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Last Updated: Tuesday, 22 July, 2003, 14:32 GMT 15:32 UK
Targets blamed for blindness
Bristol Eye Hospital
The eye hospital cancelled more than 1,000 appointments a month
Twenty five people went blind or lost some sight as an eye hospital focused on government-imposed targets instead of follow-up appointments, it has been claimed.

Richard Harrad, clinical director of Bristol Eye Hospital, told the Commons public administration committee that waiting time targets for new outpatient appointments had been achieved "at the expense of cancellation and delay of follow-up appointments".

The comments are published in the MPs' report which says standards in health and education are under threat because the government is setting too many targets.

Shadow health secretary Dr Liam Fox said: "This is the clearest and most shocking example of how ministers' obsession with targets is both immoral and unethical.

"The public will be astonished that doctors and nurses are unable to treat the sickest patients because ministers dictate to them who they should treat and when."


Mr Harrad said the hospital cancelled more than 1,000 appointments a month and some patients had waited 20 months longer than the planned date for their appointment.

Over the past two years, 25 patients, mostly those with glaucoma or diabetes, had lost vision as a result of delayed follow-up, he said.

Targets have long been controversial
One of them was an elderly deaf woman who became totally blind while her follow-up appointment for glaucoma was delayed several times, the committee had been told.

John Low, chief executive of the Royal National Institute for the Deaf, said: "People with serious difficulties with both hearing and sight must be given priority access to health care and the right support to understand and participate in their treatment."

He added: "The NHS has clearly failed this lady, who had the right to expect better."

Mr Harrad told the BBC: "We are very concerned that outpatient appointments are delayed longer than is appropriate.

"The targets have been introduced with no extra resources - they are not in themselves a bad thing."


But in a statement the United Bristol Healthcare Trust, which runs the eye hospital, said: "Managing the very large number of follow-up patients while reducing waiting times for new patients is a difficult balancing act."

The statement added that the hospital recognised the "inconvenience" caused to patients and was taking steps to reduce the time patients facing cancelled appointments had to wait.

The Department of Health said: "We have been consistently clear with the NHS that clinical priorities must come first, and that it is for doctors to decide what those priorities are.

"We said that right from the start of our targets on waiting, back in 1997, and have repeated it consistently ever since."

It has become almost impossible to have sensible discussion about targets because of the way in which the whole thing has become a political [and media] football
PAC report

According to the Public Accounts Committee - which is chaired by Labour MP Tony Wright - targets set in Whitehall could also be hampering general reform of public services.

Government should stick to a small number of key national targets leaving people on the frontline to designate other goals, it said.

The committee also recommended that an independent body be appointed to check targets being met to stop them being a "political football".

Whitehall-set targets were a "recipe for the growth of a blame culture" and could also lead to "creative accounting" when it came to issues such as NHS waiting times.

"Allegations of cheating, perverse consequences and distortions in pursuit of targets, along with unfair pressure on professionals, continue to appear. League tables are often seen as untrustworthy and misleading," the report said.

'Wrong measures'

The MPs also found that central departments often failed to understand what life was like for teachers and nurses on the frontline.

Tony Wright
Dr Wright is Labour MP for Cannock Chase

Dr Wright said that there were simply "too many targets and they do not always measure the right things", causing demoralisation and resentment among staff.

"Front-line workers and service users should be much more involved in target setting and the overall burden of targets should be reduced to the absolute minimum necessary to guarantee key national entitlements," he said.

Important role

A Treasury spokesman said: "The report recognises the important role targets play in driving real improvements in public service delivery and recognises the increase in transparency and accountability that has been brought about by public service agreements.

As we move to an increasingly devolved NHS, we need a new approach
Dr Gill Morgan
NHS Confederation
"Departments are already involving front-line agencies in the design of targets and, as part of the next spending review, the Treasury will be encouraging more consultation by departments in the setting of targets."

For the Lib Dems, Evan Harris said: "Tidal waves of targets simply swamp health care staff in a culture of tickboxes and spreadsheets - this practice puts patients' lives at risk.

Dr Gill Morgan, of the NHS Confederation, said the report backed her organisation's belief that current targets were "not delivering for patients, NHS staff or government".

June Kelly reports
"Every month the hospital cancels around 1,000 appointments"

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