Doctors say patients don't benefit from targets

In a hard-hitting speech to the BMA's annual conference in Torquay, Dr Ian Bogle said "spreadsheets and tick boxes" were now more important than the needs of patients.

His views were echoed by doctors attending the conference, who voted overwhelmingly against the "target culture" in the NHS.

They also criticised the government's flagship policy to create new foundation trusts.

Doctors said freeing top-rated trusts from Whitehall control will create a two-tier health service.

Targets under fire

In his last speech as BMA chairman, Dr Bogle said doctors supported the use of targets to measure progress in the NHS.

We now have a healthcare driven not by the needs of individual patients but by spreadsheets and tick boxes Dr Ian Bogle, BMA chairman Targets compromise patient care Watch Dr Bogle's speech

But he suggested that doctors and not politicians should set them.

"The use of targets to drive up quality and measure improvement is not a bad idea.

"Good targets like those for a reduction in death rates from heart disease and cancers are drawn up by clinicians, not by politicians looking for a quick fix to appease an expectant and impatient public," he said.

Dr Bogle suggested current targets, such as maximum waits for patients in A&E and for operations, were not in the best interests of patients.

"Targets are set nationally without any appreciation of what they might mean for individual doctors sitting in consulting rooms with individual patients," he said.

"The fundamental NHS principle of care based on need and need alone has been superseded by the principle of care based on numbers.

"We now have a healthcare driven not by the needs of individual patients but by spreadsheets and tick boxes."

Dr Bogle also raised doubts over government plans to cut waiting times for operations to just six months by 2005.

"I do not think it is achievable. There is already too much fall out to the detriment of patients. The government should discuss the timescale and how we will go about it."

Dishonesty

Dr Bogle is standing down this week

Dr Bogle said the government's targets "make honest people dishonest".

He said hospitals had gone to "extraordinary lengths" to show they were meeting the maximum four hour wait in A&E.

An official audit, carried out in late March, showed 85% of the 207 A&E departments in England met this target during the week in which statistics were collected.

But a study by the BMA found that in the following week the figure dropped to 63%.

Dr Bogle said hospitals had bussed in temporary staff, made staff work double shifts and cancelled routine surgery to meet the target.

He said ministers were turning a blind eye to these practices.

"You would think, wouldn't you that the government would be distancing itself from these corrupt and immoral practices.

"Instead, it has turned a blind eye, been triumphalist about its 'achievements' and colluded in the deception and doublespeak."

Doctors told the conference that patients care is regularly undermined by hospitals seeking to meet targets.

Dr Simon Calvert, a junior doctor, said patients with minor illnesses were often prioritised over those with more serious conditions because treating them quickly would help the trust to meet its A&E target.

It is very disappointing that, just one day after the Health Secretary John Reid said he would meet the BMA consultants, Dr Bogle has responded in such a childish way. Department of Health

He said targets were more "about meeting a manifesto commitment than patient care."

Doctors said NHS managers were bullied into meeting targets and were often driven to fiddle figures because of pressure from health authorities or the Department of Health.

"NHS targets are the most perverted policies of this government," said Dr Charlie Daniels, a GP in Devon. "Targets damage patients."

Dr Chand Nagpaul, a GP in London, rounded on the star rating system for hospitals.

He called it "a simplistic and damaging approach to measuring the quality of hospital services."

However, Liberal Democrat health spokesman Dr Evan Harris criticised the BMA for signing up to the targets, which were detailed in the NHS Plan, published three years ago.

"Targets damage patient care by preventing the treatment of the sickest quickest.

"The BMA were foolish to sign up to the target-based approach in the NHS Plan in the first place," he said.

Government response

The Department of Health expressed anger at the idea that it was turning a blind eye to figures being manipulated.

A spokesman said they had always made it clear that those found responsible would be disciplined.

A Department of Health spokesman said: "It is very disappointing that, just one day after the Health Secretary John Reid said he would meet the BMA consultants, Dr Bogle has responded in such a childish way.

"We have always been clear that we won't stand for any manipulation of statistics and those found responsible should be disciplined.

"Year on year the NHS is getting better, not because people are fiddling the figures, but because the health service is now getting the investment and the reform it needs."