It was always going to be interesting to see how the Coalition government would live with this pledge.
Over the last weekend, just prior to its conference, the Royal College of Nurses published a survey of its members reflecting their experience of patient waits in A and E. Their President was on the airwaves saying that the progress that had been made on speedier and better working with A and E patients was being lost as more were being treated on trolleys.
The Government Minister replied that “action would be taken against hospitals” who, in some unspecified way, failed to treat patients in A and E well.
Readers may remember that there was a target of a 4 hour wait for 98% of patients in A and E.
Most will also recall how between 2001 and 2006 – when this target was achieved – many clinical leaders were attacking the very idea of there being such a target.
It was during these years that Andrew Lansley worked out, with those clinical leaders, his line against ‘politically motivated targets’. It all seems a long while ago – when most medical leaders took up rather different positions from those they do now.
It is interesting, going through the BMA press releases now, to note how often they attack the Government for failing to meet targets that they themselves had said were wrong in the first place.
In the light of the politics of the recent Health and Social Care Act, and the belief of so many that the Secretary of State (a politician) should remain responsible for the NHS; it’s interesting to raise the question of exactly what is meant by ‘politically motivated targets’.
In my own experience of the 2001 election, the Labour Manifesto, and the immediate aftermath of that election when I started work in the DH, political motivation was very simple.
The question that had to be asked and answered was – Were maximum waiting times for operations and A and E treatment what the public wanted?
The answer was always crystal clear. Long waiting times specifically, and access to services in general, was the main concern of the public with regard to the NHS.
To that extent targets were indeed ‘politically motivated’.
To that extent it was correct to set such targets for a service that was paid for by the public out of their taxation and where they had a right (politics) to have what they collectively wanted. This wasn’t a slight whim on the public’s part. It was what they asked for year after year after year – and what they felt they were paying for.
What was interesting was how some staff in the NHS felt it was a really bizarre thing to worry about. Time and again the Government would be attacked for imposing these targets. Yet we knew that this was the prime thing the public wanted from the NHS.
It may have looked like a fierce debate was talking place but the experience that we had was of receiving an instruction from the public and, through the manifesto, a requirement to get this done.
So what intrigues me is how the Coalition Government by ‘abolishing politically motivated targets’ such as the 4 hour maximum wait at A and E have now managed to rehabilitate the idea and practice of targets within elements of the NHS itself.
The public have never been in doubt. They have been constant. Maximum waiting times have always mattered to them in the past and if they increase it will matter to them once again.
And yes, listening to the public is after all what politics is.