• A&E chiefs: “We’ve not been consulted on targets since 2017”
  • Other senior figures say process lacks transparency and consultation
  • NHSE said any new targets would “deliver highest standards to patients in most need”

Concerns were raised this week about the consultation process and the “brave” implementation timetable for a major review of NHS performance targets, due to publish recommendations in the spring.

Top emergency medics said they had not been formally consulted on target changes since 2017, while other senior clinical and management figures privately raised similar concerns.

NHS England told HSJ this week the focus was on “delivering the highest standards of care to those patients who need it the most” – a message already voiced by its chief executive Simon Stevens last week in a national media interview.

The statement was seen by some senior figures as an indicator that tougher standards for the most urgent patients would inevitably require watering down standards for less serious conditions, given the relatively limited funding settlement.

The Royal College of Emergency Medicine told HSJ it was “surprised and seriously concerned” it had not been formally consulted by the review team, despite senior NHS England figures discussing proposed changes in the media.

HSJ understands much of the review’s early focus has been around the four-hour accident and emergency standard, which has not been hit since July 2015, but it had also discussed the 18-week elective treatment target.

The review has taken soundings from some of the colleges, HSJ has been told, but some sources were privately critical of the lack of transparency around the politically sensitive review.

One respected figure said the timetable set out in the NHS planning guidance to “begin implementing” new emergency targets from October was “extremely ambitious…brave” and left little time for meaningful consultation. The view was shared by several other senior figures HSJ contacted.

RCEM said the review, led by NHSE medical director Stephen Powis, must not move “the goal posts without any evidence review, expert discussion or clear collaborative planning”.

College president Taj Hassan told HSJ: “The college has not been consulted at any stage on this issue since 2017. As the expert academic body on the standards of safety and clinical care delivered in emergency departments this is surprising and of serious concern.”

Dr Hassan said the four-hour target had been “a resilient, sophisticated and very successful overall marker of a hospital’s emergency care system performance for the last 15 years”.

It followed HSJ reporting last month that the review had discussed removing the four-hour target for minor ailments – a move the college said it would strongly oppose.

NHSE did not comment on removing the target for minor ailments, although sources told HSJ a number of senior NHSE figures had been pushing for a robust trail of such an option.

NHSE did, however, tell HSJ that at no point had the review discussed more radical proposals to remove the standard for all non-admitted patients.

Professor Powis said in a statement to HSJ that no decisions had yet been taken by the review.

He added: “We have been clear that the tests for any final proposals will be that they measure what matters to patients, and support staff to deliver the highest standards of care to those patients who need it the most.”

NHSE chief executive Simon Stevens has already put his weight behind reforming the four-hour target, saying that the standard did not distinguish between a strained finger and a heart attack, and was not well understood by the public.

He said during an interview on the BBC Today programme that the NHS needed “a tougher, faster set of standards for some major conditions like…sepsis, heart attack and stroke”.

An NHS England spokesman said: “[Professor Powis] has been working with the Academy of Medical Royal Colleges, Healthwatch England and many others on what matters most to patients, on the clinical issues with the current target regime, and what NHS staff believe will help them provide the best quality care for patients. Any recommended changes will be carefully field tested across the NHS, before they are implemented.”