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

A&E target trial continues at breakneck speed

The latest update from the clinical standards review suggests NHS England is increasingly likely to recommend a major overhaul — and potential scrapping — of the four-hour accident and emergency target.

A progress report by the review team repeated the well-rehearsed criticisms of the four-hour target and said a trial of new metrics designed to “remove the four-hour cliff edge” had been “promising”.

NHS England said the preliminary results from the pilot study showed that, while overall waits had slightly lengthened by an average of six minutes, waits for admitted patients had been shortened and the total admissions had been cut.

The Nuffield Trust said it was too early to tell whether these new targets might be an improvement and who the winners and losers could be under the new regime.

NHSE also issued a press release with the progress report which highlighted new polling on the issue. NHSE claimed this showed “people do not understand the four-hour standard”.

It does not take the most cynical mind to suspect this polling might be used by NHSE to claim patients want change — that ditching the four-hour target is the will of the people, to coin a phrase.

But it’s the clinical evidence for change which must really stack up.

And despite NHSE’s tight timeframe — it wants to publish recommendations in March and roll out any changes from April — there must be adequate independent oversight.

NHSE medical director Stephen Powis said it was “too early for us to draw conclusions” and testing would continue over winter, which is very welcome.

The clinical standards review group comprises highly-regarded clinicians, NHS managers and trusted representatives from the major royal colleges.

But the lack of transparency around, and breakneck speed, of the process has so far prevented much independent oversight and scrutiny. This would surely be of great value given the profound impact changing the NHS’ most important performance target could have for years to come.

In need of reform

The parliamentary committee on human rights has published its report from an inquiry into the detention of children and young people with learning disabilities and autism.

None of the sectors or organisations involved came out well in the report findings, least of all the mental health hospitals, which the committee found were frequently breaching patients’ human rights.

Of the national overseers, the inquiry members came down particularly hard on the Care Quality Commission, describing its inspections as “impaired” and in “need of urgent reform”.

In the watchdog’s defence, it has already acknowledged changes need to be made to its inspection process for settings with the most vulnerable patients.

The report also calls out clinical commissioning groups and NHS England for their role in the assurance of safe care — something which has been lacking in other recent reports.

The well-known failures in the transforming care programme were addressed by the committee with calls for a Cabinet Office led unit to push through priorities.

This report should put the safety of patients with learning disabilities firmly on the map, but a strong response from NHSE, the CQC and the government will be required for it to have any traction.