NHS staff are being diverted from frontline duties caring for patients to fill in admin about waiting-time targets, writes Professor David Galloway.
Once again staff from across Scotland’s NHS have dealt with the almost unprecedented pressure of this winter’s crisis with the professionalism and kindness for which they are renowned. But many of us fear that it’s sometimes only the goodwill and dedication of staff which allows the service to continue at all during these challenging periods.
It’s increasingly clear to me that rather than fuelling a political argument about numerical targets, we must now focus our public debate on the much more important objective of achieving the best patient outcomes.
The fundamental focus of the NHS must be to target priority patients rather than prioritising performance targets.
The problems that we’ve all seen in our hospitals over the past few weeks are pretty complex. Firstly, there is a range of strategic demand pressures on our NHS today. We have an ageing population with increasingly multifaceted health needs. Winter pressures remain a real challenge, especially with the threat presented by the largest increase in levels of flu that we’ve seen in decades. We must also tackle issues relating to supply. The financial pressures facing the NHS have been well documented, and I’m sure I’m not the only interested observer who predicts that more than one health board in Scotland will face a deficit at the end of the financial year while trying to maintain the high standards of service that our patients deserve and expect.
It’s also a simple fact that there are fewer available staffed beds in the NHS than there were even a few years ago, giving the service less flexibility to deal with surges in demand. Although in places like Glasgow, numerous additional beds have been opened this winter to bring some respite to the current crisis, we need to revisit the in-patient accommodation we actually need now – not what was considered to be the requirement by a prior generation of strategists.
At the same time we’re facing a number of serious underlying staff shortages within the health service. Some of these, like the shortage of radiologists, have an additional knock-on impact on services across our hospitals. We also face short-term staffing problems; absences from colds, flu and other winter illnesses affect NHS staff just as they do the wider population. But the area which has received less attention than others over the last few weeks has been how we best organise the operational activity in our health services to ensure that we continue to provide a top-class service to patients whenever they need it. Occupancy rates in our hospitals remain high and there are continued challenges in providing the packages of social care which patients may need at home before they can be discharged. Everyone accepts that the future of effective health care lies in seamlessly bringing health and social care together, but it can sometimes still be a real challenge to coordinate the support work required between hospitals, health boards and local authorities in order to discharge patients at the right time with all the right support in place at home. In addition to this, effectively managing the flow of patients through hospital is key to tackling the challenges we’ve seen this winter – getting the right care to patients as quickly as possible.
Working alongside representatives from Scotland’s other Royal Colleges, the Royal College of Physicians and Surgeons of Glasgow has become experienced and indeed adept at helping hospitals and health boards drill into their data and understand where the institutional pressures exist. There are many ways of tackling patient-flow problems in our hospitals, and it so often comes down to recognising the issues, identifying the working patterns that inevitably introduce delay and inefficiency, and empowering those who can produce innovative local solutions. Often the resources and the solutions are readily available and it may simply need an external view to help make these solutions more obvious. We stand ready to assist in any way possible. Over the past few months, I’ve seen clinical staff being diverted away from front-line care in order to deal with the administration of waiting times in an attempt to meet politically imposed targets. Nurses, in particular, are being faced with the paperwork associated with administering NHS targets.
At the same time, doctors have had to fend off attempts to divert them towards patients who are about to breach a target, sometimes at the expense of high-priority patients who really need their attention. This is not appropriate. It takes time and resources to manage the current regimen of targets, and so we should take stock and review which of these play a part in improving patient care, and which do not.
We also need to ensure that patients see senior clinical decision makers early on in their journey through the system. There’s some great practice in place in Scottish hospitals, but the traditional, and highly inefficient, model where patients first see a nurse, then a doctor at an early stage of training, then ultimately, and after some considerable time, a clinician with expertise, confidence and executive authority is outdated and needs to modernise.
Finally, we need to allow clinicians and staff who are working under pressure the time and space to get out of their speciality silos to communicate and to work together to address patient flow issues. Teamwork is at the heart of a successful NHS, so we need to enhance this if we’re to get the best out of the resources we have.
Given that the level of investment in the NHS is considerably less than in other developed countries our staff are doing a fantastic job under immense pressure. We need an informed public debate about how to address these challenges effectively if we’re to continue to improve. But most of all, we need a system which puts patients’ needs first.
Professor David Galloway is President of the Royal College of Physicians and Surgeons of Glasgow