Overreliance on national targets weakens NHS, review says

The NHS should abolish a number of national targets while shifting its focus towards preventing ill health, according to a review by a former Labour health secretary.

The study by Patricia Hewitt, commissioned by the government and officially published today, says a few targets help concentrate minds but having too many makes them less effective.

It comes as the NHS continues to miss targets on A&E waits, ambulance response times and cancer waits and treatment times.

The review is expected to say that adding new targets and initiatives and not being consistent with funding makes it impossible to plan new services and recruit staff, and wastes money and time. Hewitt will also say that some targets, such as those on A&E waits, leave less room for medics to use their clinical judgment.

An excessive focus on hitting targets by managers or NHS boards can lead to “gaming” of the targets and “disastrous neglect of patients themselves”, the review will say.

In her study, Hewitt will say ministers should consider significantly reducing the number of national targets, with no more than 10 national priorities.

There should also be more focus on outcomes to improve patient care. Cutting waiting times for key surgery such as hip replacements and cataract operations should be matched by a focus on reducing waits for mental health treatment, Hewitt will say.

Local leaders running new integrated care systems (ICSs) – which are partnerships of organisations that come together to plan and deliver joined-up health and care services – should be given more space and time to lead.

On preventing ill health, the review will call for the share of total NHS budgets at ICS level going towards prevention to be increased by at least 1% over the next five years.

This “shift upstream” towards preventive services is vital to prevent more older and increasingly unhealthy people entering hospitals that will never be large or efficient enough to cope, the review will say.