The Perceptions can be that the NHS is now just driven by targets and that is quite true. The trick is as the NHS is slowly coming to realize, is that you can actually have too many targets and the targets in many instances can more or less be driven by what you might think is a knee-jerk reaction or to get headline.
One of the things we really need to think about is that there is nothing wrong with targets as long as the targets are actually appropriate, sustainable and beneficial. Every nurse, every doctor, every therapist and every pharmacist appreciates a target where there’s a turnaround benefit. But equally the target as everybody knows has to be something that’s achievable.
A lot of people don’t realize that things like CQUIN’s are actually not additional money but its money that you are expecting to get as part of your budget. The way that it works is that money that you are expecting to have as part of your annual budget is only paid to you if you actually achieve a sustainable target.
If you don’t achieve the target it’s not that you don’t get money, that’s in addition to what you get. So it’s not like that you have missed out on a prize or a supplement, it’s actually you have lost money that you are normally expected to do.
It’s a way of focusing attention but it only works if the people know that they can actually do it. It’s good if it drives up quality and it’s good if it drives up expectation but it’s bad if it’s not properly resourced. CQUIN’s are very high profile and very high impact but the concerns about them is whether they are always thought through properly to say that they are achievable with the right effort rather than additional resourcing? Some people can achieve a CQUIN’s target if they had additional resources but the additional resources are to be found from money that is already being spent.
When they first came out people were talking about if we gave you the reward money, it would be that you would invest that reward money to actually make the target achievable.
For example, if somebody says I can do this but I would need an extra member of staff because I can tell you categorically that I can’t do it with the work that we’ve already got and the staff we’ve already got. This is because all of the other achievements have made sure that they are working as well and as smart as they can.
When targets are thought through they have to be made sure that people can achieve them. Targets are actually directing care on the basis that sometimes when there is an emphasis on infections like MRSA and C Diff, other infective organisms get missed.
Rather than sort of naming specific organs it should be infection in general. We shouldn’t be going,” oh you need to do this for MRSA” because we should be saying MRSA is a big problem but MRSA can be mostly counted by good factors. So with MRSA the correct thing, like with CDEF is because of over prescription antibiotics.
That particular cause to organization means the best targeting was first. How you manage antibiotics to make sure we don’t get too many resistant bugs and secondly the basics is hand washing. Who keeps thinking you’ve got to keep coming back to hand washing and glove use?
Maybe the reason why they are not focusing so much as a discipline on the basics is because they are stressed out and distracted. In other words it’s rush, rush, rush ,rush, rush and with too much rushing and too much pushing, you can actually sometimes forget your basics.
The problem is you do the best you can with what you’ve got and I think the only advice you can give is to set your priorities. That’s what targets are supposed to do in that targets tell you what your priorities are. But the priorities that are set can’t always be the same as the priorities needed. So for example, you may have a ward where there is no pressure ulcers and we meet all the targets but the problem is we don’t have any time to talk to the patients.
You can see that the next thing somebody is going to flag up from the patient representatives is that nurses are rushing around so much that we don’t have time to talk, council, or to hold hands and we don’t have time for the little things which are disproportionate to quality.
A one minute conversation with the patient can do just as much benefit as all the other things that you did and sometimes more. Getting ahead of the game and explaining to people what the reality is, so to offset a lot of patient complaints because nobody had the time to explain to the patients how the process works.
The other one is a better role for technology. For example, patients who can’t reach the buzzers may be because we’ve only got a simple hand press buzzer and the patient hasn’t got the hand function to press the buzzer. This can simply be offset by having an interchangeable range of buzzers.
Therefore, ‘oh this patient needs a voice activated one, this patient needs a head activated one’ is an invest
