BMJ  2003;327:179 (26 July), doi:10.1136/bmj.327.7408.179

News

NHS staff cheat to hit government targets, MPs say

London

NHS staff are cheating to hit the government's targets, a report by an influential committee of MPs has said.

A report by the public administration select committee, On Target? Government by Measurement, has revealed allegations of cheating, perverse consequences, and distortions in pursuit of targets.

Accident and emergency (A&E) departments were "prone to creative accounting," the report said. The BMA, the Royal College of Nursing, and the Patients Association told the committee how "targets for A&E maximum waiting times were being circumvented by imaginative fixes where trolleys either had their wheels removed or were re-designated as 'beds on wheels' and corridors and treatment rooms are redesignated as 'pre-admission units.'"

The committee also heard how 25 patients went blind because of the drive to meet new outpatients appointments. Richard Harrad, clinical director of Bristol Eye Hospital, told the committee how this target had been met at the expense of cancellation and delay of follow up appointments.

Dr Harrad estimated that 25 patients with diabetes or glaucoma had lost their vision as a result of delayed follow up.

He said: "This figure undoubtedly underestimates the true incidence and of course there is the large backlog of patients still to be seen. One particularly sad case was that of an elderly lady who was completely deaf and relied on signing and lipreading for communication. She lives with her disabled husband, who, like her, is completely deaf. Her follow up appointments for glaucoma were delayed several times and during this time her glaucoma deteriorated and she became totally blind."

MPs identified five failings in the way the targets worked: lack of clarity about what the government is trying to achieve; failure to give a clear sense of direction; failure to focus on delivering results; failures in monitoring performance; and confused accountability.

League tables also came in for criticism, and MPs said they did not help to "identify or disseminate good practice." Star ratings for hospitals also failed to reflect clinical performance.

MPs accepted, however, that government targets were necessary and called for them to be determined locally with more input from frontline workers and patients. It also called for the targets to be measured by an independent body.

Tony Wright, chairman of the select committee, said this would "avoid the sort of massaging of the figures that diminishes trust in the political process."

He added: "It is ridiculous that inflation and unemployment statistics are published by a neutral body, while the equally important figures for public service performance are not."

The committee also called for a government white paper, which would set out a strategy for reducing the number of targets. (See p 184.)

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