BMA Scotland calls for target driven blame culture to end

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Too much emphasis is placed on targets in the health service that say little about the overall quality of care, Peter Bennie, Chair of BMA Scotland has said.

In a Christmas message looking ahead to 2018, Dr Bennie warned that the many targets across healthcare don’t always focus on what is best for patients and create a culture of blame when they are not met.

As part of his message, Dr Bennie says there is a place for timescales in which patients should be treated, or discharged, but that it is not appropriate for these to be the primary, or only way of judging how the health service is performing.

Instead, Dr Bennie suggests there should be a more balanced focus on the outcomes that the overall service delivers for people across Scotland.

Dr Bennie said, “Firstly, I want to pay tribute to, and thank all the doctors working hard at this time of year to deliver a first class service for patients across Scotland.

“But the pressures they are facing are not unique to Christmas. Against a background of insufficient funding, increasing vacancies and rising demand, the expectation put on hard-pressed doctors and the whole healthcare workforce to meet the various targets currently in place is simply not sustainable. Multiple targets, an ageing population and the funding gap are creating a vicious circle, stretching the system and the workforce beyond their means.

“The current culture of using crude measures, often taken in isolation, to judge the complexities of the whole healthcare system, and to apportion blame, must end.

“I believe that there will always be a need to set standards for patient care, and for these to be monitored. Indeed, proper use of these figures can provide indications of where improvements in funding or service design are needed, and where the system is under most pressure.

“However, saying that a patient moved out of A&E, perhaps to an inappropriate ward, simply to meet the four hour target is somehow a success, when it may well have been better for the patient to stay in the emergency department, indicates the faults with the current over-reliance on targets and the pressure they place on healthcare staff.

“In our view, we need a fundamental shift to a more mature way of dealing with the data we have on our health service, which places more emphasis on doing the right things for patients, and trusting doctors and healthcare staff to use their skills and judgement.

“We must focus more on whether we have delivered the best possible care for the people who rely on our health service, not simply how long they wait to get treated.

The BMA is happy to work with the Government and indeed all interested parties to develop this approach, building on the direction of travel set out by Sir Harry Burns in his report on targets earlier this year. But we are clear that action must be taken as part of an overall approach to put our NHS on a more sustainable footing.

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