'Experiment' for new A&E target in the Midlands

Sandwell and West Birmingham Clinical Commissioning Group has launched the project due to concerns the four hour A&E target “is driving the wrong performance” from providers.

It is being supported by Midlands and Lancashire Commissioning Support Unit, which is subject to formal oversight and direction by NHS England.

The news comes after Simon Stevens, NHS England’s chief executive, said the four hour target may be outdated, as well as calls from high profile trust leaders to make the target “more clinically relevant”.

Board minutes published in July said the CCG would be working with the CSU to pilot a “case mix adjusted target” with five trusts that had expressed an interest: Sandwell and West Birmingham Hospitals Trust, The Dudley Group Foundation Trust; Shrewsbury and Telford Hospital Trust; and Royal Wolverhampton Trust and University Hospital of North Midlands Trust.

The document said there was “sufficient interest to run a controlled experiment”. It added: “Over a period of time, concerns have arisen with the 95 per cent accident and emergency target which is driving the wrong performance out of the system in pursuit of the target…

“One piece of evidence is the admission profile where there is a huge spike at 3 hours 53 minutes which shows very strongly there is a decision making point that says we have run out of time and does not bear any relationship to the clinical situation and is clearly target driven.”

The providers will still be formally regulated on the official four hour A&E target. But the pilot means they would also be monitored locally on the new case mix adjusted target, which effectively adjusts the maximum waiting time depending on the type of patient, or case.

HSJ understands the pilot, for which there has been engagement with NHS Improvement and NHS England, will begin this year and initially gather data on the different mix of patients admitted and presenting in each trust.

Following this, the trusts will implement a target base on the case mix identified through the data.

It is expected to last eight months, with initial costs of £15,000, and will also look into the admissions pathway within each trust.

In June, prime minister Theresa May said there would be a review of NHS targets.

A spokeswoman for Sandwell and West Birmingham CCG said: “We have had informal conversations with local providers and partners to gauge their interest in contributing to what has now become a national conversation.  We remain committed to this piece of work for our local population. But we are still in the scoping phase and no formal discussions have yet taken place with our partners.” 

 Article updated at 5.30pm on 3 August 2018 with a comment from the CCG.