Target culture for backlog could lead to tragedy – former health secretary

Jeremy Hunt was the longest serving health secretary in Britain.
Former health secretary Jeremy Hunt has warned against a ‘culture of targets’ in the NHS (PA)
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Ella Pickover6 October 2021

Putting pressure on NHS managers to tackle the backlog of care could lead to a “bunch of horrible tragedies” like the poor care witnessed at Mid Staffordshire NHS Foundation Trust, the former health secretary has warned.

Jeremy Hunt said that it was important not to go back to a “targets culture” as he referenced the poor care at the trust which led to a public inquiry.

The inquiry highlighted “appalling suffering” of patients treated at the hospital where managers and leadership were focused on meeting targets and did not listen to concerns of staff and patients.

The unintended consequence of breathing down the necks of managers and senior clinicians across the whole system was that we had a targets culture which meant that sometimes numbers were more important than people.

Jeremy Hunt

On Tuesday, it was reported that current Health Secretary Sajid Javid is preparing new powers to seize control of poorly performing hospitals and sack managers who fail to clear NHS backlogs.

But leading doctors slammed the claims, with the British Medical Association warning that it is “dangerous and unacceptable” to blame NHS management for the backlog – which now stands at a record 5.6 million people in England.

In a speech to the Society of Acute Medicine conference in London Mr Hunt said that the advice he would offer to new health secretaries was not to revert to the same “targets culture that was put in place at the same time as we had the last big government initiative to deal with the backlog which was in the 2000s”.

He continued: “I think that the Blair/Brown government was absolutely right to tackle waiting lists – it needed a lot of money, it needed a big political push, and I think the NHS was better at the end of that period as a result of that extra investment.

“But the unintended consequence of breathing down the necks of managers and senior clinicians across the whole system was that we had a targets culture which meant that sometimes numbers were more important than people.

“And the unintended consequence of that was Mid Staffs, and a whole bunch of other really terrible scandals which I had to deal with the aftermath of when I was health secretary.

“I think it’s very important that we don’t unlearn those lessons so we have in 10 years time having another health secretary having to deal with another bunch of horrific tragedies.”

Mr Javid told the Conservative party conference on Tuesday that his priorities are “Covid, recovery and reform”.

“Covid – getting us, and keeping us, out of the pandemic; Recovery – tackling the huge backlog of appointments it has caused; And reform of our health and social care systems for the long-term.”

Mr Hunt also warned that the backlog may not be tackled simply by outsourcing work to private hospitals because they may draw consultants away from their NHS work in doing so.

He told the meeting: “When we’re trying to bring down the backlog…. if you signed contracts with independent sector hospitals to do a whole bunch of other operations, and they will willingly sign up to those contracts but they might then get that capacity by sucking in more consultants from the NHS, which means the NHS then misses its targets for its core waiting list work.

“And so you don’t actually end up with an overall increase in capacity.”

Meanwhile Mr Hunt also said that more must be done to sure up the NHS workforce.

He said that he “regretted” not meeting his target of getting 5,000 more GPs into the system.

Family doctors have been under fire over the proportion of face-to-face appointments in general practice.

Experimental data from NHS Digital shows 58% of GP appointments were carried out face-to-face in August, the first full month since most legal restrictions were lifted in England.

The data shows that before the pandemic in August 2019, 80% of appointments were carried out in person.

Meanwhile the data shows the proportion of telephone consultations rose from 14% in August 2019 to 38% last month

Mr Hunt said: “I think it is very tough at the moment for GPs and they are doing more consultations than they were doing pre pandemic.

“And the number of face to face consultations has dropped From 80% to 60%, but they’re doing a lot more volume wise.

“The real solution to this is to increase the capacity of the system with more GPs.”

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