Letters: NHS boss is quite right to question target culture

If ever there was overwhelming evidence that performance targets have no place in the NHS, it is the case of the DoH's world-class commissioning (WCC) policy when it asked PCTs how well they had 'stimulated the market' (GP, 27 March).

I must commend Mike Farrar, chief executive of NHS North West, for challenging that target. How right he is when he said that 'the assessment merely asked PCTs how many different suppliers they used and not whether this had improved services'.

How many NHS bosses are brave enough to speak out and risk saying that patients are paramount and quality of care must come before meeting targets?

How many are fearless enough to admit that targets harm good service delivery in the best interests of patients?

How many are courageous enough to declare that targets have no place in the NHS where goodwill, professionalism and patient outcomes cannot be measured?

One hopes many more NHS bosses will have the courage to challenge the target and micromanagement culture of the NHS that is doing untold damage to healthcare.

Like many bad ideas, targets are intuitively attractive. Surely, it is argued, they enable public services to direct their efforts where need is greatest and to determine whether those needs are being met.

The service can be proactive rather than merely reactive. Measurable outcomes mean that reality can be separated from rhetoric.

So much for the theory. In practice, the impact of targets has been damaging and must bear some blame for the failure of the vast and welcome increase in NHS funding to deliver a proportionate increase in care.

Yes, waiting lists for operations have been dramatically reduced, but the hidden costs of targets have not been measured and their impact on overall activity has been costly, and in some respects, malign.

Dr Kailash Chand, Ashton-Under-Lyne, Lancashire

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