Leader: Number crunchers miss the point

Accountants have been exerting their influence on the NHS at a strategic level for years, but while they may have had a say on what services can be provided on the NHS in terms of cost, they have generally left day-to-day care of individual patients to doctors, until now.

Create a new data set, such as the quality framework, and they can't help themselves. They see numbers ripe for auditing and believe any departure from the regular distributions of statistics they learnt about at accountancy school is due to someone is fiddling the figures.

What these number crunchers have failed to grasp with their guidance to quality assessors on identifying 'fraudulent' practices, is that clustering of readings, such as BP, around the targets is to be expected.

The quality framework targets are set at particular levels because clinical studies have assessed the cost-benefits and side-effect profiles of hitting these levels through therapeutic interventions.

The bean counters have also failed to grasp that the human body is not a business or closed financial system; it is a complex biological structure, the workings of which are influenced by many internal and external factors, including medical interventions like drugs, stress, time of testing and temperature. Two BP readings are unlikely to be the same, even if they are taken by the same person on the same day.

It is right that some verification of quality scores is sought to ensure that NHS funds are being spent appropriately. But questioning levels of patients' actual biochemical markers is not the answer.

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