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NHS England’s plans to offer trusts up to £4m in a last-ditch effort to meet the four-hour emergency care target in March have been criticised by trust chiefs and experts.

NHSE confirmed on Tuesday that extra money will be given for the top ranked and most improved trusts against the four-hour accident and emergency performance in March.

The move was taken just weeks ahead of the deadline for trusts to meet the 76 per cent A&E four hours target at the end of March – national leaders have been increasingly desperate to ensure the target is met.

The extra cash is being released in a significant expansion to the criteria for trusts to access a share of a £150m capital incentives fund for improving emergency care performance, which was originally announced last year.

But chief executives of community trusts have publicly criticised NHS England’s plan – claiming that only acute providers are being incentivised while other system partners are “ignored”.

One CEO, Tracy Allen of Derbyshire Community Health Services Foundation Trust, said “it blows a hole in the longstanding NHSE argument (and truth) that managing ED access requires a whole system approach, sharing risks and transforming pathways way beyond the walls of acute hospitals.” She described the move as “very disappointing”.

However, one acute trust CEO told HSJ they were comfortable with incentivising improvement and overall delivery as it brings “focus”.

The letter, from NHSE’s national urgent care director Sarah-Jane Marsh and chief financial officer Julian Kelly, said the expanded incentive scheme would “ensure that more organisations are rewarded for the improvements they are able to make to the timeliness of patient care, and are therefore able to further invest in their infrastructure.”

The vanishing

Two acute trusts within the same integrated care system have uncovered nearly 2,500 “missing” elective patients, leading to the abandonment of a local target for reducing wait times of 65 weeks or more.

Ashford and St Peter’s Hospitals FT confirmed the discovery of approximately 2,000 patients who had “dropped off the system” and required appointments. Meanwhile, Royal Surrey FT identified 350 patients who needed to be added to the referral to treatment list due to “individual errors” in processing.

When queried by HSJ, both trusts declined to disclose the duration of wait times for the affected patients.

In board papers, Surrey Heartlands Integrated Care Board revealed the findings and admitted it was unlikely to meet its local target of having a maximum of 500 patients waiting for at least 65 weeks by March. Instead, it now anticipates 633 patients waiting for 65 weeks or more, including 119 who will have waited more than 78 weeks.

The ICB debated commissioning an “independent review of processes” but ultimately decided against it after receiving assurances from both trusts.

The most recent official RTT figures for January indicated over 2,131 patients waiting for more than 65 weeks across the system. Board papers showed a significant increase in long waiters at ASPH in October and at Royal Surrey between November and early January.

Also on hsj.co.uk today

A simulation exercise at Leicester Royal Infirmary revealed vital lessons in managing neonatal unit evacuations during major incidents, emphasising the need for tailored training and inter-agency collaboration, write Leanne Dearman and colleagues in a Comment piece. And in Following The Money, Henry Anderson offers a detailed breakdown of the implications of last week’s Budget.