Four-hour A&E standard is the ‘wrong target’, claims Javid

Mr Javid made the claim during an appearance before the Commons health and social care committee yesterday.

He also spoke about the requirement that NHS patient-facing staff must be vaccinated against covid and took the opportunity to restate his belief that radical action was needed to tackle “failing trusts”.

Mr Javid told the MPs: “Targets work if they are the right targets, and in the NHS I have already noticed there are targets which are the wrong targets and we’ve got to change them.

“The four-hour A&E target is the wrong target, it doesn’t work. It leads to really perverse outcomes.

“If you look at some NHS trusts, all of sudden when the individual in A&E has got to three hours and 55 minutes, guess what? They just admit it. That’s a poor outcome.

“There may have been a good reason to have that target in the past, but you’ve got to keep these targets constantly under review and that’s something I’m doing.”

The long-running clinical review of waiting time standards by NHS England had proposed replacing the four-hour target with a suite of other measures but the government has yet to formally respond.

In recent months, there has been a push back against the target’s abolition, with some researchers claiming scrapping it would cost lives. 

Covid vaccination

In the last few days, the government has come under increasing pressure to delay or remove the mandatory vaccination of NHS staff because of the fear it will result in the dismissal of thousands of staff who refuse.

Mr Javid claimed it was the “professional duty” of all NHS workers to be vaccinated against covid, but added that the government’s covid policies would be kept under consideration in light of the omicron variant.

He told the committee: “The whole principle is about patient safety, that’s what motivates me and what motivates the government in this decision. That principle is unchanged… When it comes to patient safety, you have got to think about the benefit of vaccination but also the… cost element of some people not getting vaccinated… and the cost of them leaving.

“Because it would be a cost. No one wants anyone, not one person, to leave the NHS because of this reason.

“Some people say… ‘If you’re going to do it then add boosters because the government and others have already set out the evidence of why two vaccines aren’t quite good enough, and you need three’, [and] others say: ‘Why don’t you drop the mandate altogether?’

“I think it is right, in light of omicron, that we reflect on all this and keep all covid policies properly under review because omicron is different to delta.

“Equally, we don’t know what the next variant is going to be, we talked about that earlier, but we are reflecting on all of this.”

Failing trusts

The health secretary was asked about how he would improve the performance of struggling NHS organisations.

He said: “We’ve got to do everything we can to make sure the leadership of every trust is as good as the best. There’s a big variation in leadership.

“I’ve seen trusts that, I think, are remarkably well run and you really see the results… they have been tested a lot during the pandemic and they have come out of it with great leadership.

“But also, I’ve seen other trusts that are just consistently, I think, failing. They are failing local people, they are failing on the way it’s delivering electives or other types of care, and that’s a problem.

“That’s why I’ve got an independent [Messenger] leadership review going on because I want to see how we can replicate the best and spread it throughout the NHS.

“We must be radical in the changes that we make. That elective waiting list is huge, no one wants to see a waiting list at this level, [but] we all understand why we’ve got this covid backlog.

“But if we are going to get through it, far quicker than in the past, we’ve got to be radical in the changes that we make and how we make them.”