Tuesday, November 25, 2008

Empty managerialism

The government has unveiled its policy to solve A&E overcrowding: an A&E waiting-time limit. But what are they going to do if a patient exceeds it? Throw them out?

That's a flippant response, but disturbingly accurate. The policy is based on UK Labour's attempts to improve quality in the NHS by introducing these sorts of absurd targets, and Ryall claims that policy was a success, having led to a reduction in the number of patients waiting for than four hours from 23% to 3%. But that success was an illusion. As noted in Adam Curtis' documentary, The Trap, faced with pressure to improve their statistics, NHS managers created a new and unofficial post, the "Hello Nurse", whose sole purpose was to greet new arrivals to A&E so they could claim for statistical purposes that the patient had been "seen". Faced with a similar target aimed at reducing the number of patients waiting on trolleys in corridors, they simply removed the wheels from the trolleys and reclassified them as beds. The targets were met, but the underlying performance didn't change one iota. Mangers being managers the world over, the same is likely to happen here. It's a general problem with this sort of empty managerialism and obsession with statistical targets: the statistical goal - measured patient "waiting time" - ends up taking the place of the real goal - patient care. And doctors and nurses end up spending all their time filling in performance spreadsheets rather than doing what they're supposed to be doing: seeing patients. In business, that would simply be amusing. In the health sector, it is likely to be deadly.

Rather than clinging to the dead 80's cult of managerialism, National should target the real problem: lack of resources. The reason people have to wait so long in A&E is because hospitals cannot afford to employ enough medical professionals to deal with demand. The reason they are parked on trolleys in hospital corridors is because there is not enough space. But solving these problems would cost money, which National would rather give to the rich in tax cuts. It's just a question of priorities - and National clearly rates redistributing wealth to those who need it least well ahead of ensuring that every kiwi has decent access to healthcare. So instead, we get statistical games and another three years of excuses, while people wait in pain. Thanks, National!