Who are the NHS really cheating?

There was a article this week that made me laugh out loud. You can read it in full here. But I will quote from two paragraphs near the end.

The survey found more people than in previous years believed they were listened to by doctors and nurses. But waiting times were longer. The proportion saying they stayed in the emergency department for no more than four hours fell from 77% in 2004 to 73% in 2008.

This might appear to show widespread flouting of the government's target for the waiting time in A&E to be no more than four hours for 98% of patients. But the [Healthcare Commission] said trusts often moved patients from A&E into a nearby "admissions unit". Patients might not be able to tell the difference in location, but time spent in an admissions unit did not count towards the four-hour target.

There is so much wrong with this situation. Error upon, incorrect assumption, upon invalid method.

Let's start at the beginning. Firstly, the practice of using surveys to find out of your service is performing well is deeply suspect. I read a report to say that customers who report that they are satisfied on surveys are just as, if not more likely to defect to another company than those who said they were not satisfied. Why? Well because more people want the survey to be over as quickly as possible and if they had bad service and were thinking of leaving why would they want to give the company more time than they needed to. Obviously with A&E you don't get too much choice about using someone else. But the principle of using surveys is still flawed.

Secondly, the article quotes a statistic that waits more than fours hours fell from 77% in 2004 to 73% in 2008. Where is the understanding of variation? Maybe both those figures are within the predictable range and nothing has changed. The four per cent difference might simply be from common cause variation. We can't know from the figures as presented.

Thirdly, the fact that they have a target of no wait being longer than four hours will be causing problems and in fact longer waits. We know that it is causing them to cheat since the commission itself explained that hospitals more people from A&E to "admission units" to avoid going over the four hours. And the "patients might not be able to tell the difference". Of course they can't. Waiting in one room is the same as waiting in another room and even more annoying if you have to get moved half way through. So even though they should not have the target in the first place, the Healthcare Commission is condoning the cheating that the target causes in order to meet the target. And the big laugh is they are still not meeting the target. We could speculate that the resources need to have an "admissions unit" and move people to it, might be better used in the A and E department.

And if you read the rest of the article you will see that 9% of people who asked for pain relief never got it.

Ouch!

Best,

Rob