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19th March 2010, 3:27pm
Weighing up the impact of NHS targets
Dr Peter Homa CBE The way targets have been used to shape NHS policy and assess standards of patient care was scrutinised in a guest lecture at the University of Lincoln by a leading voice on health policy.

Dr Peter Homa CBE has played a defining role in the revolution which has taken place in the NHS over the last decade.

He was at the forefront of the Government’s drive to achieve waiting list targets in the late 1990s and was a founding figure of the first public body established to routinely assess hospital performance.

Dr Homa, who is now chief executive of Nottingham University Hospitals NHS Trust, gave his perspective on NHS policy and the use of targets in a special guest lecture at the University of Lincoln this week.

The talk, ‘NHS Policy: we live life forwards but understand it backwards’, was the latest in the Lincoln Academy series of free public lectures.

The presentation drew on research and first-hand experience to illuminate both the intended and unintended consequences of NHS policy. In particular, it explored the development of NHS targets and how these have been used to measure progress and delivery of patient care.

Acknowledging that 'what gets measured gets managed', Dr Homa told the audience: "The risk is that if one focuses exclusively on a discrete set of targets, one may be at risk of forgetting what they are there to represent. They are merely analogues for humanity of care, of providing a form of compassion in what is often the most difficult and distressing time in a family's lives. Representing that as a target may have a place but if one becomes pre-occupied by the target, then there is a risk that one hits the target but misses the point."

However, he explained that there is strong evidence that targets, when applied sensibly, have improved NHS performance and brought about greater levels of consistency. An example is the impact of the introduction of target response times on ambulance call-outs in England.

He concluded: "As Winston Churchill once said about democracy, a target regime may be the worst system invented, except for all the others."

Dr Homa has visiting chairs in health policy at the universities of Lincoln, Nottingham and Surrey. He was appointed Commander of the British Empire in 2000. He is a companion of the Institute of Health Management and was President in 1998/9.

He began his NHS career as an operating department porter in a London hospital. He completed the NHS national management training scheme and took on a number of challenging senior management roles.
He was appointed chief executive at Leicester Royal Infirmary in 1989, when it was one of two national pilot hospitals to achieve significant improvement in both the quality and efficiency of patient care.

In 1998 Dr Homa worked for the NHS Chief Executive and Secretary of State for Health to help achieve the Government's waiting list targets. He became head of the National Patients' Access Team. In 1999 he became the foundation chief executive of the Commission for Health Improvement (CHI) and with Dame Deirdre Hine established CHI from scratch. After four years he was appointed chief executive at St George's Healthcare NHS Trust, which pioneered the successful application of private sector financial turnaround methods into the NHS. He took up his current post in Nottingham in 2006.

For more information on the Lincoln Academy lecture series, contact the University of Lincoln’s Events Team on (01522) 837100 or email

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