Select Committee on Public Administration Appendices to the Minutes of Evidence

Memorandum by The Society of Radiographers (PST 16)

  In response to the question about how public service targets assist in producing useful management information and ensuring public accountability, the Society believes that it depends on whether the whole service is being measured or just selected part of it. For managers to be well informed about how a hospital department is performing, many factors need to be taken into consideration. The issue of reducing waiting lists may mask a number of other factors, such as breakdown of specialist equipment, reduction in staffing levels and referral to a further outpatients appointment. There are many specialist radiology departments, which have managed to reduce waiting times at the expense of the health and safety of their staff, who are working more intensively, under greater pressure and often without necessary health and safety safeguards.

  Similarly, the public need a fuller and more rounded picture—it is no good stating that waiting lists are reduced if the satisfaction of the treatment or diagnosis is adversely affected because the appointment time was cut to the quick.

  Radiographers and other healthcare specialists provide a service that is both qualitative and quantitative. Therefore, to measure quantity (eg throughput times) without also attempting to measure quality is a very blunt instrument indeed. In fact, the very process of reducing waiting times may in itself prejudice quality, in that the practitioner is working to such a tight timetable that they have only a limited time to spend with each patient.

  We believe that it may be best to measure outcomes as well as outputs, but only if these covered a broad range of issues, not just the current ones. If the government were to introduce further methods of measurement, the Society would expect to play a full part in the process of deliberation, in order to avoid the introduction of further crude measures. Such measures can only serve to destroy morale and motivation among key health service workers and serve as a way to harm the public's trust of such workers.

  I believe that the public is extremely intelligent about the use of statistics and are well able to come to roughly the same conclusions as outlined above, which may explain why people are cynical about waiting list reductions, but not about reduction of greenhouse gases, which is largely quantitative in nature.

  The Society believes it would be helpful for the government to publish an across the board evaluation of how well it has performed against its targets. It would be perceived as only fair that the government should be fully accountable, when it is asking the public sector to be.

  We are not sure that the targets and league tables do in practice give the public greater choice: to learn that one's local trust is not meeting its waiting list target gives little information about quality of care and the situation may well be that the patient has no choice at all but to attend an apparently "failing" organisation.

  We are clear that professionals should be consulted about targets and the types chosen. It seems well known that on occasion, patients are treated because of the target rather the need. This is not only poor practice for patients, it is extremely demoralising and insulting for professionals.

  Choice of targets is not easy. Central to the issue is what use is made of them. If trusts/other organisations are so fearful of the consequence of not achieving, one result may be creative reporting, another diversion of effort away from the real priority. A system of trust needs to be built first, then joint objectives agreed, which may differ in different parts of the country and in different services.

  The Society and College are pleased to have been asked to offer a contribution and will be most interested in the outcome of your inquiry.

Ann Cattell

Chief Executive Officer

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