasis on doing the right things for patients, and trusting doctors and healthcare staff to use their skills and judgment.

“We must focus more on whether we have delivered the best possible care for the people who rely on our health service, not simply how long they wait to get treated.”

An Audit Scotland report on the NHS in 2016/17 published in October found seven out of eight key performance targets had been missed.

Health Secretary Shona Robison said she agreed with the BMA there should be a balanced approach.

She said: ” Targets and indicators form part of this balanced approach and have an important role in giving people clarity on what to expect from health and social care services, and in monitoring performance across the country.

“But they can never be an end in themselves.”

She added: “Our ambition must be to not only improve the care of individuals needing treatment, but to utilise the information from improved systems to enhance the health of Scotland as a whole.”

Scottish Labour health spokesman Anas Sarwar said: ” As Peter Bennie notes, the SNP’s mismanagement of our NHS has left staff over-worked, under-valued and under-resourced.

“Standards are important, but it is essential the NHS and wider care sector has the resources they need to realistically meet those standards and deliver the quality of care that patients require.

“Labour has already established a workforce commission to tackle the SNP’s staffing crisis in our NHS – and we would use the powers of the Scottish Parliament to invest in our health and care services.”