The NHS England medical director has said the quality agenda ‘should define the financial strategy’ for NHS chief executives, amid growing pressure to make cost savings.

  • Scrapping waiting times targets “has zero relationship to the finances”, says Sir Bruce Keogh
  • Changes to reporting not an attempt to cover up failure
  • NHS England medical director sets out principles for future changes to targets

Sir Bruce Keogh also explained his decision to remove two of the three elective waiting time targets, and to change publication of accident and emergency performance data from monthly to weekly.

He spoke to HSJ last week, as national leaders made announcements focusing the NHS’s priorities on making large efficiency savings this year. These include limits on agency spending for clinical staff, and the Care Quality Commission measuring efficiency as well as quality.

Bruce Keogh

Bruce Keogh’s target decisions ‘has zero relationship to NHS finances’

He said the changes he had recommended to NHS England chief executive Simon Stevens on performance targets were not related to finance. He said: “Let me be absolutely clear. My focus on [referral to treatment standards] has zero relationship to the finances of the NHS and a 100 per cent relationship to how we make it easier for organisations to do the right thing.”

Asked whether chief executives were being sent a message by health service leadership to prioritise finance over quality, Sir Bruce said: “We have remarkably courageous chief executives in our NHS who are driven by powerful values of public service.

“These values are the same values that drive their clinical colleagues, to help people who are anxious and in pain. I recognise they have the added burden of finances.

“I have always argued that the quality agenda should define the financial strategy, not the other way round.”

The medical director responded to accusations that the proposal to move all public reporting against performance standards to monthly, including for accident and emergency waiting times, which are currently reported weekly, was intended to cover up failure.

He said: “I’m very worried about that perception because I’ve spent the vast majority of my professional career arguing for transparency and I believe transparency is one of the strongest drivers for quality in our health service.

“But transparency should also be accompanied by simplicity and coherence, and at the moment we publish data in a way that’s remarkably haphazard, both in timing and in presentational style.”

He said the current approach “sometimes makes it easy for people to draw isolated conclusions out of context”.

He added: “I’m not and never have been and never will be in the business of manipulating either the presentation or publication of data to hide anything.”

Sir Bruce’s recommendations say there will be further consideration of the A&E four hour waiting time standard and of a pilot change to an ambulance response time standard.

He set out several principles for the “direction of travel” for targets. He said changes should be set:

  • according to “where we need to make the most improvement”;
  • to “respond to public expectations”; and
  • to “respond to changing medical achieve and technology which may influence the way we’re able to deliver services”.

Sir Bruce added that they should be “simple and easily understandable”, and that “we have a duty, if we recognise that a target is creating a perverse incentive, to address that”.