I am a GP & find that many patients stay in for much longer than necessary ,one 90y old of mine stayed in for 3w following a vasoval /slow pulse episode .The last 7 days were sitting aroung for a 7day heart monitor & after the daughter kicked up a fuss eventually was discharged having had a 1day one with a 7day one 'planned'as an outpatient !!
No wonder our PCTs have no funds they are being fleeced yet again by secondary care !!!!

Tim Southwood, Nailsea, North Somerset

What do you expect when management consultants are employed to set targets from a position of ignorance (confused with objectivity)? Management consultants are the vermin feeding on tax-funded capitalism.

Fred, Maidenhead, England

I do agree with this.

I am a doctor in the NHS and find that many patients are admitted just for the sake of targets.

we need to do something.

sss, wessex, uk

in nhs dentistry the same thing has happened and the police. targets have become more important than people,sevice, qulaity of care and out come. they shouldnt of attached finaical incentives to these things they should of just monitiored them.
As an nhs dentist if i need to reapi one filling i would get target points which would take 5 mintues and if a [teitn need ed 3 large fillings this would take over an hour with the patient yet the practice would still eranr only 3 target points. target points = £'s. so what the goiverment are saying is i can earn more if im selctive about my treatments. And this is what a proportion of nhs detnsits are doing by not offerring certain procedures becasue there too expensive on the nhs. This target driven system is possibly at odds with the hippocratic oath of do no harm!

amit hindocha, leciester, uk

My wife broke her foot a few weekends ago. She was triaged quickly, then X-rayed and seen by a doctor within what was considered to be a very acceptable time. She needed to be strapped up and return the next day for plastering.

We waited and waited for ages before a very junior nurse came to strap up her foot. Around 90% of the work had been completed quickly but the system did not respond to complete the interim treatment. Instead of getting us out the door as soon as possible, job completed, the culture appears to be that not only is the 4 hours a maximum but also almost a minimum.

Richard, west midlands,

Band 1 NHS Dental treatment 15.90 covers exam, xray, 1 filling, 1 extraction, scaling
Band 2 NHS Treatment 43.60 covers more fillings, root canal treatments, more extractions that are not covered in band 1
Band 3 NHS Dental treatment covers 1 to 32 crowns, dentures, bridges in addition to everything in band 2.

WHO'S IDEA WAS THIS?

NULABOUR.

IDIOTIC GORDON BROWN AND HIS CRONIES.

And his minister Anne Keen says everything is hunky dory in NHS Dentistry.

Dont blame dentists for deserting NHS.

Genco Abbandando, Naples, Italy

I am pleased a quango has identified this - it must be true! My consultant physician colleagues have known from the outset what distortions the 4 hour target has caused. A common example is the patient being transferred from A/E during the first interview with a doctor - if he/she has had to go and answer a phone /visit the loo etc. On return no patient ! - might have breached the target. I can assure you all we are currently dealing with a raft of new silly targets - but lets wait until another official " body " picks it up! Seasonal best wishes!

Andrew, Kent,

I work in A&E as an emergency nurse practitioner and have done so for 20 years. Yes patient 's are admitted to prevent a breach of the 4 hour target, usually because test results are not available or specialists cannot see them within the 4 hours or high workload/sick pts.

But where would you rather wait for 6-8 hours? on a trolley in a corridor, in the waiting room in pain? or in a bed on a ward?

Before the 4 hour target there was no incentive for Trusts to sort out the long waits in A&E, then the complaint was long waiting times in an unsuitable environment.

I am proud that my A&E delivers a high level of care for the vast majority of patients within 4 hours, but that is because we are on the whole efficient, have good processes for starting investigations early and work together as a team with other specialties.

As for ambulances not unloading patients, this is because there is NO room inside the A&E to safely provide care, so again where do you want to wait?

Andrew Carr, Cambridge, UK

Wow! If Gordon thinks he has a chance, he'd better read this lot. I am too an ex-teacher who got fed up with paperwork. Please stop people voting fo him, AND Cameron the whizz kid. His lot are just as incompetent. Lets give the Libdems a chance, they couldn't be worse than the last 20 years of Tory/Blair/Brown sleaze and mis management. As for going to war in Iraq - no wonder he became a Catloic so he could go to confession and be absolved for murdering a million Iraqis!!

Peter Groves, Surbiton, Surrey, UK

Patients admitted to hospital simply to hit targets.
What a waste of money, why cannot they practice in their local parks or some other open area

stanley, haifa ,

Using these type of statistics it is impossible to say what has really caused the increase in admissions in England. Many Emergency Departments (EDs) set up observation wards at the onset of the 4-hour target. This suits managers because it "stops the clock ticking". However, doctors also like it because there is often a clinical and risk benefit from observing a patient for 4 to 6 hours prior to discharge. This will account for the high proportion of ED admissions being discharged the same day. It must also be remembered that the money is flowing within the NHS and is not a loss to the taxpayer.

A much more likely cause of the increase in admissions is the collapse of Out of Hours General Practice. Patients are often left with no alternative than to 'phone 999 outside office hours. Once they've hit the ED there is a much higher chance that they will be admitted than if they had been seen by a GP that they know.

Admitting patients (so-called gaming) to make money just doesn't happen.

dave smith, Newcastle upon Tyne, England

I have worked as a doctor heavily involved in acute admissions through casualty.

CHKS are absolutely right. If it is impossible, due to bulges of attendancies, to process admissions within the four hours the casualty staff have two options. They can let the patient "breach" the target, be seen then discharged direct from casualty (most convenient for the patient) and then face the spanish inquisition from management. The alternative is to send the patient to the ward to be seen then discharged there and this is what happens

What patients actually need is to be seen quickly, which means having enough doctors and nurses available and, if they do need an admission, a bed should be available. Unfortunately capacity on both fronts has been reduced. Similarly to fight MRSA hospitals need less occupancy (to aid isolation) and quality assured cleaning. Its much cheaper, however, to bully staff with fatuous targets

jack, london, uk