Two headline waiting times targets for planned care are being dropped by the NHS on the basis they are creating ‘perverse incentives’, HSJ can reveal.

The move to drop the admitted and non-admitted elective waiting time targets is expected to be announced by the health secretary this morning.

The third elective target - the “incomplete standard”, which states 92 per cent of patients who have not yet started treatment should have been waiting no more than 18 weeks - will be retained.

Bruce Keogh

Bruce Keogh wants to ‘abolish the measures as soon as practically possible’, he said

However, a review of current waiting time standards by NHS England medical director Sir Bruce Keogh has said the main accident and emergency target - to see 95 per cent of patients within four hours - should be retained.

A letter from Sir Bruce (see attached) shared with HSJ states: “My advice is that we abolish the admitted and non-admitted measures as soon as practically possible, [instead in future only] using the so-called incomplete standard - the only measure which captures the experience of every patient waiting - as our main measure.”

The letter says: “The NHS constitution sets out that patients should wait no longer than 18 weeks from GP referral to treatment. That is an important commitment which must be maintained.

“However, we currently measure this in three potentially conflicting ways - through the admitted, non-admitted and incomplete standards. It has become increasingly clear that within this confusing set of standards there are in-built perverse incentives.

“The admitted and non-admitted standards penalise hospitals for treating patients that have waited longer than 18 weeks. As soon as a patient has crossed this threshold, a hospital will effectively receive a black mark for treating them. While hospitals may be the ones penalised directly, the true penalty is for the patient. This cannot be right.”

The letter also claims that the move will “reduce tick-box bureaucracy and expose hidden waits”.

It says that a current pilot to change ambulance waiting time targets, giving services additional time to consider whether to send an ambulance, will be extended in the summer.

In relation to the four hour A&E target, Sir Bruce says it will be retained, but there will be further consideration of how to use it alongside a “wider range of clinical measures” of urgent care.

A letter (see attached) due to be sent by NHS England chief executive Simon Stevens to NHS chief executives today states: “The NHS has made dramatic reductions in recent years in waits for care, which has been a key driver in record rates of public satisfaction with our services. We are determined to lock in that achievement, and go further cutting waits for other services, including mental health.

“In doing so, we want to ensure that the way the key NHS Constitution standards are tracked makes sense for patients and does not give rise to unintended consequences. To that end I asked the NHS’ national medical director, Sir Bruce Keogh, to review how this is being done.”

It says he has “considered [Sir Bruce’s] recommendations, and discussed them with the secretary of state” and “our aim is that these should take effect very quickly, and NHS England will be issuing operational implementation guidance shortly”.

HSJ has also revealed today that work has been stopped on minimum staffing guidance by the National Institute for Health and Care Excellence, in response to Mr Stevens announcing a review of this approach.


What targets have been dropped?

The main referral to treatment standards prior to the review were that 90 per cent of admitted and 95 percent of non-admitted patients should start consultant-led treatment within 18 weeks of referral. Both these will be dropped. NHS England guidance prior to the review states: “In order to sustain delivery of these standards, 92 per cent of patients who have not yet started treatment should have been waiting no more than 18 weeks.”  This is the standard which will be retained.