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Chasing targets – care cannot be delivered by numbers

The push to meet staffing levels is proving costly and will do little to drive up long term quality of care for patients

The NHS is currently facing a serious, nationwide shortage of qualified nurses. Worrying figures published last month by Nursing Times show that fewer than nine out of ten hospitals are meeting their own nurse staffing targets.

Good nursing is the backbone of the NHS. Experienced nurses working tirelessly at the front line provide a crucial role in ensuring patients receive safe, high-quality care. These latest figures are of major concern to those of us who see the human cost of under resourcing on a daily basis.

I spent ten years working as a nurse both in accident and emergency and on cardiology wards. Towards the end of my nursing career I experienced the targets culture first-hand and fear that, as important as ensuring adequate nursing levels are, hospitals’ focus on getting the numbers up will prove counterproductive. The danger is that by focusing too heavily on achieving required staffing levels, hospitals will fail to tackle other more critical areas where they are falling short, namely the need for good, consistent management, staff training and the provision of quality care.

Historic cuts in the number of nurses being trained are now being felt and added to this, experienced nurses are leaving the NHS in droves. As a result hospitals are being forced to recruit from abroad and use agency nurses to fulfil quotas. This is both a costly and a temporary fix with some agency nurses costing up to £1,800 per day per nurse and many of those drafted in lacking experience working in a hospital setting.

Targets, whether they relate to staffing levels, waiting times or other outcomes are meaningless in a healthcare setting and are part of the problem for the NHS, rather than the solution.

Targets were brought in by the Blair government in order to tackle some of the negative impacts of long-term underfunding of the NHS. Back in 1997, there were long waiting lists and patient outcomes that compared poorly with other countries. Imposing targets was part of a package of reforms to the health service, aimed at improving performance. The measures were brought in with good intentions and there have been some tangible benefits, however there have also been many unforeseen consequences that have been damaging to our health service. There is evidence of some people gaming the system and in some cases misreporting data to avoid sanctions. In my experience working in nursing, it was clear that the target culture brought out the worst in people and did nothing to inspire nurses in a profession already suffering from low morale.

The targets went hand in hand with constant management restructures that saw senior nurses repeatedly reapplying for their jobs and cycles of mass redundancies followed by mass recruitment. Many of those making the decisions were non-clinical staff. These managers don’t understand the demands placed on healthcare professions and in my experience are unwilling to consult doctors and nurses when taking major management decisions. These changes frequently destroyed management systems that had been working well and added to disillusionment amongst nurses. Whilst poor pay has always been an issue in the profession, nurses never went into the job for the money. It has been the top-down, target driven culture that has contributed to many deciding to leave the profession altogether.

Good coordination and proper, stable and collaborative management of nursing staff is far more important than driving up numbers, as are the promotion of good practice and care. We need experienced and motivated nurses who are not just doing what they are told and following procedures but are using their experience to anticipate problems. They need to have the time to demonstrate compassion towards those in their care rather than being taken up with box ticking exercises.

In one case I have acted in, a patient bled to death because whilst a nurse was dutifully reading and recording a blood pressure chart as she had been asked, she didn’t understand that the pattern being plotted meant the patient was bleeding and action needed to be taken.

Our nurses carry a great deal of responsibility and are central to ensuring good outcomes for patients. Well managed, well resourced, quality healthcare from trained and motivated professionals is what we need in our NHS and I do not believe that targets are the way to achieve that outcome – care cannot be delivered by numbers.