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One in 10 hospital nurses asked to fiddle waiting time figures


Forty per cent of nurses believe their colleagues are involved in helping to meet waiting time targets by underhand means, often referred to as ‘gaming’.

And one in 10 hospital nurses say they have personally been asked to engage in gaming to help meet waiting times this autumn.

The figures are revealed as part of Nursing Times’ investigation into pressures on the front line, which included an online survey of around 600 acute sector nurses.

There have been long-standing concerns about trusts fiddling the system to meet the Department of Health’s “operational standard” that 98 per cent of patients should spend four hours or less from arrival at A&E to admission, transfer or discharge.

Nottingham University Hospitals Trust was forced to apologise last month after admitting it had altered figures to meet the target.

Doctoring of figures, with incorrect discharge times being recorded for patients nearing the deadline or altered later, was one of the most common examples of gaming cited in the survey.

One said: “I have witnessed other colleagues altering times of patient leaving A&E department, so they do not breach, but I will not take part in this myself.”

Other examples include patients being temporarily moved from A&E – for example, to observation areas, corridors and in one case the theatre recovery ward – and patients being unnecessarily admitted to mixed-sex bays or sent to specialist wards without being seen by a doctor first.  

One respondent said part of their A&E department had been re-badged as the “clinical decision unit” and was no longer deemed part of A&E.

The Nursing and Midwifery Council warned that nurses would be in breach of the code of conduct if patient safety was put at risk as a result of gaming. NMC chief executive and registrar Dickon Weir-Hughes told Nursing Times: “Nurses and midwives should never be pressured into acting in a way that could cause them to breach their code.” 

He said those concerned that gaming was taking place should inform their senior manager or nurse director, and warned: “Senior nurses could be putting their registration at risk if they fail to make the care of people their first concern,” Mr Weir-Hughes said. 


Readers' comments (6)

  • 'Gaming' is common practice in health care today and I would argue that one in ten is an exceptionally small number compared to reality. I am an avid supporter of the 4 hour standard as I have seen the state hospitals got in to (especially A&E departments) prior to its inception. What the government has failed to do is rather than looking at demand and processes to see if it is even feasible to meet the 4 hour target, it has regimentally insisted the target be met. There has been very little robust research to look at the quality of care delivered in A&E departments since the 4 hour standard was implemented. This needs to happen before the target culture can be challenged.

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  • Ruth Spellman

    Fiddling waiting time figures in A&E departments is another example of what staff can be driven to, in cases where targets are put before people. This latest report suggests that, in some cases, the pressure NHS staff are under to meet the four hour waiting time target imposed by the Department of Health, is leading to a rushed job. The situation is compounded by the increased pressure on all public services to deliver, as budgets grow ever tighter.

    Too much attention on targets can stop people focusing on what is really important. It is the responsibility of managers to look after people (in this case, staff and patients) first, targets second. Poor management and ambitious targets encourage staff to cut corners. In the case of healthcare professionals, the mad dash to meet targets is to the detriment of adequate and appropriate levels of patient care. The NHS is well-known for its target-driven culture, yet surely this latest story could be the one that motivates managers to take decisive action?

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  • Fiddling targets is nothing new under the John Major government we had Waiting List Initiative in orthopaedics but they were less stringent so we did lots of simple day case stuff and the occasional proper op but it meant the trust could turn round and say they had done so many ops, since 2003 we have had a CDU where patients waiting for a clinical deision can be placed off the main A/E and drop off the 4 hr target even if it takes 10 hrs and this not Trusts being devious this is from Whitehall so DoH can't be suprised if they provide a loop hole managers will use it! i have not seen staff fiddle the figures but when the senior staff have to account for the breaches on their shift to senior mangers and graphs and performance figures appear weekly on the walls then you can see why they might be tempted and why many are leaving, I for one am glad to be a grunt at times in this day and age

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  • This is a common practice where I work (A&E). The staff are all pushed so hard to meet the 4 hour breaches that sometimes, even often, the patient is just shipped off somewhere else before they are stable. Even when the patient does breach, mysteriously the next day when you look at the list from the day before, the patient will be shown as leaving the dept at 3 hrs 59 minutes - even if in reality they were taken off the computer at 4+ hours. It makes a mockery of the whole system, how can we possibly show that we're drastically undertstaffed and underequipped when all the 'fudged' figures show that we're meeting 98% of our 4 hour breaches, where in reality we're not even close?

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  • I work in the Countess of Chester A&E and since 2004 the senior managers and directors constantly pressure all staff to 'click' patients as discharged or transferred out of A&E before they breach the 4 hour target. The NMC need to home in on the senior managers and not those on the shop floor. We try to work within our Code of Conduct, but reality is that it is not worth the hassle you get from the work place if you do not tow the party line.

    The DoH need to wake up and smell the coffee - of course Chief Executives and senior managers will stop at nothing to fudge the figures if it means them collecting the pennies/rewards for meeting 98% targets.

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  • My father in law was about to breach the four hour rule while in A and E.. He has COPD and had been admitted in a very poor state!! All of a sudden the cubicle door opened and in rushed two porters to take him to x ray. The grabbed the trolley and hurtled at breakneck speed round the corner with someone shouting "whatever you do dont put him back in that cubicle"
    My mother in law and I had to gather his things in such a hurry and run after him but he had gone!
    By the time we caught up with him after we had been left sitting in x ray for 40 minutes he was up on the assessment ward!! No one gave thought for where we were!! It was a case of get him out of there as fast as possible!! I have been a nurse since 1974 and and I know lots of targets are fiddled!!
    I feel however that we have lost sight of our main aim and that is caring for the patient!

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