Indiana Lansley and the 18-week NHS target

As Indiana Lansley approaches the altar sweat pours down his face. Lansley tries to control his pounding chest and rattled nerves as he eyes his prize. To get to this precarious spot he ducked the poison darts from the opposition benches, he rolled past the whirling blades of the BMA, he outwitted the deadly collapsing floor of his backbenchers. His companion wasn’t so lucky and his body is still impaled on the wall of the commons lobby as a warning to others to leave things that don’t belong to them well alone.


Indiana Lansley and the 18-Week Idol

As Lansley squats in front of the idol created by the Labour tribe, the danger he has faced melts from his thoughts as he is calmed by the simplicity of the creation that sits quietly before him.

He is still.

But Lansley knows that he is not out of danger yet. He steadies himself and mentally weighs the golden object before him. He takes a bag in his right hand and measures the policy ideas it contains. He looks again at the idol and back to the bag. He takes a fistful of directives from the bag and drops them to the stone floor. He glances back at the statue and then discards a few more diktats from the bag. He is ready. His right hand holds the bag as close as possible to the idol, his left hand poised on the other side.

One more breath.

As the last wisp of air leaves his lungs he smartly tips the idol off the plinth, simultaneously rolling the sandbag into its place with a gap that could never be noticed. Or so he hopes.

Lansley pauses. Waits. Listens. His body still taut.


His shoulders drop a fraction and he allows a small smile of relief and victory to creep across his face. He starts to stand to leave with his prize. For a fleeting moment he has done it. He has removed the Golden Idol of the NHS 18-Week Treatment Target. No one thought he could do it. Even he wasn’t sure. He knew it was the right thing to do. But has he forgotten something from the ancient legends?

Lansley tenses. A deep, distant rumble. In a moment the roof of the cavern is crashing down. The floor cracks beneath his feet. The altar explodes in his face. He must run.

As he dodges more darts and nearly loses his Fedora to spear flying out of a wall beside him, his mind rushes back to the warnings of the old man in the village. The sage said that you can’t just remove a target and replace it with sand. “It is right,” said the man, “to remove the 18-week target. The Labour tribe wouldn’t listen when it was said they shouldn’t create the evil target idol in the first place. The problem is that targets appear to magically work even if they are really dysfunctional. But if it is to be removed it needs to be replaced with a proper method. So if you take it away, as you must, you need to leave in its place a sustainable way to treat patients well. Only the timely and appropriate delivery of treatment in the NHS will stop the whole thing collapsing. Only then will the 18-week target not be required, and it can be beaten in in ways no one could imagine.”

All at once, Lansley screeches to a halt amid all the chaos and dashes back through the flying debris. Swinging the 18-week target high he brings it crashing down onto the splintered remains of the altar. “Come on!!” he shouts. Surely putting the 18-week target idol back will stop the pandemonium and collapse? Nothing changes. In fact the disintegration of the NHS seems to hasten.

Indiana Lansley rushes for the fast dropping door. If he doesn’t make it he will be crushed by the rubble of the NHS, never to be seen again. As he runs he can feel the glow of the 18-week idol behind him. Its power burning into his spine as he flees. The door falls ever faster.

He has always got there in time before…

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  1. Helen Jackson -

    Phrases along the lines of “ careful what you wish for..”, and “..people will chase what they are measured on..” spring to mind.

    Excellent blog with two really critical messages from a Lean perspective. 1.Unless you measure the whole process from the cutomer’s viewpoint, not just one aspect of the process, you are unlikely to achieve a sustainable and satisfactory outcome. 2.If you don’t measure anything you will achieve chaos (however, even that is better than measuring the wrong thing, which gives you expensive chaos!!).