Saleyha Ahsan

NHS needs more doctors, not targets

Posted by Saleyha Ahsan on 25 June 2010 | 0 Comments

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I want to abolish a management myth. Although only a mere A&E doctor, I do actually have an awareness of time. It is an essential element within patient care, drummed in from early student days. Time is the enemy. Any delay in treatment is not in the best interest of the patient, whatever the reason, whatever the speciality. In the worst case, it can also be a killer.

John Appleby writes on Cif that "targets and terror" worked and wonders whether the NHS can guarantee acceptable waiting times, without the whip cracking. 

Does that suggest that a clinician without targets would adopt a more leisurely approach to patient care? Would time-dependent care waltz out of the window as doctors tackle clinical responsibilities with a "we have all the time in the world" approach?

From my position, the maths is pretty simple. More staff, thus more patients seen, equals shorter waiting times. How about transferring funding to the shop floor, to ensure we work with a full complement? I appreciate this is unlikely in the current financial climate, but above all, patient care is paramount, and pushing doctors in A&E to speed-consult with patients is clinically unsafe.

It comes with good reason that the College of Emergency Medicine welcomes the government's plan to allow a 95% target hit instead of the 98% of the four-hour patient wait in A&E. But looking at figures does not illustrate reality. Let me take you to my office. It's Saturday night in an east London A&E and there's some anxiety around a computer screen. A patient's name lights up in red on the screen. The phone rings simultaneously.

The harassed charge nurse picks up the phone. The bed manager wants to know why there's a "breaching" patient in department. Everything feasible has to be done to prevent that red turning yellow – the shade of shame, confirming a breach.

On one occasion, while working on an unstable patient in high dependency, I was asked to deal with another one of my patients who was soon to breach. There were many contributing factors, including the two-hour wait in department, which had led to this. The breaching patient was stable.

"Can you save the breach first?" asked the bed manager. To be fair, she had a job to do. If hospitals don't meet targets, they are penalised. It's an unfair system. As a nurse herself, she understood our pressures and the Olympic gymnast stretches we were doing that night with two doctors down.

I was caught in that place that we medics hate – stuck between a breach and a sick patient. It makes me wonder at such times what my role is: please the managers or do my best to stabilise patients? This is not an isolated case, and many colleagues have been in that exact spot, too.

The NHS today looks far healthier than it did 10 years ago, but that's more to do with the investment it so badly needed more than anything else. The four-hour target does get the patient out of department, but they then go on to wait somewhere else. The rush to move the patient on can sometimes mean that essential basics are not done. That cannot be right at any cost and, at worst, is dangerous. A patient is not a product on a conveyor belt and they deserve not to be treated thus.

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