NHS staff
revealed their experiences of fiddles with waiting-list figures in a report
commissioned by the department of health.
The report, completed in 2005 and released by the department under
the freedom of information act (FOIA), resulted from a survey of health staff
about Tony Blair’s NHS reforms, such as the creation of “foundation
trusts”.
It also shows problems with the focus on waiting-time targets, with
one psychiatrist reporting that figures were being fiddled at his unnamed
urban mental health trust somewhere in southern England.
He told the survey: “They are not cutting waiting times…
but make it look like waiting times are cut when they have not actually been
reduced. The trust has found a way to make the data look like they’ve
been reduced.”
More evidence of such problems came from amb-ulance staff. One paramedic
working for an unnamed ambulance trust in southern England, said: “Some
of it is perceived as game playing, for example an aim to say you’re
reducing [accident and emergency] waiting times. But it’s no use if
your patient’s waiting for an hour in an ambulance to be booked in,
which does happen at one hospital in our area.”
An ambulance liaison officer, also working for an unnamed ambulance
trust in southern England, spoke of how hospitals' targets conflict with those
of ambulance services: “I have an awful lot of problems with wards and
hospitals that have their own targets to meet and unaware of ours or really
care about ours. So consequently we get lots of complaints about ‘I
want an ambulance now when I want one’… I really feel that the
patients are being forgotten.”
The survey shows widespread discontent about Blair’s NHS reforms
among those who must implement them. Blair believes, the report notes, that
his reforms would increase “choice” and “flexibility”
for patients.
It says: “Many are positive about the ideology of the changes,
however in the short term the constant pace of change, the resulting increased
pressures on workload and the development of a ‘tick-box culture’
all of which take time away from patient care creates negativity and resistance
to change.”
“Overall, practice nurses and PCT [primary care trust] managers
tend to be positive about the changes, but some GPs tend to be negative. There
is some evidence of strained relationships between the GP practices and PCT
management. There are mixed views on relationships between PCTs and other
organisations.”
“In the main, staff in both acute trusts and mental health trusts
identify more problems than opportunities with foundation trust status and,
in particular, are concerned about the impact these trusts will have on the
rest of the local health economy. Moreover, some in mental health trusts do
not feel foundation trust status applies to them. SHAs [strategic health authorities],
arm’s length bodies and the department of health are more positive about
foundation trust status, but are concerned about regulation and share the
concern about their impact on local health economies.”
“There is general agreement that future leadership needs to be
less autocratic and more participative in order to manage change successfully.”
“Many of the behavioural barriers that were ident-ified were
attributed to pace of change, workloads and a lack of understanding how the
elements of system reform will ultimately benefit patients.”
“Reassurance is needed that changes are indeed patient focused
and will in the long-term be beneficial for both patients and staff. This
need for reassurance is particularly relevant to consultants and GPs.”
The report quotes some comments from GPs to the survey. One said: “Staff
resources are stretched to the limit. There is too much data collection and
computer input.”
Another: “We are judged on targets which I don’t think
give an accurate estimation of clinical skills.”
And a third: “I am fed up of change that ignores patients.”
Comments from consultants include: “Foundation trust is all negative
at the moment.”
“The surgeons have just doubled their salaries by doing waiting
times and it’s not fair really.”
“Constant change makes us cynical. It will all change again.”
Comments from nurses include: “[Tendering of contracts] is a
negative because you have situations where hospitals go for lowest tender
and service just not up to scratch, for example cleaning.”
“There’s lots of ‘dosh’ sloshing around in
the NHS, but it seems to be in the wrong places.”
Turning to the views of health staff in general, the report adds: “Some
are concerned about how foundation trusts fit into the ideology behind the
NHS, for example making it a two-tier, elitist system, too commercially focused
rather than patient-care focused or providing choice only to those who are
more mobile.”
Comment
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