Reporting the War of Margaret’s Shoulder, the Times has a useful Q&A on how the commissars manage their hospital waiting statistics:
“Cancellations are only recorded if they are postponed on the day the procedure was due to take place…NHS trusts do not want to appear to be getting worse, so many hospitals look at the next day's list of an afternoon and consider what operations can be delayed. This practice is no secret and chief executives openly admit it takes place.
Are these figures an accurate reflection of the number of cancelled operations?This real number is likely to be much higher because of the way cancellations can be massaged. The other complication for hospitals is the target of getting patients out of accident and emergency within four hours. They either have to be treated and discharged or admitted to hospital and 95 per cent of NHS Trusts are meeting that target, but largely by admitting more patients. There has been an almost 23 per cent increase in admissions in the final three months of the year since 2002. The figure then was 574,983 but last year it was 705,901.
What impact is admitting more A&E patients having on hospitals?The main consequence is the cancellation of elective surgery, but it is impossible to know to what extent as no figures are kept for this. One example can be seen at the Queen Elizabeth Hospital in Woolwich, though, which has had a freeze on elective surgery since January because of the rise in patients being admitted from A&E.
Are waiting times for operations going up or down?It depends how you look at it. It's true that the longest waiting times have been cut, but the average times have only seen a modest decrease.”
As those other commissars discovered so long ago, once you start managing by target you’d better make damned sure you specify and measure every single output. Tractor production can be ramped up to record highs, but that’s not much help if you haven’t specified they should all have engines. Of course, you need a huge planning and inspection staff to manage it all. Oh yes, and time to get everything properly sorted. Thirty or forty years should do it. Probably.
How much easier to put decision-making power directly in the hands of producers and consumers.