Trusts will keep being performance managed against the four hour accident and emergency standard in a bid to maintain “grip” on waiting times. The move comes after the government signalled a relaxing of the timescale for the transition to a new monitoring system.
In a letter setting out changes to how providers will be measured against the new A&E indicators, NHS director of performance Alan Hall said the focus on waiting times should “avoid a deterioration in performance in total time”.
Instead of being expected to achieve the minimum threshold against five of the eight new A&E indicators from 1 July, as set out in the NHS operating framework, providers will have to meet just two of the indicators – one relating to timeliness and one relating to patient impact. Trusts failing to meet these standards will be judged “not achieving” under the NHS performance framework.
However, trusts will also be judged as not achieving if they fail to meet the four hour standard, regardless of performance against other indicators.
The changes mean the acute and community NHS standard contracts 2011-12 will have to be amended.
Health secretary Andrew Lansley announced plans to abolish the four hour target a month after taking office last year. But David Cameron recently promised NHS waiting times would not increase.
National clinical director for emergency care Matthew Cooke told HSJ the changes did not mark a return to “four hours being the sole focus” but said “when announcements were made last summer that the four hour target was going some people interpreted that as time was no longer important. This [letter] was re-emphasising that time is still important”.
“We have had 10 years of a culture of targets… it takes many years to change culture,” he said.
The new indicators were introduced in April to replace the four hour target. They will also be used by Monitor as part of its compliance framework from 1 July. Trusts that fail three or more of the five indicators will be judged as failing, affecting their governance risk rating.
Earlier this year the Foundation Trust Network called for more “lead-in time”.
Professor Cooke said the decision to continue collecting the situation report data on the four hour target was partly because the data was accurate and “worked”, while there were still inconsistencies in data collection on the new indicators.
College of Emergency Medicine president John Heyworth said there had been a “widespread interpretation” of the indicators as targets, particularly among managers.
“This seems to be trying to strike a balance between time and patient impact. Timeliness is important to retain patient flow,” he said.
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