The NHS has become obsessed with targets and perfomance indicators. And no wonder, because failure to meet targets, or poor results when the perfomace indicators are audited leads to extra hassle for managers who get massive grief about it from above, and ultimately results in  cuts to budgets. Yet these targets or performance indicators are often extreely poorly related to quality of clinical practice.Often they INTERFERE with quality of clinical practice. Some real-life examples from personal experience: our service has been criticised for failing to ask the marital status of our patients – which is a performance indicator for our trust. We work with 5-15 year olds! an A&E doctor moved an aggressive adolescent patient on a section who was AWOL from another hospital onto a general paediatric ward, even though we all agreed she and the other patients were safer is she stayed on A&E till staff from her inpatient psychiatric unit could fetch her. She3 was moved despite the risks because if she had stayed on A&E she would have breached a waiting time target. Attendance at Mandatory training is another performance indicator even though most mandatory training is a pointless waste of time as the training is only margininally related to your role – or is totally unrelated. It costs a fortune to monitor these targets. The targets are merely proxy indicators for good quality care and they are poorly related to quality of care. You can deiver great care and meet zero targets, or dreadful care and meet all your targets. Stafford hospital got great results on their performance indicators while patients were dying in their droves. Scrap them!

Why is this idea important?

Targets and performance indicators have resulted in trusts that focuson chasing targets instead of delivering quality care. Targets are poorly related to quality of care, as the Stafford outrage showed. Centralised control and micro-management is enormously costly, time consuming and above all leads to worse care for patients. Some broad guidance is fine: controlling everything is not. Trust health care professionals and set us free!  


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