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

Target practice

NHS bosses have set out controversial plans to ditch the NHS’ four-hour emergency access target, despite concerns removing the uniform benchmark could lead to quality standards being watered down.

NHS England was keen to stress this was not a fait accompli and the proposals would only get the green light if they pass a period of piloting and consultation, which begins next month.

This may well be true, but managers certainly seem in a hurry to make their decisions about the future of what, since 2004, has been the key NHS performance indicator.

A testing period for the new standards will run from April 2019, a further rollout following in autumn 2019 and then full rollout from April 2020 (should it pass the pilot phase).  

Compared to the recent changes to ambulance targets – after all, it took several years to reform this less far-reaching target – this looks very ambitious.

The timing was also unfortunate, coming just a month after the health service slumped to its worst ever performance against the four-hour benchmark.

The NHS last hit the four hour target in July 2015. It may now fail to do so ever again.  

To summarise

Eight months ago, the Dudley Group Foundation Trust’s chair Jenni Ord received the kind of mail no chair wants to receive – a whistleblowing letter from 42 senior clinicians, raising concerns over the behaviour of the trust’s chief executive, former chief nurse, medical director and head of HR. 

Fast forward to the end of last week, a summary of a long-awaited report into these allegations has been published, concluding the claims could not be substantiated by the law firm tasked with carrying out an independent review. 

Some have welcomed the summary findings, calling for the board to be allowed to move on. Others are more sceptical, with a local union rep dismissing the report as “whitewashing” clinicians’ concerns. 

A few commentators have pointed to the trust’s recent poor staff survey results. Staff satisfaction with the quality of care has dropped over the last year, while the proportion of staff saying they have experienced bullying and harassment has risen. 

The summary review has also been published at a time when the trust is struggling with its accident and emergency performance. It was rated “inadequate” for urgent and emergency care services and received four formal warnings from the Care Quality Commission