PERFORMANCE targets have never been more important to NHS chiefs and government ministers, nor have they ever been as stringent.
Set by health secretary Nicola Sturgeon, targets are the headache of senior managers and medical staff across the country.
If NHS Lothian slips in any area, from waiting times at accident and emergency to the length of time it takes someone to get
treated for cancer, it gets berated, even if the decline was marginal and brief and fails to meet standards set by Holyrood.
In spite of this, NHS Lothian chiefs have announced delivery plans of their own for the next three years, and they are far tougher than the national goals.
Even though its own record on key issues, like waiting times and general health and wellbeing, stand up to scrutiny against other Scottish health boards, it wants to push further ahead.
If these are to succeed, a series of ambitious levels have to be reached across various health issues.
Child dental registrations must reach 83 per cent, 44 per cent of new mums must be encouraged to breastfeed their newborns while eight per cent of smokers must be persuaded to kick the habit by 2012.
All of these goals exceed the national targets, but health chiefs believe by setting their own tougher standards, government aspirations will be met with ease.
Director of strategic planning Jackie Sansbury said of the statistics: "This is what we have to do, rather than how we are going to do it. We have to work on our local targets here to make sure we are achieving what we need to.
"In order to be a top quality system you have to do more than is being asked of others, otherwise you are just average."
It all comes as part of NHS Lothian's ambition to be regarded as one of the top 25 healthcare organisations in the world, but more immediately – if realised – these targets would help it become the best health board in Scotland.
A great emphasis is being placed on psychiatric health. By December, the Scottish Government has told health boards to reduce repeat psychiatric admissions by 10 per cent, but in the latest document, NHS Lothian pledged to better that by double.
Dementia is also a key problem to focus on. Early diagnosis of the devastating illness will increase by a third under the plans, considerably better than Holyrood's 21 per cent.
Improvement in the number of superbugs contracted in the area's hospitals – a field in which NHS Lothian was once the worst in Scotland – would see rates of MRSA and C.diff cut by 40 per cent, 10 per cent more than national targets.
The increasing use of anti-depressants has to be arrested, in line with government policy, and then reversed, but NHS Lothian has pledged to reduce it 25 per cent over the next few years. To do this, some GPs are already piloting schemes which see patients with mild-to-moderate depression given free access to gym facilities and encouraged to get out and about more, rather than always reverting to tablet taking.
Children and adolescents with mental health issues will have to wait no longer than 18 weeks for a first appointment, nor will those awaiting drug addiction treatment.
Away from healthcare, the organisation – which employs 28,000 people in the Lothians – has indicated it will seek to cut its CO2 emissions by a fifth.
Work is also ongoing with the Scottish Ambulance Service and NHS24 to see how attendance rates at A&E can be cut. That could mean seeing more "field hospitals" staffed by ambulance crews on busy nights in Edinburgh city centre to treat drunks on the spot rather than them showing up at the ERI's casualty ward, which is already the busiest in Europe.
These all come in addition to higher profile targets to be hit nationally within the next couple of years, including ensuring patients wait no longer than a month after being diagnosed with cancer.
Experienced board members like Alison Meiklejohn, the health board's head occupational therapist, have previously questioned the drive to become a well regarded organisation on global terms, saying bread-and-butter issues such as everyday care and compassion should be a priority, and that the general public didn't care much for targets, statistics and aspirations.
And this sentiment was today echoed by the director of the Scotland Patients Association, Dr Jean Turner, who said: "There's been an overuse of targets in recent years, and they've become more important than people.
"Just ticking a box to show a target has been met doesn't tell the whole story. What should be measured is the outcome of all this on patients. We need to get our eye off targets and onto patients.
"This is all well and good, but to make it work you need the nurses, the doctors, the theatres, and the clinics."
The full article contains 825 words and appears in Edinburgh Evening News newspaper.
