A&E Waiting Times

Idiot/Savant is sceptical of the planned policy to have maximum waiting times for A&E. He claims that in the UK, the response to such targets was:

The policy is based on UK Labour’s attempts to improve quality in the NHS by introducing these sorts of absurd targets, and Ryall claims that policy was a success, having led to a reduction in the number of patients waiting for than four hours from 23% to 3%. But that success was an illusion. As noted in Adam Curtis’ documentary, The Trap, faced with pressure to improve their statistics, NHS managers created a new and unofficial post, the “Hello Nurse”, whose sole purpose was to greet new arrivals to A&E so they could claim for statistical purposes that the patient had been “seen”. Faced with a similar target aimed at reducing the number of patients waiting on trolleys in corridors, they simply removed the wheels from the trolleys and reclassified them as beds.

I’m not sure whether to be appalled or impressed by the ingenuity – reclassifying trolleys as beds!

The targets were met, but the underlying performance didn’t change one iota. Mangers being managers the world over, the same is likely to happen here. It’s a general problem with this sort of empty managerialism and obsession with statistical targets: the statistical goal – measured patient “waiting time” – ends up taking the place of the real goal – patient care. And doctors and nurses end up spending all their time filling in performance spreadsheets rather than doing what they’re supposed to be doing: seeing patients.

Idiot/Savant arguments would be stronger, if the status quo had not failed so badly. Under Labour we have had $3.5 billion of exra funding for health, no targets for A&E, and the result has been 20% of people waiting for more than eight hours.

Why does he think throwing more money at it, without targets will work? Can he cite an example in the world where it does?

As I said yesterday, the benefits of targets are it creates transparency. DHBs can cost what the cost will be to meet the six hour target. Dedicated funding can be applied for. If the Government refuses, then people can hold the Government accountable.

Rather than clinging to the dead 80’s cult of managerialism, National should target the real problem: lack of resources. The reason people have to wait so long in A&E is because hospitals cannot afford to employ enough medical professionals to deal with demand.

And without a target to aim for, how on earth can one calculate what it would costs to have the extra staff?

The reason they are parked on trolleys in hospital corridors is because there is not enough space. But solving these problems would cost money, which National would rather give to the rich in tax cuts. It’s just a question of priorities – and National clearly rates redistributing wealth to those who need it least well ahead of ensuring that every kiwi has decent access to healthcare.

And now we just get the blind slogans, instead of intelligent analysis. Idiot/Savant is not stupid. He has read National’s fiscal package. He knews that the tax cuts are being funded almost entirely out of changes to KiwiSaver. Not from less spending on Health.

In fact National has pledged significant funding to train up more doctors, to set up 20 new surgicial wards etc etc.

The Herald editorial is supportive of the policy:

It is also all the more reason to welcome Health Minister Tony Ryall’s plan to impose maximum patient waiting times on emergency departments, and to hold district health boards and their management accountable for meeting them. His initiative is sure to attract criticism. Such targets are always something of a crude measure, if only because they fail to give sufficient recognition to quality of care, which should, ideally, be hospitals’ paramount concern.

The target are no silver bullet, but frankly we should be debating why we have never had them before, not be surprised that these minimum measures of accountability are being introduced.

But Mr Ryall can be excused for starting at this point. There is a sense that, while the Labour Government increased the health budget by more than $3.5 billion, too much of this was swallowed with little discernible increase in efficiency. There were neither quantitative nor qualitative improvements. At the very least, targets incorporated into performance agreements will lay the foundation for better results by increasing accountability in emergency department operations.

Indeed. The status quo has seen massive funding and little way to judge how well utilised that funding was. Now that is great if you are Minister of Health, but not good for patients and taxpayers. This si why I said Ryall’s policy was brave – it actually creates an accountability for him as as Minister that was previously lacking.