Theresa Fyffe: Get rid of targets to help improve NHS Scotland

our current targets often measure the wrong things, skew clinical priorities and waste resources. Picture: John Devlin.

our current targets often measure the wrong things, skew clinical priorities and waste resources. Picture: John Devlin.

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RETHINKING NHS Scotland’s ‘targets culture’ will benefit us all, writes Theresa Fyffe

NHS Scotland’s targets (or “Local Delivery Plan Standards” as they’re officially known) are set by the Scottish Government, which then holds NHS boards accountable for delivering them each year. They’re intended to give assurances to politicians and the public on how our health services are performing. We have waiting times for cancer, psychological therapies, IVF, drug and alcohol treatment; we have an 18-week referral to treatment time and a treatment time guarantee. And, of course, the high profile four-hour A&E waiting time target.

This is all well and good and we certainly never want to go back to the bad old days of waiting two years for a hip replacement or sitting in A&E for hours on end, waiting to be seen.

Yet what the current targets measure is how long it takes our health services to deliver. And it’s true that, sometimes, speed is of the essence when it comes to health. But there’s nothing in the current range of targets which measures how successful treatment has been or if an individual’s health has improved as a result of the care they’ve received. So, current targets will tell us if someone got seen in A&E within four hours – but they won’t tell us if they saw the right clinician, got the tests they needed or were admitted to the right ward. Current targets encourage health boards to focus on, and often invest money in, those areas with a target, sometimes at the expense of those areas where there isn’t one. In other words, our current targets often measure the wrong things, skew clinical priorities and waste resources.

Wouldn’t it be better if we measured how successful our health services are at improving health and wellbeing in Scotland and achieving positive outcomes for those who use them?

That’s why, over the last year, the Royal College of Nursing Scotland has gone out and discussed with other health professionals, with colleagues in the third, independent and social care sectors and with politicians of all parties, how we can measure success in a different way to improve health and wellbeing in Scotland.

And it’s why, in June this year, having listened to a wide range of opinion and having researched what works and what doesn’t, we published a new report setting out a number of principles for a new approach to measuring success across our health services.

This new approach should, we believe, focus on Scotland having a single set of health outcomes across all services. We also believe that clear, public accountability is crucial, so that health and well-being services deliver what matters to people. And individuals must be listened to by their health and care professionals and supported to achieve their personal health outcomes.

All the conversations we’ve had and the work we’ve done over the last year have also underlined the urgent need for a new approach. Marginal change round the edges will not be enough to create a more sustainable health service in Scotland, given the pressures faced.

Changing the current targets culture will be challenging and it’s good to see that the Cabinet Secretary is listening and agreeing to a review. But whenever that review begins, it must take a fundamentally new approach and put all options on the table for consideration. Only by doing so will NHS health boards be able to focus on the right things and invest in improving outcomes for individuals and health and wellbeing across our communities.

• Theresa Fyffe is director of the Royal College of Nursing Scotland

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