MSPs have questioned whether pressure to meet performance targets in the NHS is resulting in the best use of public money.
Holyrood’s health committee has called on the Scottish Government to consider whether there should be more flexibility around high-profile targets such as the four-hour A&E waiting time standard.
During an examination of health board budgets, the committee heard resources were often diverted if there was a risk a target would be missed, to the possible detriment of other projects.
A focus on key targets could result in “large sums of money being spent to achieve marginal improvements” in performance, for example through the hiring of consultants.
MSPs also heard there was no way to assess the level of investment being made by the NHS to fully meet the final percentage points of targets.
“The boards agreed that the focus on achieving high-profile target measures could lead to an inefficient allocation of resources,” a committee report said.
It added: “The committee asks the Scottish Government how it makes sure that the drive to meet the targets remains an efficient use of money for NHS boards, when it is not able to establish how much it is costing boards to meet the last percentage point of these targets.
“This is especially relevant where a board’s performance may only be 1-2 per cent below the target and the money may be able to achieve much greater gains elsewhere. The committee ask the government to consider whether some flexibility in the targets might be appropriate.”
Committee convener Duncan McNeil MSP said: “The use of targets in the NHS has long been controversial. Whilst there clearly needs to be some measurement of output and delivery, our committee has questioned if meeting that final percentage of performance targets is really the best use of public money.
“Given that there is no way to measure the amount of investment that goes into this, we are calling for the government to consider whether there should be flexibility in the targets to ensure any investment goes towards actual improvements in the quality of care.”
Health secretary Shona Robison said: “We know that rigorous targets can deliver improved services for patients - as our health service is now delivering some of the lowest waiting times on record.
“However, we do need to ensure we have the right targets for the right things and set at the right levels. This needs to balance delivering the best possible results for patients with allowing boards to respond to local needs and circumstances.”
“That is why we have already reduced the targets we set boards from over 200 to just 20.”