Kevan Christie: Targets are a godsend for poor management in the NHS

The mounting pressure being placed on health secretary Shona Robison, not least from her political opponents over missed NHS targets, deserves closer scrutiny.

Health secretary Shona Robison has been criticised over missed targets - but often these targets are numbers plucked out of thin air, writes Kevan Christie
Health secretary Shona Robison has been criticised over missed targets - but often these targets are numbers plucked out of thin air, writes Kevan Christie

Despite writing constantly about the state of the NHS in Scotland under the current government and jumping on the weekly free-for-all around missed waiting times, I feel the cabinet secretary has been hamstrung by her own ministers and NHS boards. The reason for this is down to the NHS Local Delivery Plan (LDP) Standards or targets that currently have to be met on all aspects of healthcare, replacing Heat targets in 2015-16.

An eagerly-awaited report which was initially due in the spring by Sir Harry Burns, the Chief Medical Officer for Scotland from 2004 to 2015, will provide initial recommendations into the targets and indicators of health and social care.

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The problem with targets – and specifically those who set them – is that they are an absolute godsend for mediocre managers everywhere. They should only come prefixed with the word “sales” and are the first port of call for those who can’t manage effectively. They are a tool for bosses who shy away from communicating with “real” people and in a worst-case scenario represent a form of insidious bullying.

There’s only one target, especially where the NHS in Scotland is concerned, and that is to make things better.

There is no commonsense or scientific basis for the accuracy of most targets, all they do is assume things will improve every year and often a number is plucked out of thin air without any rational or logic behind it. They don’t provide an accurate picture of what is going on in the NHS, the great breakthroughs being made in medical science for instance.

So, we now have the weekly feeding frenzy every time a target is missed.

Is it really a national “disaster” if , for example, the number of patients having to wait no longer than 12 weeks for their essentially free treatment falls from the 95 per cent target by a few per cent?

The 10 per cent fall in meeting the target for key diagnostic tests, including procedures to detect cancer, as reported yesterday, marks a low point in target culture but it’s been coming.

What the Scottish Government does not seem to grasp is that the problem here could be the actual targets which they are responsible for setting along with NHS boards.

They have set themselves up for failure and in doing so have created the now irreversible perception that they are failing on health.

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Targets are nothing more than a big stick with which to beat hard-working staff, and give the Scottish Government’s political opponents a ready-made stockpile of ammunition.

I imagine our excellent doctors, nurses and medical staff are fed-up having to read about another missed “artificial” target which does nothing for morale and paints a negative picture of the great work they are doing.

This culture doesn’t look like changing anytime soon and is all-pervasive throughout the Scottish public sector, with the police and other bodies having to meet a constant stream of targets.

Unless things change – and they could after the National Review of Health & Social Care Targets and Indicators report is finally published – the next incumbent of the health secretary hotseat will have no chance.

Surely, the political will has to be there to do away with these meaningless targets?