Hitting the target....but missing the point?

There has been much debate, discussion and speculation about the impact the Mid Staffordshire public enquiry and the subsequent Francis Report is having and will continue to have on health care delivery. Today I was invited to attend a presentation by Professor Ian Cumming, Chief Executive of Health Education England the new organisation who explain their role as:

"We are the NHS engine that will deliver a better health and healthcare workforce for England. We are responsible for the education, training and personal development of every member of staff, and recruiting for values. We are England’s health and healthcare people service."

Professor Cumming describes a culture in many organisations (and certainly found in the Mid Staffs culture) of documenting at all costs, even over caring for patients and went on to describe a few scenarios he had witnessed where service user need was secondary to process requirements and meeting targets. The issue of record keeping, documenting client care and statistics recording has always been important but perhaps has  become more so over the last 20 years?

Since the early 1990's with the advent of the Access to Health Records Act 1990 and the free market principles of the Purchaser/Provider split  and subsequent changes with successive governments there has been more accountability, more business culture within the NHS coupled with a social change of a shift in greater litigation culture. This has all had an impact on how we practice as occupational therapists and how we educate and train occupational therapists. As a manager in the early 1990s I remember numerous conversations with practitioners who bemoaned the fact that documentation and statistic recording was time consuming and took them away from patient care - the mantra at that time was "If you don't record, it hasn't happened. If it hasn't happened then we are not a viable or valuable service to patients or to the organisation". Perhaps sewing the seed for the position many seem to be in today of shifted priorities detrimental to patient care.

As an educator of occupational therapists, one of the areas I teach is Legal and Ethical issues in practice. Students' awareness is heightened during these sessions of what could constitute harm, neglect and breach of Code that may result in being struck off the HCPC register or taken to a civil court for breach of duty in common law. These sessions are intended to create best practice, adherence to COT Code of Conduct and HCPC Standards of Practice and to ensure that the ethical principles of autonomy, beneficence, non-maleficence, veracity and equity are considered in everyday practice. I still believe that this is vital for a student to understand before they go out onto their first placement (one week observation not included). However, I would like to pose a question.......

Are we in danger of hitting the target and missing the point? Do we as occupational therapists spend too long on process and administration to the detriment of client contact? Whilst most of the discussion in the arena is currently focusing on nursing and medics, allied health professionals will not be excluded and I would be interested to hear what your experience of hitting targets and missing the point may be.