Exclusive: Ministers ditch NHS England’s A&E target review

Multiple senior figures familiar with the process, from inside the NHS and government, said the performance focus for the next two years will be on the two existing accident and emergency waiting time measures, as well as ambulance handover delays.

For the last three years, NHS England has been lobbying government to scrap the headline four-hour target, and replace it with a bundle of measures which have been trialled at around a dozen providers. This work has been led by medical director Steve Powis.

HSJ understands the decision to continue using the existing four-hour target was driven by concerns among ministers and senior NHS figures that the bundle of measures was too confusing, both for patients and as a means for government to hold the service to account.

Health secretary Steve Barclay has also announced he wants to slim down the number of NHS targets and focus on delivery.

The sources told HSJ the decision had been taken ahead of, and was represented in, the asks outlined in the government’s autumn statement. The statement said the NHS would need to publish full recovery plans in the new year to make “year-on-year improvements in A&E waiting times over 2023-24 and 2024-25”.

Ministers hope a stronger focus on the four-hour and 12-hour waiting times can help the system get a much better grip on performance after a chaotic few years, during which the protracted targets review has often been viewed as a distraction, with major concerns about the lack of transparency around decision making.

While the pandemic has clearly been the main driver of vastly inflated waits, emergency care leaders have also blamed NHSE’s decision to signal that the four-target was being scrapped (without formally replacing it) for leaving the system “in limbo” and causing a “performance vacuum”.

NHSE declined to comment, but did not dispute that the existing four-hour target and 12-hour breaches would be the primary focus of regulatory attention. However, one source said the clinical review of standards remains ongoing.

In September, the short-lived health secretary Therese Coffey told the House of Commons the four-hour target would be retained, but this was never backed by substantive detail, and such was the chaotic nature of the Liz Truss premiership that the comments were not viewed as a definitive decision. Mr Barclay’s intervention is understood to be substantive.

NHSE has been lobbying ministers for over three years to ditch the four-hour standard, and replace it with a new basket of measures which a group of trusts have been trialling since April 2019. NHSE bosses had long been confident they had won the argument, following consecutive health secretaries, Matt Hancock and then Sajid Javid, backing their reform agenda.

The reforms also had the backing from NHS Providers, patients groups including Healthwatch England, and, critically, the Royal College of Emergency, which had initially opposed ditching the four-hour target.

The Department of Health and Social Care declined to comment directly on the CRS being ditched. The department said in a statement: “We have supported NHS England and its senior clinicians to look at the way performance is tracked. Existing performance standards including the four-hour standard remain in place, and we continue to work with the NHS on the next steps.”