Intended for healthcare professionals


MPs attack NHS for putting finances and targets ahead of patient safety

BMJ 2009; 339 doi: (Published 03 July 2009) Cite this as: BMJ 2009;339:b2706

Finances and targets ahead of quality and safety

Here we go again! MPs and other politicians are quick to express
shock and distress that the NHS puts finances and targets ahead of safety
and other aspects of clinical quality. All MPs know well that it has been
politicians themselves who have dictated that NHS Trusts put finance and
nonsense targets ahead of safety and real quality.

Because they don't know how to measure most truly important things
they use inappropriate proxy measures - the 4 hour accident and emergency
wait is just one good example- and pretend to the public that they have
set a clinically meaningful target. Complaints from clinicians and
enlightened managers that such policies cause harm are ignored.

Because politicians don't want to be seen personally as the cause of
the problems they devolve enforcement down the line, primarily to
Strategic Health Authorities who make clear the dire consquences to Trusts
if the political targets are not met. Clinicians and most managers would
readily put safety and true quality above the false targets but the
bullying and intimidation they receive means that huge amounts of time are
spent chasing the wrong things so that 'good news' can be passed up the

In the last decade of my work in an NHS trust I saw many good
managers terrified by the perceived consequences of patients waiting a
minute over 4 hours in an emergency department, even though the patients
were receiving good care and when movement quickly to the wrong place
would have been hazardous. Any MP thinking that bullying is banned from
the NHS should take the trouble to see personally how intimidation from
high level is destroying staff morale at the sharp end.

Similar examples of inappropriate attention to targets can be found
in the way continuity of care has been sacrificed to other dictats but
clinical concerns from staff for patients fall on deaf ears. There is no
shortage of incident reports; the problem is that acting on them is
hampered by imposed bureaucracy.

Perhaps instead of the bleating question 'who allowed these problems
to happen?' there could be recognition that it is often MPs themselves who
have failed to be sufficiently honest. A 'wise before the event'
committee would be a wonderful innovation but the current level of
political ability and integrity might preclude a quorum.

Competing interests:
None declared

Competing interests: No competing interests

13 July 2009
David Levine
Retired Physician
Penzance, Cornwall TR19 7AX