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Targets 'undermining patient care'

Efforts to improve standards of patient care in the NHS are being undermined by performance measures that encourage the manipulation of data, a report has claimed.

Although public access to healthcare data has led to greater transparency, the report argues that an obsession with targets in the NHS has encouraged practises designed to inflate achievements and mask problems.

Healthcare data analysts Dr Foster said these range from "tunnel vision" - excessive focus on only those aspects of clinical performance that are measured - through to "gaming" - the wilful manipulation of data to make performance appear better than reality.

Its report highlights a number of examples of malpractice including how two independent audits of NHS waiting lists, in 2003 and 2014, which it said showed clear evidence of "gaming" of waiting time data, including deliberate mis-recording in some trusts.

It also pointed out "huge" variations between NHS hospitals in England's prevalence of patients coded as receiving end-of-life care.

It said that as palliative care patients are expected to die, this can make actual recorded deaths in hospital appear lower than expected.

Pressure to meet the four-hour waiting time target at A&E departments has also seen patients being held in ambulances outside hospitals to delay the clock starting, the report said - while waiting rooms and even corridors are used so that patients can be categorised as having left A&E.

Dr Foster's Roger Taylor, who co-authored the report, said: "Good data can spotlight excellent practice and illuminate dark corners where things are going wrong.

"Conversely, measurement, target setting and publication of results can become oppressive, activity can be distorted to produce more acceptable numbers, and arguments about data validity can distract attention from real issues, diverting scarce resources from much-needed improvement.

"The challenge is to use performance data to provide accountability and stimulate improvement, without leading to adverse effects which swamp the intended gains."


From Belfast Telegraph