Targeted Healthcare

The code of ethics forbids us to allow our judgements to be adversely affected by targets, profits and other incentives; however this week I've seen a number of ways in how healthcare organisations are affected by them.

Of course, this is deliberate. These means are ways for organisations – public and private – to be motivated to doing the things that society wants, as directed by the invisible hand of the market and our masters in government, who are in turn informed by the focus groups, the constituencies and the tabloids.

Certain things are wanted, so the survival of the company or the hospital or the professional is tied to delivering those things. For the next 5 and a bit weeks, my priorities as a specialist healthcare professional are altered to ensure we deliver on the things that we're not yet delivering on.

In one of the areas that I look after, we're giving more blanket provision of a particular pharmacy service. I won't go into details, as I've too small a space to explain it and I'm sick of the sound of the drugs we're using more of.

Don't think for a second that patients are at risk. Certainly my budget is, but finance is no longer an issue; at least not the next 5 and a bit weeks.

But what disturbs me is that, much more than usual, I'm not providing targeted healthcare to those that would most benefit from it. I'm doing blanket stuff to a large group of people. Almost like I've been in the enviable situation of having been able to perform MURs for patients in order of their risk of poor concordance and then been told not to worry about whether the patient would benefit, to just do 20 per month for anyone.  The proactivity drilled into me from undergraduate level must be put aside in favour of ensuring that we comply with expectations.

In pursuit of targets, I'm  not able to provide a targeted service, at least not for the next 5 and a bit weeks.