New A&E target branded ‘extremely unambitious’

Adrian Boyle, president of the Royal College of Emergency Medicine, also told the Commons health and social care committee today that the objective – included in NHS England planning guidance for 2023-24 and agreed with government  – could also drive “perverse incentives” for some emergency department managers.

The new target to admit, transfer or discharge 76 per cent of patients by the end of 2023-24 is the first time a specific bar has been set against the four-hour standard for several years. It followed government ending NHSE’s previous efforts to scrap the target, as revealed by HSJ. 

Although the formal standard – setting a 95 per cent target – has never formally been dropped, it has not been met since 2015 and has seen little enforcement in recent years. 

In December, just three acute trusts were hitting the new 76 per cent objective.

But Dr Boyle told MPs: “The aspiration from NHS England is that we return to a four-hour target performance of 76 per cent. We think that is too unambitious, and we think that is going to create all sorts of perverse incentives, because it’s going to encourage managers and senior clinicians just to focus on people who can be discharged from hospital, without dealing with our problem, which is exit block [people who cannot be admitted as wards are full].

“We think the 76 per cent is an extremely unambitious target. It was 95 per cent – I know that’s going to be a long way to go back to and we haven’t achieved it since 2015, but we would say we need to have a trajectory to a higher target.”

Julian Redhead, NHSE’s national clinical director for urgent and emergency care, told MPs that the urgent care metrics considered in NHSE’s “clinical review of standards”, which it had hoped would eventually replace the four hour target, could still have some use in future.

Professor Redhead said: “[The metrics] are still there in terms of potentials that we might be able to use as mitigating or balancing measures towards a four hours target. The four hours target has been useful in the past, it does still provide a basis for how we go forward, to ensure we are providing timely care to the patients.

“There are always ways that departments will try to make sure that they are achieving that target, and we need to make sure they are achieving that target as well as providing that great patient care that I know they want to give.”

‘Biggest strike day in NHS history’

Elsewhere, Chris Hopson, chief strategy officer for NHSE, told MPs that NHSE’s urgent and emergency care recovery plan was due to be published “in the next fortnight,” whilst independent assessments of the long-term workforce strategy are expected in “the next two months”.

Mr Hopson told the committee that factors such as high levels of flu and covid make it “very difficult” to identify the causes of excess mortality – which national statistics suggest has been high since the spring and particularly in recent weeks. RCEM has previously said up to 500 people per week could be dying each week because of emergency care delays, a figure based on research about the link between mortality and long waits in emergency departments.

Mr Hopson said next month will see a “step change” in industrial action between the trade unions and the government, and 6 February would be “the biggest strike day in NHS history” due to a combination of both ambulance and nursing staff due to go on strike, nurses potentially walking out for two days rather than one, and it being a Monday, which is typically a big day for discharge and admissions after the weekend.