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Last Updated: Monday, 22 January 2007, 18:12 GMT
Can NHS targets really be scrapped?
The Tories want to get rid of NHS targets. But is it as easy as it sounds?

GP writing a prescription
GPs will be central to the Tories vision of the NHS

In saying they will scrap NHS targets, the Tories may have picked on the "bete noire" of the health service.

Leader David Cameron said instead of focussing on targets such as waiting times he would look to improve what matters most to patients - the results of treatment.

Unsurprisingly, many of those working in the health service have welcomed the move.

Dr Jonathan Fielden, chairman of the British Medical Association's consultants committee, said: "The government's obsession with crude targets has, in many places, distorted clinical priorities and ignored the health outcomes of patients."

And Dr Gill Morgan, chief executive of the NHS Confederation which represents over 90% of NHS organisations, added: "This is an important step in the right direction for health policy.


"Both the target culture and the NHS payment system incentivise outputs as opposed to outcomes.

"So we measure how many hip operations we perform, but not whether the patient actually has better mobility afterwards.

"We need to radically overhaul the way that we measure success in the NHS, by putting patient satisfaction and outcomes at the heart of a new approach."

It is easy to criticise targets but they have done a job many patients said they wanted doing - reducing waiting lists
Jennifer Dixon, of the King's Fund

But many experts believe this is not as easy as it sounds.

Jennifer Dixon, of the King's Fund health think-tank, said: "It is easy to criticise targets but they have done a job many patients said they wanted doing - reducing waiting lists.

"If you focus on outcomes, it sounds good, but how will it be achieved? You risk losing focus.

"If you don't have an 18-week waiting target, as we do for 2008, we will never get down to that."

Others believe the move away from "process" targets, like waiting times, to outcomes ones, such as cancer survival rates, is in line with what the government has been doing anyway.

The 2000 NHS Plan contained more than 200 targets but within five years these had been slimmed down to 20.


Joe Farrington-Douglas, a researcher at the Institute for Public Policy Research, said: "Many of the targets were a product of their time and have since been achieved.

"We are seeing more focus on outcomes, but the trick is picking things that the NHS can affect.

"If someone becomes less healthy, is it the NHS's fault or down to a change in that person's lifestyle?

It may be that some waiting is good if people are going to be treated according to clinical need
Joe Farrington-Douglas, of the IPPR

"The other thing is that it requires the Tories to move away from focussing on things such as waiting lists to attack the government. It may be that some waiting is good if people are going to be treated according to clinical need."

If targets are going to focus on outcomes, there is also going to need to be someone nudging the NHS in the right direction.

The Tories have identified GPs for this role, arguing they should be given control of local health budgets to commission services.

But GPs themselves have given this a lukewarm response, and Ms Dixon believes this is not surprising when their recent track record is considered.

Family doctors already have the opportunity to run local budgets through the government's practice-based commissioning scheme, but little over a third of practices are signed up to it.

Ms Dixon said: "It seems doctors are not that interested in doing this, they just want to get on with the business of being GPs.

"So where is the NHS going to get its momentum from if central control is relinquished?"

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