Health Care Targets
Dr Liam Fox (Woodspring, Conservative)
That is one of the most absurd arguments that I have ever heard. If a trust has contracted-out cleaning, but the hospitals are filthy, why pay the contractors? It should get someone else in to do the job. One of the biggest problems with hospital-acquired infections is simply cultural. Transmission of infection between patients has nothing to do with expenditure but a great deal to do with washing one's hands. For a doctor or nurse to wash their hands after seeing one patient and before seeing the next does not require a Government grant. It is part of the culture of the system—it is not helped by any Government target and is good practice for professionals who deal with patients. It does not require Government intervention, but it does require a bit of thought about patient care.
One area where morale has been particularly hard hit is general practice. Medeconomics, the specialist health magazine, reported in September this year:
"There are now fewer GPs per patient than five years ago. In 1997 there were 54.3 GPs for every 100,000 people, compared to 54.1 in 2001."
Figures published this month show that the number of vacancies has gone up. More than two thirds of GP vacancies were unfilled for more than six months, and the number of such vacancies has increased by 31 per cent. since 2002. Dr. John Chisholm of the BMA's general practitioners committee said:
"We are not surprised by this increased vacancy rate . . . in England. Indeed it matches the findings of our own GP vacancy rate survey . . . The upward trend is a matter of great concern."
Finally, targets have another cost. A target culture breeds bureaucrats in the same way as micro-organisms breed in a culture dish. If a target is set, it must be monitored, the results of that monitoring passed to someone else, and so on. Co-ordinators have to co-ordinate other co-ordinators, and the gap between decision making and delivery is filled with an ever-growing volume of interference, control and obstruction. It is no wonder that more people joined the Government payroll in the past year than work in the European Commission—there are hundreds of posts in monitoring units, delivery units, assessment teams and co-ordination groups. The overall number of public sector workers has risen by 0.75 million in the past five years so that they now account for one in four of the work force. It is little wonder that the Government's extra spending and our extra taxes have not resulted in clear benefits for patients.
Targets are not about patients but about politics. The NHS is being run to suit the spin of the Government machine, not the clinical needs of patients. Political expediency is given priority over the need for care. New Labour has corroded the integrity of the NHS. It has put statistics before patients, demoralising NHS staff—the staff I trained and worked with, who are becoming increasingly difficult to recruit. This is no longer about the health of the public but about the political health of the Government. And they told us that things could only get better.