Cash-starved NHS struggles with targets

As the junior hospital doctors started their second day of strike action, new figures were released which showed that the Government’s strategy of starving the NHS of money are having an effect on patient treatment.

The NHS has a target to deal with A&E patients within four hours of their arrival. The target was originally set by the Blair Government – which was criticised by the Tory opposition for being too focussed on those targets, at the (alleged) expense of giving doctors freedom to take decisions based on clinical need. Certainly there were stories about the tips and tricks doctors could use to make it appear that they had complied with the four hour target in ways which made little difference to patient treatment. However, now they are in government, the Tories have not changed the target system – and the figures are now showing how the NHS is struggling to cope.

Figures for January showed that only 88.7% of A&E patients were dealt with within the four hour time limit – which is the lowest monthly figure on record. NHS England put the slump down to more people needing the NHS, revealing that emergency admissions had risen sharply within an overall statistic of a 10% rise in all hospital admissions.

NHS England also pointed to “bed blocking” as another factor delaying treatment. This is the term used for patients who are medically well enough to be discharged from hospital in fact having to stay there, as there are not enough support facilities in the community for them to be safe at home. Government cuts in local authority funding are thought to have reduced community support services, leading to patients who are clinically fit for discharge having to stay on in hospital. This, in turn, keeps patients waiting in A&E for a bed to become available on a ward – which pushes the “four hour” figures up.

NHS England has estimated that there were 160,000 “bed blocked” days in January, which is the second highest since records began. These 160,000 days of lost treatment, combined with the increase in demand, have put great pressure on NHS services.

The financial pressure the NHS is facing is also stopping it from being able to increase its services in order to meet the rising need.

•Hospitals are under government pressure to reduce the number of agency staff they use, as these staff cost more than directly employed workers. Holding back on booking temps can lead to delays in treatment, as nurses and other staff run round trying to cover for absent colleagues so that hospitals can avoid hiring temporary staff.

•A much greater financial problem for most hospitals comes from the various PFI contracts that most Trusts have taken out. These are a tremendous drain on NHS resources, with hospitals often paying vast sums to private company partners as loan repayments, together with management fees.

Alongside the two main headline figures on A&E targets and bed-blocking, the NHS has also revealed a string of other missed targets.
•The target that no patient should wait longer than 18 weeks for a routine operation was missed for the second month running.
•The target that cancer patients should start treatment within 62 days of their GP’s referral was missed again: this target has only been met once in the last 20 months.
•The target on waiting times for diagnostic tests was missed.
•The targets on ambulance response times was missed for the eighth month running.

The NHS is behaving like a duck at the moment: trying to stay calm on the surface, while underneath its little feet are paddling away like crazy. The Government has asked the duck to swim upstream – so despite the crazy paddling, its not making much progress in getting to where it wants to be. All credit to the staff who work so hard to keep the NHS afloat – but wait for the Government to announce that poor performance against targets calls for services to be handed over to the “efficient private sector”. If that happens, we’ll all need to duck.

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