• ‘A&E special measures’ plans set out by system leaders this month will not go ahead, Jim Mackey says
  • The regime was trailed in a letter sent to London trusts from NHS England and NHS Improvement directors
  • It prompted concerns from senior managers that the move would not help address systemic issues

A proposal to introduce “A&E special measures” will not go ahead, NHS Improvement chief executive Jim Mackey has told HSJ, after it was revealed in a letter to trusts.

Mr Mackey issued a statement to HSJ today which said the regulator would “not be introducing a new type of special measures for A&E performance” – an idea which had prompted criticism from senior NHS managers.

The move followed HSJ revealing last week that a letter jointly signed by NHS Improvement and NHS England’s London regional directors, sent to trust leaders in the region, said that “if [a struggling system] fails to deliver improvement by June, consideration will be given as to whether they will be placed in A&E special measures to ensure patient safety”.

The letter, sent on 17 March and seen by HSJ, added: “The plans will be monitored weekly by NHS England and NHS Improvement regional directors, with systems meeting with Simon Stevens, Jim Mackey and [national leader for A&E improvement] Pauline Philip before Easter to discuss implementation plans.”

HSJ understands the idea of an A&E special measures regime was part of discussions about how to try to improve performance in health systems, but has now been dropped. It is unclear whether the “special measures” regime would have been applied to health systems or trusts.

Mr Mackey said in today’s statement: “We are absolutely focused on improving A&E performance across the country and we will be working with those most challenged hospitals and health areas to ensure waiting times are reduced.

“We will step in to provide intensive support to providers and health systems that are not able to improve sufficiently on their own, but NHS Improvement is not introducing a new type of special measures for A&E performance.”

The London letter prompted senior managers to raise concerns to HSJ, and readers also raised concerns in response to HSJ’s report last week.

One HSJ reader, whose view is known to be held by other senior managers, said: “I think NHS Improvement have to really think about what they are doing. Quality special measures and financial measures are largely in the gift of trusts – A&E is most definitely a system issue. So, if they are serious, it is the system which needs to be judged, not the A&E.”

The letter also said that trusts would be placed in one of four groups. HSJ understands this system will still be retained. The four groups are:

  • Group one: Systems with longstanding challenges and the highest level of intervention and support
  • Group two: Systems with low levels of performance and a high volume of breaches that require regional intervention and support
  • Group three: All systems not in groups one, two or four that will be monitored by the region via urgent and emergency care elements of their STPs
  • Group four: High performing systems that are delivering consistently

The moves are part of a number of national measures designed to get the system back on track against the four hour waiting target, which has become the key focus for system leaders.

HSJ revealed that from April, sustainability and transformation fund money would only be made available to trusts hitting their A&E targets. During 2016-17 the funding is also depended on cancer and elective waiting time targets.

Providers have also been told to ensure every hospital has a front door “streaming model” by October, linked to an additional £100m capital funding announced in the spring budget.

NHS Improvement has told trusts to reach 90 per cent of patients being seen in four hours by September, and to reach 95 per cent by March 2018. The NHS mandate published earlier this week, however, included a slightly delayed target of the end of the 2018 calendar year.