Tricks and cheating rife to meet care targets, says BMA

Cheating, dishonesty and the fiddling of figures have become rife in the NHS because of pressure from the Government to meet performance targets, the leader of Britain's doctors said yesterday.

Politically motivated demands for cuts in waiting times and increased productivity were putting intolerable pressure on the system, turning doctors into bean counters and making "honest people dishonest", Ian Bogle, chairman of the British Medical Association, said.

Dr Bogle told the BMA's annual conference in Torquay that the proliferation of targets set by ministers was distorting clinical priorities, eroding professional autonomy and sapping doctors' morale.

"The principle of care based on need has been superseded by the principle of care based on numbers," he said, to applause. There were "countless examples" of "trickery and ruses" used by managers to meet targets. A BMA survey of accident and emergency departments found temporary staff were bused in, permanent staff made to work double shifts and routine surgery was cancelled to free beds in the week when their performance was being assessed.

Other tricks included keeping patients in ambulances before admission to A&E, classifying those on trolleys as "admitted" and putting patients on reserve waiting lists. "And if all else fails, cheat," he said.

A National Audit Office survey of 41 NHS trusts found three where figures had been fiddled so blatantly that the chief executives were sacked. But, Dr Bogle said, the Government had colluded in the deception. He told the conference: "Given this Government's obsession with issuing diktats on the minutiae of NHS activity, I'm surprised there isn't a target for the passing of motions. The auditing of every bowel movement on every ward on every NHS hospital would be a fitting memorial to Alan Milburn [the former health secretary]."

Support for targets came from Jonathan Fielden, a hospital consultant from west Berkshire. "Like them or hate them, targets have improved care," he said. A spokesman for the Department of Health said: "We have always been clear that we won't stand for any manipulation of statistics and those found responsible should be disciplined."

* Doctors voted overwhelmingly to oppose the establishment of foundation hospitals. They would benefit rich areas at the expense of the poor, delegates argued.