Nine years ago I audited the records of my diabetic patients whom I had referred to see a hospital consultant. I was shocked to find that half of them had not been seen – and these were elderly, housebound, highly vulnerable patients over whom I had concerns ranging from sight loss and nasty ulcers to suspected mini-stroke (TIA).
So the fact that the majority of patients are now seen and treated within 18 weeks is a huge improvement. Yet the NAO report on inaccurate reporting of waiting times casts a shadow on the reliability of the figures, leaves patients doubting the validity of published data on which they have partly based their treatment decision and compounds doctors frustration over their loss of discretion to who to treat first.
This is an independent audit and whilst some errors can be genuine, that can’t account for the 25% of data found to be falsely recorded. In the old days, this is the kind of fiddling that the local Community Health Council would have uncovered. Sadly they now take the emasculated form of Healthwatch, bodies which are under funded and left to react to news stories rather than undertake any proactive monitoring and scrutiny. The Department of Health refute the NAO’s numbers, but the NAO is an independent body reporting the facts as they find them. It might be politically inconvenient but it’s also a politically driven target. Waiting lists had already fallen significantly in the early naughties as independent sector treatment centres (ISTCs) were commissioned to undertake more procedures and bring down the long delays experienced by patients between referral and operation. 18 weeks was brought in as the target referral to treatment time in 2008, along with 100 pages of guidance. It was one of the targets retained by the coalition government.
So, what to do? Well yet again this is another reason we should all have integrated, personal electronic health record (PHR). Not only could a referral date not be disputed, but the patient would know exactly what was going on, all correspondence would be visible and obtainable, and manipulation would be prevented or visible by the electronic audit trail. NHS Choices says that if you wait for longer than you should, the ‘NHS’ should do something about it. It would help having the proof at your finger tips, but really, if there isn’t a named patient advocate, then is anything really going to change? And the patient reviews on the site don’t include anything about waiting times, so if we are relying on the hospital’s own reporting system, why would they want to jeopardise the CEO’s job with revelations about missed targets?
I think we all understand the value of targets. I know they are a useful measure for politicians and the public alike, but they also produce some perverse behaviours. Anything that needs 100 pages of guidance is not fit for purpose – and the manipulation of figures revealed today indicates an intelligent review is urgently required.