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Trusts have been told by NHS England to focus on non-admitted emergency patients in a bid to meet a key national target, HSJ has learned.

Pressure appears to be coming from NHSE’s regional teams for trusts to focus heavily on non-admitted emergency performance to meet the 76 per cent target for four hours accident and emergency performance by the end of March, sources have said.

The NHSE edict has raised concerns among some trust chief executives that the focus is “non-patient focused” and “politically motivated”. However, one CEO has welcomed the move.

The Royal College of Emergency Medicine and others have previously warned that greater focus was needed on admitted patients – as they are the most likely to suffer long waits and harm.

Most acute trusts are consistently falling short of the 76 per cent target, and it has not been met nationally during any month of 2023-24 so far. RCEM has previously branded the 76 per cent target “unambitious”.

Birth control

Very few HSJ readers are likely to choose to give birth unassisted. But an increasing number of women do seem to be going down this route – and that presents a challenge for the NHS.

Some of these women will give birth without problems and not come into contact with the NHS during labour but others will call for help or change their mind as labour starts. Trusts may then be reluctant to send a midwife, either due to staffing levels or because they know so little about the woman and her pregnancy and would rather see her in hospital, where more help is there if needed.

Now the Nursing and Midwifery Council is getting interested parties together – though whether this will result in a joint policy is uncertain. One thing which might help is a better understanding of how to encourage women who want an unassisted birth to have safer births.

For some it may be reassurance about midwife-assisted births or births in hospital which could change their minds; for others it may be a fall-back plan and help to recognise when things are going wrong. Heavy-handedness or threats of social services referral will simply drive this phenomenon deeper underground.

Also on today

A welter of red tape is hampering commissioners in Devon in their desperate bid to save cash as part of efforts to exit NHSE’s special measures regime, writes Nick Carding in West Country Chronicle. And we report that capital spending plans in some health systems are being adversely impacted by an accounting change that was not supposed to affect operational decisions.