Memorandum by The Society of Radiographers
(PST 16)
In response to the question about how public
service targets assist in producing useful management information
and ensuring public accountability, the Society believes that
it depends on whether the whole service is being measured or just
selected part of it. For managers to be well informed about how
a hospital department is performing, many factors need to be taken
into consideration. The issue of reducing waiting lists may mask
a number of other factors, such as breakdown of specialist equipment,
reduction in staffing levels and referral to a further outpatients
appointment. There are many specialist radiology departments,
which have managed to reduce waiting times at the expense of the
health and safety of their staff, who are working more intensively,
under greater pressure and often without necessary health and
safety safeguards.
Similarly, the public need a fuller and more
rounded picture—it is no good stating that waiting lists
are reduced if the satisfaction of the treatment or diagnosis
is adversely affected because the appointment time was cut to
the quick.
Radiographers and other healthcare specialists
provide a service that is both qualitative and quantitative. Therefore,
to measure quantity (eg throughput times) without also attempting
to measure quality is a very blunt instrument indeed. In fact,
the very process of reducing waiting times may in itself prejudice
quality, in that the practitioner is working to such a tight timetable
that they have only a limited time to spend with each patient.
We believe that it may be best to measure outcomes
as well as outputs, but only if these covered a broad range of
issues, not just the current ones. If the government were to introduce
further methods of measurement, the Society would expect to play
a full part in the process of deliberation, in order to avoid
the introduction of further crude measures. Such measures can
only serve to destroy morale and motivation among key health service
workers and serve as a way to harm the public's trust of such
workers.
I believe that the public is extremely intelligent
about the use of statistics and are well able to come to roughly
the same conclusions as outlined above, which may explain why
people are cynical about waiting list reductions, but not about
reduction of greenhouse gases, which is largely quantitative in
nature.
The Society believes it would be helpful for
the government to publish an across the board evaluation of how
well it has performed against its targets. It would be perceived
as only fair that the government should be fully accountable,
when it is asking the public sector to be.
We are not sure that the targets and league
tables do in practice give the public greater choice: to learn
that one's local trust is not meeting its waiting list target
gives little information about quality of care and the situation
may well be that the patient has no choice at all but to attend
an apparently "failing" organisation.
We are clear that professionals should be consulted
about targets and the types chosen. It seems well known that on
occasion, patients are treated because of the target rather the
need. This is not only poor practice for patients, it is extremely
demoralising and insulting for professionals.
Choice of targets is not easy. Central to the
issue is what use is made of them. If trusts/other organisations
are so fearful of the consequence of not achieving, one result
may be creative reporting, another diversion of effort away from
the real priority. A system of trust needs to be built first,
then joint objectives agreed, which may differ in different parts
of the country and in different services.
The Society and College are pleased to have
been asked to offer a contribution and will be most interested
in the outcome of your inquiry.
Ann Cattell
Chief Executive Officer
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