As a follow up to both points.

I think all the targets will always create an opportunity for the media to push endless negative coverage simply because it's easy, lazy journalism to constantly beat up the NHS and it sells papers. This seems relentless last year.

The politicians will introduce, remove, change and play the targets to suit themselves and Mr Hunt is busy doing it already in his new term. Watch the targets fall away as further financial pressures pile up and he fails to correct the poor ones. He has already killed off the NICE work on safe staffing numbers, guess where that's leading!

We do need targets, the NHS like all organisations needs them and I agree with having the 4 hour target in A&E. As correctly suggested it's no perfect but it's valuable for most patients and maintaining a focus.

When we shine a spotlight on department heads and managers more generally we most be mindful of the way they are pulled in every direction between finances, staffing, targets, safe practice even stupid friends and family surveys. I believe every member of a hospital has patient care at their heart but these very strong influences can make this a significant challenge for them. When so many trusts are not massively overspent, the CCGs fining trusts for missed targets, threats of reduced payments, many CEOs told in no uncertain terms in the lead up to the election to 'make stuff happen' it makes it a minefield of compromises and people trying not to play the system.

It's interesting that Mr Hunt took such a tough line on bullying in the past year, but it was his own department that enacted this bullying more than anyone (filtering it through the system from the very top) and much of this was focused on trusts meeting their targets to ensure the government did not loose face in the run up to the election.