Ludicrous

The Accident and Emergency (A&E) departments in English hospitals have to ensure that 98 percent of patients transferred or discharged within four hours. If they fail, they are subject to financial penalties. One result is that, since these targets were imposed, more patients are transferred to hospital wards 'just in case'. This is costly in resource terms, but it benefits hospitals who receive as much as £1000 per admission, compared with about £100 for a patient treated in A&E. And, as The Times puts it:

The increase in admission through A&E could have another explanation, apart from the four-hour target. To admit more patients is greatly in the financial interests of hospitals because under payment by results they get paid much more. Using the system in this way is called “gaming” within the NHS and is frowned upon.

This the sort of nonsense that happens when a government imposes Mickey Mouse micro-targets. The letter of the intent is strictly adhered to; the spirit is ignored. I do agree that we need some sort of target for government funds, but such targets must be broad and meaningful to ordinary people. A&E throughput rates are irrelevant to the health of the population; if government is concerned about health then it should target health. Of course, defining health and measuring it is more difficult than measuring the length of stays in A&E departments, but with sufficient ingenuity - of the sort that is currently applied to gaming the system - it can and should be done.