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.”
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