Staff in some hospital accident and emergency departments are threatening the safety of seriously ill or injured patients because of pressure to meet government targets limiting casualty waiting times. BMA targets put very ill at risk, 'The Guardian', 14 March 2005When government does get round to targeting outcomes (rather than giving taxpayer funds to favoured agencies or activities), it most often chooses Mickey Mouse goals. So in the UK, rather than target broad indicators of health, the Government has promulgated a panoply of micro-targets, such as the percentage of patients seen through hospital Accident and Emergency departments within four hours. Somebody in the Government has decided that this figure should be 98 per cent by the end of this month. One result is that people with serious, urgent conditions have to wait for treatment so that those with relatively minor conditions can be seen and discharged. This is especially so as the end of the 'four-hour envelope' approaches.
What effect does this have on patients? A quarter of hospital consultants surveyed said the care of the most ill patients was being compromised; 40 per cent said patients were being discharged before their condition was adequately assessed and stabilised, and half believed people were being rushed into inappropriate wards so that they would be wiped off the casualty unit lists. To comply with the government targets some departments simply redesignated beds within their units as separate wards.
This sort of nonsense is typical of governments when they try to outguess the market. Under a Social Policy Bond regime, a government would set meaningful, broad goals, rather than a range of easily measurable but irrelevant micro-targets dreamed up by a handful of middle-level bureaucrats with little capacity or incentive to see the whole. Instead of costly, intrusive and ultimately counter-productive monitoring of useless pseudo-objectives, a bond regime would target broad outcomes, such as infant mortality, or quality-adjusted longevity. The market would then decide how best these can be achieved. Markets are better than bureaucrats at allocating resources; they are far more responsive to particular circumstances and events than government agencies. Government should stick to what it is good at: representing and articulating the wishes of its constitutuents, rather than trying to micro-manage its way to re-election.