Short-term micromanagement is distorting the NHS, managers claim

8 Nov 01
The government's micro-management of the NHS is frustrating innovation and preventing managers improving the service to patients, the NHS Confederation claimed this week.

09 November 2001

The managers' body said the current performance-management system promoted short-termism as NHS organisations strove to achieve targets. 'The government is struggling to get out of a continuous cycle of micromanagement of the NHS. If it does not, we are arguing that attempts to turn round the NHS may fail,' said confederation policy director Nigel Edwards.

Performance management threw up many contradictions, he argued, with ministers encouraging radical action and risk-taking but naming and shaming those deemed to be failures, for example.

'Much of what we do to measure performance in the NHS undermines our attempts to improve it. We are told to be innovative, yet avoid diversity; take risks, but don't fail; change from the bottom, yet do what we are told,' said Edwards.

The system may not be producing the desired results, he added, citing heart attack treatment targets. Victims have a better chance of survival if they receive anti-blood clotting drugs within 60 minutes of the onset of chest pain, so targets have been set for individual parts of the NHS in an attempt to ensure this happens.

An ambulance service that meets its target of reaching a heart attack patient within 20 minutes of a 999 call would be recorded as a success in the 'tick box' performance management system. But this would be the case even if the patient had delayed calling an ambulance for an hour after the onset of pain, and therefore had a lower chance of survival.

Edwards acknowledged the government had the right to set standards but insisted it must focus less on detailed, specific targets and more on identifying key pointers that showed how the whole NHS was performing.

The managers' body published three discussion papers this week. These say any new performance management system should be based on four principles.

It should create pressures for improvement by equipping patients and staff with the information and opportunities to improve the NHS; set direction for the system through a few, simple targets; support innovation and change; and provide coherence through collaboration between health care organisations.

PFnov2001

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