Senior medic calls for NHS to focus on patients instead of targets

Shona Robison has been under pressure over the NHS. Picture: Greg Macvean
Shona Robison has been under pressure over the NHS. Picture: Greg Macvean
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Doctors and nurses are being “diverted away” from frontline care in Scotland’s under-siege hospitals to deal with paperwork and “politically imposed” targets, one of the country’s most senior medics has warned.

And the way hospitals deal with the surge of patients in A&E wards has been branded “highly inefficient” and “outdated”, with a greater focus ­needed on identifying those who are seriously ill, according to Professor David Galloway, president of the ­Royal College of Physicians and ­Surgeons of Glasgow.

He hit out at the approach of a “generation of NHS strategists” to hospital accommodation and said more beds are needed, along with action to tackle underlying staff shortages.

Many patients have faced waits of eight hours or more in Scotland’s swamped A&E wards this winter as the country found itself gripped by the most ferocious flu outbreak in years.

Health Secretary Shona Robison has insisted that NHS staff are coping well under the circumstances and waiting times are not as bad as those faced by patients in England.

But Prof Galloway says in an ­article for The Scotsman today that only the “professionalism and kindness” of NHS staff allowed the service to continue at all over the winter months.

The medic called for the NHS to target “priority patients” rather than “prioritising performance targets”.

“Over the past few months I’ve seen clinical staff being diverted away from frontline care in order to deal with the administration of waiting times in an attempt to meet politically imposed targets,” he said. “It takes time and resource 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.”

Nurses in particular are being faced with the paperwork to meet targets. Doctors are “fending off” efforts to pull them away from seriously ill patients to deal with others who may be about to breach a target, regardless of their condition. The focus on targets is responsible for much of the “delay and inefficiency” in dealing with patients, according to Prof Galloway.

A&E wards should also rethink the way they bring patients through the system.

“The traditional, and highly inefficient, model where patients first see a nurse, then a doctor at an early stage of training, then ultimately a clinician with expertise, confidence and executive authority is outdated and needs to modernise,” Prof Galloway added.

He said that although Glasgow had introduced extra beds this winter to deal with the surge in demand, NHS boards would have to look again at shrinking capacity levels in hospitals.

“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,” he added.

Ms Robison has insisted that investment will have increased by £2 billion by the end of this parliament – which has resulted in record staffing numbers in NHS Scotland.

She added: “Targets and indicators form part of this balanced approach and have an important role in giving people clarity on what to expect from health and social care services, and in monitoring performance across the country. But they can never be an end in themselves.”

A report by former chief medical officer Sir Harry Burns last November will allow ministers to devise “new methods” of understanding the experience of patients while using health and social care services.

Opposition parties at Holyrood last night called on the Scottish Government to act on the concerns being highlighted. Labour health spokesman Anas Sarwar said: “This is an important intervention from Professor Galloway, and the SNP government must pay attention to it.

“After a decade of SNP mismanagement, our NHS is not delivering for patients at the level it should. Not through any fault of our incredible NHS staff, but rather because they are under pressure and under-resourced.”

Tory health spokesman Miles Briggs said change is now needed after the chaos and challenges” faced by the NHS over the winter months.

He said: “We should examine the operational side of the NHS, ensure that clinicians are not being taken from front line duties and that patient care is always paramount. Unfortunately, SNP mismanagement has made providing top ­quality patient care much more difficult for staff.”