Senior NHS chiefs have begun ramping up the pressure on providers and commissioners to improve performance in accident and emergency during a round of high level meetings which began last week.

Held already in Portsmouth and Brighton, the meetings are headed by the chief executives of the NHS “tripartite” organisations: Simon Stevens from NHS England, David Bennett from Monitor and David Flory, from the NHS Trust Development Authority.

They come amid growing high level concern that any demand for extra resource will depend in part on the service’s ability to use additional income already received to hit national A&E targets.

Around a dozen areas are expected to be summoned to the tripartite meetings over the next month, HSJ understands.

The meetings are being held with members of each area’s “system resilience group”, which brings together providers and commissioners to plan how to hit key emergency and elective surgery targets.

The national leadership is understood to be concerned that failure to hit the four hour A&E standard, despite more than £600m of extra cash being ploughed into the system resilience group regime, could undermine the case for extra investment in the NHS.

Mr Stevens last month told senior NHS leaders gathered at regional meetings that failing waiting time standards could hamper efforts to secure funding increases, HSJ has learned.

The service had to demonstrate it could use additional money to meet standards, he is understood to have said.

The latest figures for the week ending 26 October show nationally just 93.7 per cent of patients were admitted or treated and discharged within four hours, against the target of 95 per cent.

When figures for minor injuries units and urgent care centres are excluded just 90.6 per cent of patients were seen within the target time.

In the same week last year the figures were 95.3 per cent and 92.9 per cent respectively.

Last week eight trusts had performance below 80 per cent, compared to just one at the same time last year.

Sources with knowledge about the talks said they would focus on making sure organisations’ plans for the system resilience money will be about improvement in performance.

In a joint statement the TDA, Monitor and NHS England said: “There is little doubt A&E departments are the pinch point of the health and care system; when there are problems elsewhere, they are usually found here. 

“This is why senior leaders from Monitor, NHS England and the TDA have been speaking to NHS organisations in areas currently facing the biggest challenges to their urgent and emergency care systems to ensure they are doing everything they can to improve performance for the benefit of patients, and have any support they need to do so.”  

Russell Emeny, director of the emergency care intensive support team at NHS Interim Management and Support, told HSJ the poor A&E performance was being driven by an “acute sector running at such high bed occupancy rates that even minor variations in demand or capacity can lead to crises”.

“The solid and systematic implementation of good practice is the cornerstone of effective emergency care. This takes time, money and collaboration both within hospitals and across local health systems.

“It’s unlikely that calling in chief executives will do more that set them on the right path. They need support, encouragement and, importantly, an understanding of what ‘good’ looks like.”