Lincolnshire Independents have released three letters this week raising concerns about targets being put ahead of patient safety.
In the first a surgeon complains that he feels that he is being “coerced” into doing things which are unsafe.
The second refers to surgical lists being overcrowded in order to meet targets and refers to a patient death, with an implication that this overcrowding was a contributory cause.
The third is from a clinical director who warns the Chairman of the Trust, Paul Richardson, that there has been a shift toward meeting targets at the expense of patient safety.
Letter One - The Surgeon (12/2/2010)
Written after the cancellation of a surgery due to there being no Intensive Care Unit beds available. The author of the letter feels pressured into performing the surgery days before beginning annual leave.
“I do not think it is ethically right or would be acceptable to my colleagues or to the GMC if I were to perform such an operation and go on holiday three days later.”
“I have to put the patient’s safety first. That is my priority as a doctor. If I were to fail to do that, it would put my registration at risk.
“Therefore to perform this gentleman’s surgery this week would not be safe...”
“Targets should not come into this and should not over-rule patient safety.”
“I do not think there would be any defence either in court or in front of the GMC if I put the Trust’s target in this instance above the patient’s welfare and I do not think this is right to do so.”
“I do not think I should be coerced into performing surgery on a patient in an environment which I do not deem to be safe to do so.”
Letter Two - Overcrowded surgical lists (8/2/2010)
“The enormous pressure exerted by the (redacted) targets has resulted in ad hoc arrangements for surgery at short notice, as sessions beyond the working day, or as sessions occurring at weekends.
“Beyond this, the expectation of my (redacted) surgical colleagues to undertake cases at short notice, outwith their normal job-planned hours and often on patients with whom they have had no prior contact is unacceptable.
“This is not only prejudicial to ongoing patient care but present enormous and unsustainable pressure on the operating surgeons. This cannot be tolerated in all but exceptional circumstances.”
“My colleagues have indicated to me that with immediate effect they do not feel able to undertake additional sessions outside of their job plans to chase the (redacted) targets - which as we all acknowledge for (redacted) are arbitrary and have little impact on (redacted) survival.”
Letter Three - The Clinical Director (3/3/2010)
“I feel I must make you aware on my concerns about the balance between patient safety and target and inform you that in my view the current bullish and sometimes ruthless pressure from above on the management team in my Directorate is unfair and unacceptable.
“Such a culture that has evolved over the last few months has caused a subtle but significant shift in the balance between achieving targets and the quality and safety of our service to patients.”
“...the impressions being given in recent performance reviews is that the Directorate has in some way failed to meet a commitment resulting in an insidious and remorseless increase in pressure that could result in poor judgement and staff taking risks with patient safety which, in normal circumstances, they would not take.”
“My understanding is that the previous Chairman of the Trust had raised the issue of the potential conflict between quality and volume and resigned as a result of his concerns being refuted.
“I believe someone needs the courage to admit this organisation will continue to fail some activity targets...”