Friday, 9 December 2011

Lansley’s 60 step plan – the route to measurement overload

I fear that Andrew Lansley is, yet again, complicating things.

Like a plumber resorting to stuffing his own overalls into the leak to stop the increasingly violent flow of water, the Secretary of State for Health has come up with yet another strategy for improving the NHS. To endorse this new initiative, Lansley has made an extravagant claim in the Daily Telegraph yesterday, when he stated that he believed this could save 24,000 lives. He went on to say that his time as minister would be a ‘failure’ if 60 new outcome targets do not improve standards.

Interesting – so the T word (targets) has crept back into the agenda. This may not be a U turn but it is yet another path to be explored, accompanied by increasingly desperate narrative.

Lansley, quite rightly, has suggested that the bickering over the reforms has to stop and people should be concentrating on improving patient care. Yep – can’t argue with that! He continued with ‘We’ve really got to get into the big picture, which is delivering improvements in the results we achieve for patients right across the board – we know we can do it’. Alas, that statement had the scarcity of substance so common with answers we have grown used to from politicians these days, especially when it comes to health.

I fear for the practicality of these 60 benchmarks, which will include clinical data, mortality rates and patient surveys. You can almost hear the collective sigh from every poor soul in NHS hospitals who will be responsible for collecting this information. Surgeon’s success rates will also be under scrutiny. I hope, but very much doubt, that all this information will be taken in context. One patient’s favourite surgeon could be another’s nightmare. Survival rates are not just dependent on care as there are so many other pertinent factors.

With each new element of reform, comes the reassurance that this is the initiative which will deliver. We are now told that the 60 step plan of target standards is the magic bullet. I wonder what will come next?

The 60 goals are laudable, covering premature death, quality of life, recovery after ill health, the patient experience and treating people safely, but measurement and analysis will be complex, time-consuming and expensive. Even bereaved relatives will be surveyed – an emotional minefield to be crossed only by the most highly trained and empathetic.

Oh how I wish for those good old days when targets were based on proactive objectives not reactive surveys. As the ancient proverb states – ‘no one grows just because they are measured often’. I remember with fondness as we whinged about performance targets, based on best practice, measured with relative simplicity and rewarded by tariff.

Happy days – even if we didn’t realise it at the time.


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