NHS targets need to follow ‘whole journey of care’, advises Sir Harry Burns

Targets - credit Justin Ladia

Current NHS targets in Scotland are too fragmented and need to follow patients to improve the whole system, a new review has recommended.

Currently the NHS has a series of national performance targets, as well as specific ones around waiting times for treatment and referral, and discharge from hospital.

The health and care targets review, led by former chief medical officer Sir Harry Burns, said a different approach is necessary.

Targets should better reflect the overall quality of care people receive, it recommended.

“The present system of targets and indicators is fragmented and many of the indicators do not lend themselves to effective improvement interventions,” it said.

Speaking at the report’s launch, Burns said: “If we really want to understand why some parts of our system appear to function better than others, we need to look across the whole journey of care, not just take a snapshot of isolated bits of it. Health is the product of a complex system and we should measure how we manage it appropriately.

“At present, much of our attention is given to how long people wait to get into hospital. If we are to improve health and wellbeing, we need a better understanding of what makes them ill enough to require hospital care in the first place and we also need to measure the outcome of that care.”

Health Secretary Shona Robison said current targets, such as for cancer treatment, A&E, and the Treatment Time Guarantee, will remain but be “informed by the principles” of the report.

“Targets and indicators have an important role in giving people clarity on what to expect from health and social care services, and in monitoring performance across the country,” she said.

“But they can never be an end in themselves. To be clear, the targets will remain in place, but Sir Harry’s report is absolutely right that we must shift the emphasis to ensure we have a more sophisticated approach which helps drive improvements in health across the population.”

Dr Peter Bennie, chair of the BMA in Scotland, welcomed the report.

“The BMA has warned for some time of the risk that inappropriate targets can skew clinical priorities and those concerns are reflected in this report,” he said.

“Decisions over the treatment of patients should always be based solely upon clinical need. While there is important information that targets and indicators can tell us about how well the NHS is functioning, there needs to be more maturity about how we respond to such information.”

Scottish Conservative health spokesman Miles Briggs welcomed the report but said it should not used by ministers to “rip up” targets that have failed to have been met.

“These recommendations should give all our medical professionals the time and confidence to deliver the world class health care we all want to see,” he said.

“Scottish Conservatives have long advocated a shift in our health services to outcomes based approach and I hope Sir Harry Burns’ Report will be fully implemented by Scottish ministers.”

Scottish Labour's health spokesperson Anas Sarwar said the report had been set up in an attempt to scrap targets.

“The SNP’s response to consistently failing to meet patients’ standards was to set up a review in an attempt to scrap them,” he said.

“Shona Robison needs to recognise that resource isn’t meeting demand and that her workforce crisis is what is causing patients and staff to be failed.”