Posted on 07/22/2003 12:14:15 PM PDT by Timesink
July 22, 2003
Bristol Eye Hospital was so determined to meet targets for new outpatient appointments that managers allowed follow-up visits to be delayed. In one case, according to the hospital’s clinical director, an elderly lady who was already deaf went blind after her follow-up appointment for glaucoma was delayed several times.
The Commons Public Administration Committee today calls for a root-and-branch reform of public service targets. In a highly critical report it gives warning that the quality of all public services is now under threat as professionals are put under pressure to meet national objectives. Professionals are putting target-setting before patients’ health, it says.
Richard Harrad, the Bristol hospital clinical director, told the committee that waiting time targets for new outpatient appointments were achieved at “the expense of cancellation and delay of follow-up appointments”.
The report cites evidence from Dr Harrad that the eye hospital cancelled more than 1,000 appointments a month, with some patients waiting 20 months beyond the planned date for their appointments.
He said that clinical incident forms had been kept for all patients, most of them with glaucoma or diabetes, who had lost vision as a result of the delayed follow ups. “There have been twenty five in the past two years,” he said. But Dr Harrad said this figure underestimated the true incidence and that there was still a huge backlog of patients to be seen.
The MPs’ report calls for an immediate reduction in the hundreds of targets set by the Treasury, an independent auditor to monitor whether key targets are met, and more local input into which objectives should be the main priorities. Doctors at the eye hospital are expected to see new patients within 21 weeks this year. Next year the target has been reduced to 17.
The report also quotes Dr Ian Bogle, the Chairman of the British Medical Association, who said that the ophthalmic unit in his area cancelled 19,500 follow-up appointments in a six-month period in order to reach the target for new patients being seen.
The Government has long been accused by the medical profession of distorting clinical priorities to meet political targets. Last year a study by the British Society of Gastroenterology found that younger cancer patients were waiting longer to have their illness diagnosed as a consequence of the Government’s waiting times strategy.
United Bristol Healthcare Trust, which runs the Bristol Eye Hospital, said that it had an ever-growing burden of work which made some cancellation inevitable. It admitted cancelling one in four follow-up appointments a month.
“Bristol Eye Hospital is a specialist ophthalmology centre and sees over 70,000 patients a year,” it said in a statement. “Following treatment for conditions such as glaucoma and cataracts, patients may require regular follow-up appointments for as long as they live. This means that demand is growing year on year. The hospital sees almost 60,000 patients in follow-up clinics.
“Managing the very large number of follow-up patients while reducing waiting times for new patients is a difficult balancing act that means the hospital has to cancel a large number of non-urgent follow- up appointments in order for the new patients to be seen.”
The MPs’ report was seized on by the Conservatives last night. “This is the clearest and most shocking example of how ministers’ obsession with targets is both immoral and unethical,” Liam Fox, the Shadow Health Secretary, said.
“The public will be astonished that doctors and nurses are unable to treat the sickest patients because ministers dictate to them whom they should treat and when.”
The Commons committee says that many managers “cheat” or carry out “creative accounting” to meet the hundreds of targets set by the Treasury. “Allegations of cheat- ing, perverse consequences and distortions in pursuit of targets, along with unfair pressure on professionals, continue to appear,” it says. “League tables are often seen as untrustworthy and misleading.”
Kind of like passing a bad traffic accident just as you are starting out on a long trip.
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