• Changes to new targets — including in A&E — to be phased
  • Will be introduced alongside change to service models
  • NHS needs to “right-size” on beds

The NHS can expect a phased implementation of new operational targets from April — instead of a full switchover on day one — NHS England’s number two has said.

In an interview with HSJ, chief operating officer Amanda Pritchard said its testing so far still suggested — as NHSE’s clinical review of standards reported before Christmas — the four-hour emergency target did not work well for the current model of care.

However, she said introducing new measures needed to take place alongside — rather than ahead of — further redesign of urgent and emergency services. Ms Pritchard said this included, for example, reducing bed occupancy to around 92 per cent, redesigning emergency departments, developing 111 and urgent treatment centres, and improving the response of community reablement services.

She told HSJ: “We know that implementing new measures in itself isn’t going to suddenly, dramatically impact on the way that we provide care. What this is about is helping us drive the improvements in A&E care that we’re looking for, as well as for mental health care, cancer and elective care, over the coming years.”

However, these proposed next steps indicate the NHS should still expect changes to the four-hour target to go ahead, despite recent renewed concern about the move.

The clinical review of standards is due to report again next month, and as well as emergency care, is considering changes to targets on cancer, mental health, and elective services — but final recommendations on the latter two are not expected until next year.

NHSE planning guidance for 2020-21 said there would be “further operational guidance” on targets in March.

Ms Pritchard, who took up her role with NHSE/I last summer, having been Guy’s and St Thomas’ Foundation Trust chief executive, said this would tell people what was required in 2020-21. 

But she said it would not involve a wholesale switch to the standards on 1 April, but instead a “phased implementation”, alongside the service reforms.

Meanwhile, in relation to the planning guidance’s request for acute hospitals to keep winter beds open, and to move to 92 per cent bed occupancy — down from the current 95 per cent — she said: “We are the least bedded health service in Europe. What the guidance is trying to do is find the right balance between saying absolutely let’s keep going on efficiency, redesign and transformation, but we have got to right-size ourselves for the population demand that we now have.

“Because there is a proportion of patients who are sick and need to be, in our current model, in beds — and that’s not the wrong thing for them.”

She said that if service redesign, transformation and efficiency work did not continue, the growth in beds would need to be even greater. 

ICSs must move beyond ‘transformation’, says Pritchard