NHS targets pile on the pressure

Insiders believe NHS finance directors are suffering from an overwhelming pressure to fiddle with statistics to meet stringent performance targets, following the political push to improve the NHS.

Bettering the performance of the NHS is about as near to the top of the political agenda as it gets. Prime minister Tony Blair has solemnly pledged to make reforms to the NHS that will create a smooth, efficient and accountable healthcare machine.

Should Blair fail to deliver on his promise by the next general election, it could easily leave him with enough egg on his face to lose his job, and possibly lose Labour its majority vote.

The reform process has so far taken two stages. First, a cash injection was needed. Raising taxes was out of the question, so chancellor Gordon Brown last year announced a rise in national insurance of 1%.

This will bring in £8bn a year from 2003. In this year’s Budget, chancellor Brown claimed there would be 80,000 more nurses and 25,000 more doctors by 2008.

Secondly, the NHS needed benchmarks with which to measure its performance.

The government specified targets for waiting times, hygiene, number of cancelled admissions, staff environment and so on.

A system of ‘star ratings’ shows individual hospital performance on each area and makes it possible to compare hospitals. NHS finance directors supply the figures for the star ratings to the health authorities.

While the benchmarks are stringent, ministers have also developed a financial allocation system, meaning that if a hospital fails to meet its star rating target, it can either lose funding or get a bigger target for cost reduction.

This increases the emphasis on meeting targets.

Ian Perkin, former finance director of St George’s hospital in London, believes this is putting an insurmountable pressure on hospital management to present positive figures.

The real worry, he says, is that the health service is reaching a point where there may be no acceptable reasons for failing to hit targets.

Perkin believes if this happens, managers, including finance directors might prefer to fiddle the figures rather than risk the consequences if they don’t.

‘You’ve got to change the culture so that people can occasionally put their hands up and say: “Excuse me, but there are valid reasons why we can’t hit the target,”‘ he says.

Former health minister Lord Hunt took a strong view on fiddling statistical information for star ratings. ‘The department of health finds fiddling unacceptable. Where deliberate misrecording has been found, people have lost their job,’ he told Accountancy Age, days before resigning over the Iraq conflict.

During Hunt’s reign, health secretary Alan Milburn emphasised the importance of the existing whistleblower policy, and launched a new helpline in a bid to end the ‘secret society’ culture. He urged people to speak about misconduct and mismanagement, and promised that ‘whistleblowers were now protected in the NHS’.

But recent examples of whistleblowing have portrayed a different image.

In real life, people have good reason to fear that the whistleblower loses his job, not the fraudster.

In October 2001, Perkin believes he came across a problem at St George’s Hospital in Tooting. The issue concerned cancelled surgeries, a key target where St George’s had been under-performing.

Perkin’s concern involved the reporting of zero-cancelled surgeries on a form to the health authorities, instead of the 23 cancellations that had been recorded in the hospital’s books. He alleges that he found inaccuracies in previous weeks and raised the matter with the board of the hospital, insisting that they report the truthful statistics to the health authorities.

The hospital admitted faulty reporting and said this was ‘partly due to a computer glitch and partly due to not properly analysing the data’.

Perkin, who had worked with the hospital for 16 years, was fired from his job in July 2002. The hospital has denied it unfairly dismissed Perkin.

He has started a legal procedure to be reinstated to his £100,000 a year job. This week, the eight-day hearing began at an Employment Tribunal in South London. The judge is expected to reach a decision in the case on 1 May.

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