--> I would have to question some of your statements here, AF:
>Nothing wrong with the target as far as I'm concerned (well, that's not
>strictly true...but read on).
--> So something IS wrong... And, as with most other such schemes, other
bits are right... "Other than the fact that the patients keep dying, the
procedure is rather excellent"...
>The target's transformed our department; in the space of 2 or 3 years we've
>moved from 2 middle grades to 8, from 2 consultants to 4, from 4 ENPS to
>10, from 8 GP sessions to 24; we've got OTs, psyche liaison nurses, IT
>techs, audit clerks; functioning MAUs, SAUs and CDUs; faster discharges,
>more responsive radiology and pharmacy; better social services. I could go
>on.
--> No need to go on. This list is packed with the people you list here, to
whom our patients and ourselves owe this improvement. Even the government
(if you'll excuse me using the word in this context) can be credited with
the funding for many such resources as have been added. These PEOPLE/STAFF
have transformed departments with the aid of the FUNDING. The TARGET had
nothing to do with that - it is only a device by which a standard is defined
for an audit to be possible so that a result can be demonstrated to help
re-election, hence the choice of a clinically-irrelevant set of targets, all
to do with numbers voters can be impressed with.
>OK, the way the government's achieved this was by creating an arbitrary
>time-related target, ignored the whinges and moans from ourselves and said,
>"get on with it, we don't care how you manage it, just do it", or words to
>that effect.
--> Agree with 99% of this sentence. Disagree strongly with the "OK" bit. I
don't accept you are a "whinger and moaner", AF. Seems to me that there is
something here you are uncomfortable with as a senior clinician. If you have
two similar procedures, one of which has a lousy "side effect" such as these
targets are, you choose not to use that procedure. If it's a good procedure,
then you get rid of the side effect if you can! You do not accept it merely
because the procedure it came with works.
>Now the academics amongst us may object to this approach, but how else can
>you transform emergency medical services in this sort of time frame?
--> I am not, nor can I even spell AKKADEMIK. Never read books. Like dirty
gloves. But I also OBJECT, if only because of the effects I see these
targets having on patient care and on the CARERS themselves. On us... We are
all seeing the negative effects of these targets clouding the positive
effects of the resources they accompanied.
>At the end of this grand initiative, even if the targets are abolished, at
>least the new resources will remain in place (although many will whittle
>away without the targets to fuel them). But I suspect the time-sensitive
>targets, if they do go, will only be replaced by more sophisticated targets
>that will be just as demanding to achieve, but a lot more difficult to
>monitor. And only marginally more satisfying to the academics amongst us...
--> I have nothing against sophistication and demanding objectives. Most of
us are stimulated by such goals. I agree they will be more satisfying, but
this is secondary to them being less harmful! If our resources depend on
what you and I and all others agree are "arbitrary time-related" targets,
then we need to do something about the managers/politicians in whose minds
this misconception has developed and in whose (hopefully temporary) power it
is to "punish" us and our patients for these targets' elimination.
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