in nhs dentistry the same thing has happened and the police. targets have become more important than people,sevice, qulaity of care and out come. they shouldnt of attached finaical incentives to these things they should of just monitiored them.
As an nhs dentist if i need to reapi one filling i would get target points which would take 5 mintues and if a [teitn need ed 3 large fillings this would take over an hour with the patient yet the practice would still eranr only 3 target points. target points = £'s. so what the goiverment are saying is i can earn more if im selctive about my treatments. And this is what a proportion of nhs detnsits are doing by not offerring certain procedures becasue there too expensive on the nhs. This target driven system is possibly at odds with the hippocratic oath of do no harm!

amit hindocha, leciester, uk

My wife broke her foot a few weekends ago. She was triaged quickly, then X-rayed and seen by a doctor within what was considered to be a very acceptable time. She needed to be strapped up and return the next day for plastering.

We waited and waited for ages before a very junior nurse came to strap up her foot. Around 90% of the work had been completed quickly but the system did not respond to complete the interim treatment. Instead of getting us out the door as soon as possible, job completed, the culture appears to be that not only is the 4 hours a maximum but also almost a minimum.

Richard, west midlands,

Band 1 NHS Dental treatment 15.90 covers exam, xray, 1 filling, 1 extraction, scaling
Band 2 NHS Treatment 43.60 covers more fillings, root canal treatments, more extractions that are not covered in band 1
Band 3 NHS Dental treatment covers 1 to 32 crowns, dentures, bridges in addition to everything in band 2.

WHO'S IDEA WAS THIS?

NULABOUR.

IDIOTIC GORDON BROWN AND HIS CRONIES.

And his minister Anne Keen says everything is hunky dory in NHS Dentistry.

Dont blame dentists for deserting NHS.

Genco Abbandando, Naples, Italy

I am pleased a quango has identified this - it must be true! My consultant physician colleagues have known from the outset what distortions the 4 hour target has caused. A common example is the patient being transferred from A/E during the first interview with a doctor - if he/she has had to go and answer a phone /visit the loo etc. On return no patient ! - might have breached the target. I can assure you all we are currently dealing with a raft of new silly targets - but lets wait until another official " body " picks it up! Seasonal best wishes!

Andrew, Kent,

I work in A&E as an emergency nurse practitioner and have done so for 20 years. Yes patient 's are admitted to prevent a breach of the 4 hour target, usually because test results are not available or specialists cannot see them within the 4 hours or high workload/sick pts.

But where would you rather wait for 6-8 hours? on a trolley in a corridor, in the waiting room in pain? or in a bed on a ward?

Before the 4 hour target there was no incentive for Trusts to sort out the long waits in A&E, then the complaint was long waiting times in an unsuitable environment.

I am proud that my A&E delivers a high level of care for the vast majority of patients within 4 hours, but that is because we are on the whole efficient, have good processes for starting investigations early and work together as a team with other specialties.

As for ambulances not unloading patients, this is because there is NO room inside the A&E to safely provide care, so again where do you want to wait?

Andrew Carr, Cambridge, UK

Wow! If Gordon thinks he has a chance, he'd better read this lot. I am too an ex-teacher who got fed up with paperwork. Please stop people voting fo him, AND Cameron the whizz kid. His lot are just as incompetent. Lets give the Libdems a chance, they couldn't be worse than the last 20 years of Tory/Blair/Brown sleaze and mis management. As for going to war in Iraq - no wonder he became a Catloic so he could go to confession and be absolved for murdering a million Iraqis!!

Peter Groves, Surbiton, Surrey, UK

Patients admitted to hospital simply to hit targets.
What a waste of money, why cannot they practice in their local parks or some other open area

stanley, haifa ,

as an Ex- a&e dr and now a GP, the above is one of the many reasons why i left the hospital

the pressure to discharge or admit at 3hrs 59min is so immense that you just ended up admitting the patinet becasue there was just no time to observe them further...maybe another 1 or 2 hrs of observing them or waiting for results would mean all the diference between admission and a safe discharge.

ahappyGP, manchester,

The idea of the target is to reduce the amount of time patients wait for treatment'

It's easy to blame the government, but is it absurd for a minister to expect targets to be met without this sort of "playing the system"? Can they not rely on highly paid NHS decision makers to meet the target by addressing the purpose of the rule rather just complying with the letter?

Jamie Gilmour, Bolton, UK

Under the tories people waited 3.5 years for a new hip (6 months now).....the lists now for routine ops have plumitted. A&E under the tories was anything up to 24 hours......you people must be young..... or have very poor memories.

Karen Butterfill, Hurstpierpoint, United Kingdom

Managers get paid proportionally to the size of the department they manage. Whole empires are built on the administration of useless targets, guidelines & protocols. The excuse is that doctors & nurses can't be trusted to do their job properly.

peter, doncaster, uk

Just experienced something similar with my GP.
GP " you need to see a consultant"
Me: "can you arrange for it after the 21st January as I'm away with work until 19th Jan"
GP "no, you must be seen within 3 weeks."
Me" well thats fine I don't mind waiting one more week"
GP" no you must be seen within that time"
Me "Eh?"
GP" you can only have a date within the next three weeks to meet targets"
Me "i cant make it then"
GP" well come back to see me on the 21st, then I can kmake an appointment"
Me" so I'll have to wait 7 weeks from now"
GP "yes"
Me " so you are not meeting a 3 week target"
GP "yes from me referring you"
Me "i want to be referred now and sent in 4 weeks"
GP " i can make the sappointmentfor now, we will met our target, and if you mis it you will have to start again."
ME" pointless eh?"
GP " no we meet our targets"
Me " not orienatated to the patients needs Then?"
GP " we ensure they are met within 3 weeks"
Me" even

Catch 22...you just couldn''t make it

Steve, Chichester,

First rule of performance management - "if you measure the wrong things, you create the wrong behaviours".

Second rule of performance management - "if you let a bunch of low intellect dullards run the country, you waste a lot of money and don't have much to show for it."

stuart, dublin, ireland

Was it this bad under the tories? I at least remember them getting some things right - but I am struggling to think of one thing done well by Labour. That's after 10 years - frightening - even more scary is that they think they are fit to govern.
And no the economy doesn't count as it was just starting an upward trend and a Squirrel could have managed it successfully

Anna Charlton, London, UK

Anybody who votes labour at the next election should spend a week in hospital, a mental hospital.

roger jones, kettering,

Welcome to the world of government managed care. Of course government sets targets. How else can they go back to the voters and say see we are doing such a wonderful job. See the numbers. And thats what patients become numbers on a graph to be explained to some other government panel who in turn give it to some other government panel. Then come election day they all stand there and say look voters elect us see how these graphs tell us what a great job we are doing. Course they are so far removed from the patients they are clueless about the true cost. And patients have nothing to say because its the government and they dont see it either until they go to the hospital.Maddening. And the Liberal elitists over here are trying to set up the same hair brained scheme. Just surrender control of your lives to the government because the elitists know better. Maddening. But we got plenty of suckers that will fall for it.

CynicalCitizen, USA,

What was it this government couldn't organise in a what now?

Andy Iddon, London, UK

I'm astonished that this is news; as a hospital doctor, I just assumed this was normal.

It's nothing to do with making money. Here's how it goes:

1. Patient is coming up to 4 hours in A&E. In a few minutes they will "breach".

2. You have not finished making your initial diagnosis, you are waiting for test results (Xrays, bloods), you have begun some treatment, but the patient does not yet feel well enough to go home, the patient is well enough to go home, but there is a brief delay while social services/the nursing home/family arrange getting the patient home.

3. If the patient goes over 4 hours all hell will break loose. In hospital medicine we call this the only true remaining medical emergency. A "breach" delivery, so to speak.

4. You make the obvious decision to admit the patient so you can continue to deliver appropriate medical care, with a plan to get the patient home one diagnosis/testing/treatment/discharge planning is complete.

And a happy new year.

Ben, London,

As a former A&E doctor who changed career due to frustration with the 4 hour rule, I can confirm everything you say. Patients are now admitted to a ward for the most trivial of reasons, such as to await a blood test result, simply to avoid a breach of the 4 hours which would cost the hospital a fine.

As well as the cost of the admission, this policy endangers sick patients, who are moved from the A&E department, with its relatively high staffing levels and clinicians with expertise in resuscitation, to standard wards. I have literally had to run down a corridor behind an 80 year old bleeding profusely from a scalp wound, trying to stem the bleeding because the patient could not be kept in A&E.

The 4 hour rule has not been all bad: it has attracted resources to previously neglected A&E departments. However the target that 98% of patients must leave the department within 4 hours is unrealistic, expensive and detrimental to patients.

JB, Cheltenham,

O I C, after I waited 4 hours at A&E (I thought my GP had made me a timed appointment) watching an endless stream being triaged in front of me, they said they would keep me in "for observation". It was mystifying. But now I understand. I didn't stay, I discharged myself and never got nhs treatment.

John Ledbury, Kings Lynn, England

Well, this says it all about NU Labour's culture of 'Targets' and 'Perfornace Indicators'. When Governments set targets, People become Victims. All too reminiscent of the old Soviet Style 5 Year Plans!

Performance Indicators are important, but what is being measured should be useful, true and required. Not the plethora of imposed targets that are daily spewed out of NU Labour back-rooms by Jobsworths who truly think that they are 'Special & Different' from the rest of us Earthlings!

The truth of the matter is that nobody, including those Jobsworths really gives a damn about these targets. NU Labour Ministers have agreed that there are far too many targets -- but they won't do anything because they are too scared to be seen to be 'different' from the rest of the herd!

Its all just so much Humbug. 'Bull-droppings' from on high. Nu labour is in my opinion, just like a 'Wild West Show' full of Snake-Oil Salesmen -- A Barnum & Bunko Artist Party of 'Toss-Pots' and Bludgers!

B Clarke, Chelmsford, England

This shows the quality of management at Ministerial level is seriously flawed. The one definition of an adult that I remember is that it is a person who can resonably foresee the results of their action. So they fail even on this count to qualify.
At every department of this government we are seeing dire management, huge waste (of OUR money) and and more importantly a lack of control. It's like watching the fall of the Roman Empire again, as these idiots focus on spin over their failings and pushing the latest populist iinitiatives.

Diddly Do, Liverpool,

Perhaps we should have a system where the need for admission is based on a doctors assessment of the clinical condition of the patient rather than by a manager with a clipboard.

John, Bristol, UK

Nu Lab has used perverse targets everywhere. The police must increase the number of offender brought to justice - not burglars or persistent offeders - anyone will do. Hence the persecution of young people for school boy fights and chalking on pavements. Neighbour or family disputes are another favourite. The police hit their targets, the politicians are happy but the streets are no safer!

SMR, England,

Aren't we all paying 10% more National Insurance to "save the NHS"?

Wasn't that Gordon Brown who said that?

So you and I are paying to pander to HIS pathetic agenda, which goes on nothing other than waste?

Prudence?

Get out Gordon, the sooner the better.

Tim, Bristol, UK

When I read the headline "Patients admitted to hit targets", I couldn't help wondering if that meant they were allowed to play darts.

Edmund Burke, Kingston upon Thames, England

The wider picture is the creation of an internal market where none existed before. The cost of an admission is a figure plucked out of thin air. Clearly it is in the hospitals interest to admit as many as possible at a£1000 a time at the PCTs expence.
Targets are over used and ineffective and like so many "health improvemnts" this government has introduced eg: "choose and Book " NHS direct and the NHS computer system have been costly failures.
The money would be better spent on front line caring staff.

Nigel, epsom , surrey

if people need to be admitted to hospital admit them forgetcosts and targets- just do what needs to be done that is what the NHS is all about

peter odner, devizes, england

who are all these people who are really sick a don't get admitted because there is not any room on the wards, who spend hours and hours on a trolley in a corridor and have been know to die before they even see a ward. My husband was sent home three times, from A. & E. before he was admitted and waited 7 hours for a bed. He's dead the bugs got him and the only way you would get me in hospital is over my dead body. I seen it and I think if I am going to die my warm soft bed is were I want to be.

June Hart, Hockley, Essex,

Step forward Mr Alan Johnson and take a bow. Why do you tolerate this mindless stupidity?

Doug, Glasgow,

Another way used to play the system, is not to let ambulance patients into the department until the backlog of patients have been cleared. Outside our local A&E department ambulances wait in line with their patients, thus tying up ambulances and causing a shortage within the town.

John, Huddersfield, W Yorks

'One day to save the NHS' - you know how to vote next time.

Ian Burgess, Bristol,

Using these type of statistics it is impossible to say what has really caused the increase in admissions in England. Many Emergency Departments (EDs) set up observation wards at the onset of the 4-hour target. This suits managers because it "stops the clock ticking". However, doctors also like it because there is often a clinical and risk benefit from observing a patient for 4 to 6 hours prior to discharge. This will account for the high proportion of ED admissions being discharged the same day. It must also be remembered that the money is flowing within the NHS and is not a loss to the taxpayer.

A much more likely cause of the increase in admissions is the collapse of Out of Hours General Practice. Patients are often left with no alternative than to 'phone 999 outside office hours. Once they've hit the ED there is a much higher chance that they will be admitted than if they had been seen by a GP that they know.

Admitting patients (so-called gaming) to make money just doesn't happen.

dave smith, Newcastle upon Tyne, England

I have worked as a doctor heavily involved in acute admissions through casualty.

CHKS are absolutely right. If it is impossible, due to bulges of attendancies, to process admissions within the four hours the casualty staff have two options. They can let the patient "breach" the target, be seen then discharged direct from casualty (most convenient for the patient) and then face the spanish inquisition from management. The alternative is to send the patient to the ward to be seen then discharged there and this is what happens

What patients actually need is to be seen quickly, which means having enough doctors and nurses available and, if they do need an admission, a bed should be available. Unfortunately capacity on both fronts has been reduced. Similarly to fight MRSA hospitals need less occupancy (to aid isolation) and quality assured cleaning. Its much cheaper, however, to bully staff with fatuous targets

jack, london, uk