Current Scottish NHS targets “measure the wrong things” and “waste precious resources”, according to the Royal College of Nursing, which today set out new principles for assessing results.
RCN Scotland’s report calls for a different approach to judging the success of NHS services based on patients’ needs and the outcomes that really matter to them.
The report comes a day after ministers announced a review of health service targets in Scotland.
“Over the past year there has been an increasing awareness that NHS targets need an urgent overhaul,” said RCN Scotland direct Theresa Fyffe. “They measure the wrong things, often skewing clinical priorities and wasting precious resources.
“The vision put forward by the RCN today champions an outcomes-based approach which delivers for individuals and respects clinical judgement,” she said. ”But it also acknowledges the importance of public accountability and the rights of patients.”
However, she acknowledged moving away from current targets – often based around hospital performance – would require a “transformational change” in policy.
This would include moving away from simply measuring waiting times for services. The report uses the example of an elderly woman who has been discharged from hospital after a fall.
“Scotland needs to change its understanding of success in health”
Under the current system, she could expect an appointment with her GP and possibly an outpatient appointment within a certain time.
However, her priority is to be able to get out to the shops and see her friends, which could be achieved through regular home visits by a nurse to provide practical care to help heal her leg and advice on pain relief.
“A waiting time target will not empower her to regain her good health and wellbeing or claim her right to health,” stated the report, which said the NHS and others need to prioritise more “personal outcomes”.
The report called for the development of a national outcomes framework to help set key priorities for health and care services.
This should be developed with the “full participation” of the public, and health and care professionals across the public, private and voluntary sectors, said the RCN document.
Once the framework is set, the next stage would be to come up with a “small set” of new national indicators for health and wellbeing.
The report also said clinicians, such as specialist nurses, should have a key role in defining measures of success as part of expert networks that would also include people who have experienced particular conditions.
“If adopted these principles will move Scotland away from targets, which focus on hospital process and tiny changes in performance, which drive investment in acute services,” said Ms Fyffe.
“They will instead focus attention on what’s best for patients clinically and then measure how successful treatment and care is,” she said. “Scotland needs to change its understanding of success in health, and quickly, if people are to live longer, healthier, happier lives at home.”
The Scottish government announced yesterday that it will hold a review of national NHS targets.
An expert group will be set up to lead the review, working with staff, stakeholders, social care and clinical bodies.
It will examine a range of national targets to ensure they are continuing to deliver better outcomes for patients as well as making best use of NHS resources.
It will also look at how target setting aligns with the government’s strategy for the future direction of NHS and social care services, in the context of the existing outcomes and indicators for health and social care integration.
Health secretary Shona Robison announced the review, which will publish in 2016-17, as she opened the first health debate of the new Scottish parliament.