From a withdrawn distance politicians glance at the statistics and it appears that everything is going swimmingly well. Target X is being met, Target Y is on track et cetera. Not all is as it first seems.
In quantum physics the Heisenberg uncertainty principle ensures that it is not possible to know the values of all of the properties of the system at the same time; meaning that as one increases the accuracy of one measurement, the accuracy of another is decreased. It is also another well known phenomenon in physics that one cannot observe a system without having unwanted effects on that system.
I can hear our regular readers muttering 'the stupid bastard's going off on one about physics again'. But no, Dr Rant is fact applying logic in a slightly abstract and lateral manner to solve the problems that New Labour are obviously too dim to appreciate.
As soon as a target such as the 4hr A/E wait is applied to a system, the dynamics of that system are changed completely. Priorities and motivations are drastically altered as the target is absorbed into the system, and this adaptation results in the target being a far from perfect measuring tool. Again our political overlords have no appreciation for complex interactions like this, and are very quick to assume perfection in their creation. It's yet more evidence that physics A-level should be made complsory for all politicians.
In context this means that in A/E the manager will be extremely upset if a patient 'breaches' (is in the department for more than 4 hours) even if the case has been handled perfectly from a clinical point of view and the 'breach' was completely unavoidable; this is because their seniors need to meet the targets to keep their jobs. The manager however does not care when a patient dies thanks to being inappropriately transferred to the ward too soon, in a quite deliberate attempt to avoid the patient 'breaching'.
In this way targets imposed obsessively from the top result in a ludicrous and dangerous state of affairs whereby clinical need is ignored in favour of harvesting more political propaganda. In this way the motivation of gathering target based propaganda for spin gets passed down the NHS food chain from the filth at the top.
There is no uncertainty about targets, they should be clearly marked as health hazards. If something doesn't get given a target then it just gets ignored, take the unacceptable waits that patients are currently enduring for radiotherapy for example. The top down control freakery means that managers end up killing patients thanks to their lethal prioritisation of political gains ahead of clinical need.
This is Tony Blair's and New Labour's real legacy. Their thirst for power has lead to patients being sacrificed just so that they can get reelected. It's hard to find the words to sum up just how low these putrid gerbil gropers have sunk. They have instilled a culture of fear and intimidation into all the public services, just to ensure that they are able to collect their propaganda material. Good managers are sacked and replaced with agreeable 'yes men', as quality services are replaced by a network of propaganda factories. And what is their answer to the overt failure of targets? Why yes, more targets! even the under fives are monitored by targets these days.
It's getting worse. No, it's getting better. It's bloody worse. No, it's bloody better. It's fucking worse. Have a control order. It's still worse you know. Right, have a flight to Egypt free on us. I'm no idiot, it's still awful. Enjoy this hot rectal probe for a second. Oh, I see now, it's all getting better, it's our best year ever. Why yes, it is, it's out best year ever!
Like fuck it is. Heisenberg would certainly have had no uncertainty that our government are lying deceitful cunts.
In quantum physics the Heisenberg uncertainty principle ensures that it is not possible to know the values of all of the properties of the system at the same time; meaning that as one increases the accuracy of one measurement, the accuracy of another is decreased. It is also another well known phenomenon in physics that one cannot observe a system without having unwanted effects on that system.
I can hear our regular readers muttering 'the stupid bastard's going off on one about physics again'. But no, Dr Rant is fact applying logic in a slightly abstract and lateral manner to solve the problems that New Labour are obviously too dim to appreciate.
As soon as a target such as the 4hr A/E wait is applied to a system, the dynamics of that system are changed completely. Priorities and motivations are drastically altered as the target is absorbed into the system, and this adaptation results in the target being a far from perfect measuring tool. Again our political overlords have no appreciation for complex interactions like this, and are very quick to assume perfection in their creation. It's yet more evidence that physics A-level should be made complsory for all politicians.
In context this means that in A/E the manager will be extremely upset if a patient 'breaches' (is in the department for more than 4 hours) even if the case has been handled perfectly from a clinical point of view and the 'breach' was completely unavoidable; this is because their seniors need to meet the targets to keep their jobs. The manager however does not care when a patient dies thanks to being inappropriately transferred to the ward too soon, in a quite deliberate attempt to avoid the patient 'breaching'.
In this way targets imposed obsessively from the top result in a ludicrous and dangerous state of affairs whereby clinical need is ignored in favour of harvesting more political propaganda. In this way the motivation of gathering target based propaganda for spin gets passed down the NHS food chain from the filth at the top.
There is no uncertainty about targets, they should be clearly marked as health hazards. If something doesn't get given a target then it just gets ignored, take the unacceptable waits that patients are currently enduring for radiotherapy for example. The top down control freakery means that managers end up killing patients thanks to their lethal prioritisation of political gains ahead of clinical need.
This is Tony Blair's and New Labour's real legacy. Their thirst for power has lead to patients being sacrificed just so that they can get reelected. It's hard to find the words to sum up just how low these putrid gerbil gropers have sunk. They have instilled a culture of fear and intimidation into all the public services, just to ensure that they are able to collect their propaganda material. Good managers are sacked and replaced with agreeable 'yes men', as quality services are replaced by a network of propaganda factories. And what is their answer to the overt failure of targets? Why yes, more targets! even the under fives are monitored by targets these days.
It's getting worse. No, it's getting better. It's bloody worse. No, it's bloody better. It's fucking worse. Have a control order. It's still worse you know. Right, have a flight to Egypt free on us. I'm no idiot, it's still awful. Enjoy this hot rectal probe for a second. Oh, I see now, it's all getting better, it's our best year ever. Why yes, it is, it's out best year ever!
Like fuck it is. Heisenberg would certainly have had no uncertainty that our government are lying deceitful cunts.
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30 comments:
I bloody love targets.
They help me to become a better person.
p.s. Is this the best calender year or financial year in the history of the NHS? If it's the latter, then they'll be a few tears come April 5th, but we can all look forward to an even better one next year.
The A&E target may be cynical and crude but if I was a patient attending A&E I would rather do so now than 3 years ago.
The 4hr-target has little affect on sick patients - they need angioplasty, theatre, ITU, etc.
If they are hanging around in casualty for hours on end it's almost always a sign of inadequate medical management.
And what about the so called 'minor cases', abscesses, uncomplicated fractures, minor ENT and opthalmic problems, etc ?
Under the old system they were continually pushed down the queue every time a potentially more complex medical case booked in.
Specialty doctors used to wander down when they had a spare window, and the bed managers had little incentive to move patients to a hospital bed with any great urgency.
In the old days Monday morning was like a war zone with rows of anxious patients desperate to be moved from a cubicle to the exotic luxury of the wards.
A&E staff oscillated between tremendous guilt then hostility when two inevitable questions arose time and time again, 'when am I going to be seen' and later 'when will I be moved to the ward' ? - after a while I took to carrying a piece of string and I would invite patients to guess its length each time the dreaded two questions were uttered.
Of course the target will be quietly dropped sooner or later - it will only be then that we will look back wistfully and sigh about how much more efficient things used to be in A&E and why have we let the service become so crap again.
the A&E Charge Nurse
things may have improved in some ways, but to assume that this is down to targets is slightly dubious.
personally I'd rather see minor stuff wait a few hours and the real sick patients get sorted properly.
There is clearly a happy medium where standards need to be set in an intelligent manner. However blanket targets that lump the dying moribund in the same 4hr wait as a bruised little finger are plain bad.
There is certainly something to be said for making the ridiculous stuff waiting at least an hour or two, to make sure people learn that AE is not the place to come with a toe you stubbed two weeks ago that is now better.
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