A recent study has found that hospitals in England are prioritizing patients based on targets rather than clinical need, potentially compromising patient safety. This behavior, known as “gaming” the system, is driven by the pressure to meet national performance targets, such as the 18-week referral to treatment standard. The study, conducted by researchers at the University of Birmingham, analyzed data on treatment waiting times for all non-specialist acute NHS hospital trusts in England between January 2016 and September 2021.
The findings revealed a spike in treatment around the target threshold, indicating that hospitals prioritize those patients closest to meeting the target. This leaves patients who have waited the least or longest times at a disadvantage. The proportion of NHS hospital trusts meeting the 18-week target has also worsened over time, falling from 92% in 2015-16 to 64% in 2021-22. The removal of financial sanctions for missing targets in 2016 led to a decrease in the proportion of patients seen within 18 weeks, and the COVID-19 pandemic further exacerbated this issue.
The researchers suggest that hospitals close to meeting the target are motivated to clear it, while those further away may not make the same effort. This can lead to distorted clinical decision-making, where patients are chosen based on the target rather than clinical need. The study did not explore the underlying triggers and motivations behind this behavior. The researchers recommend policymakers to carefully design targets to mitigate these threshold effects and ensure that clinical need remains the primary consideration.
In related news, the NHS has recently reduced the number of cancer waiting time indicators from ten to three. This decision has sparked concerns about the potential impact on patient care. Nigel Edwards, CEO of the Nuffield Trust, highlights the unintended consequences of targets, citing the Mid-Staffordshire hospital scandal as an example. He emphasizes the importance of a balanced approach that considers outcomes and involves those responsible for delivery. Targets should not overshadow the broader understanding of healthcare issues and the promotion of a caring culture. The NHS spokesperson has reassured that treatment priority is determined by clinical needs and the length of wait, and the NHS has plans in place to reduce the COVID-19 backlog and improve wait times.
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