The must-read stories and debate in health policy and leadership.

Don’t rush it

The headlines from the monthly performance data make grim reading; admissions up 6 per cent in 12 months at major accident and emergency departments, total attendances hitting a record 2.27m and four-hour performance down again last month.

The figures show that, for the first time, the winter crisis in A&E has continued straight into summer, with no respite or recovery, and lay bare the NHS’s failure to curb demand, an ambition it pledges year after year.

When dealing with figures of such epically gloomy proportions it is crucial to stress they are not a poor reflection on the efforts of frontline staff.

Despite soaring temperatures, ever increasing capacity and workforce constraints and a gruelling winter, hospitals managed to treat, admit or discharge a record number of patients – 1.8 million – within four hours in July.

The figures raise wider questions about why the demand continues to surge and what can be done about it.

But they also prompt a more immediate question; with the system heading into what all the data indicates will be its toughest winter ever, is now the time to fast track through a new A&E performance regime?

NHS England has cogently set out the shortcomings of the four-hour target in its clinical standards review which also set a bold timetable with new A&E performance targets to be rolled out nationwide from April 2020.

But, as our survey last week revealed, managers view the existing target as a valuable tool for measuring and managing hospital and systemwide performance, despite all its undisputable faults.

If a new system is to be introduced, it will also doubtless have faults. So there needs to be enough time to ensure whatever the new regime is, it is materially and demonstrably better than the existing one. Otherwise, why bother changing?

A rushed approach will only raise the prospect of a botched implementation without securing sector-wide buy in, which would heap further misery on a system already teetering on breaking point.

While commending system leaders for grasping the nettle on reforming and updating the performance standards, it would be wise to take a more measured, transparent approach, and the time to secure buy-in from across the health service on whatever the review concludes.

Devon exemplifies national autism challenge

Much work is being done to deliver improved autism care across the country since the long-term plan singled out the neurological disability for the first time.

A clear example of the challenge facing the NHS can be found in Devon, where children and teenagers face an average wait to be assessed following a referral of 67 weeks. The longest recorded wait is 122 weeks.

Given the fact the recommended maximum waiting time is three months (according to the National Institute for Health and Care Excellence), it’s clear the service is failing its users terribly.

In addition, there is now a record number of under 18s in Devon awaiting assessment with 1,800 children and teenagers stuck on the waiting list, their families sharing in their anguish.

The situation appears to have reached a tipping point now, as Devon Clinical Commissioning Group has begun the search for an extra provider to reduce the backlog.

Time will tell if the initiative succeeds.

It’s important to point out Devon is by no means alone in struggling to cope with the number of people referred for autism assessment.

Research last year by former health minister Norman Lamb revealed a snapshot picture showing people waiting at least a year for assessments in Berkshire, Yorkshire and Staffordshire.

In this context, the National Autistic Society’s Anna Bailey-Bearfield described the situation in Devon as “unsurprising”.

She hopes to see improvements nationally after September, when NHS Digital publishes the first collected figures on waiting times for autism assessments across the country.