NHS performance against the four-hour accident and emergency target hit a new record low in February – for the second month in a row.

NHS England data, published today, revealed overall A&E performance was 84.2 per cent – down from the previous record low of 84.4 per cent in January – against a target of 95 per cent. The target was last hit in July 2015.

Performance for major departments, type ones, was 75.7 per cent, which was down on the previous record low of 76.1 per cent in January 2019 and 76.9 per cent for the same month last year.

The data also revealed a huge increase in demand compared to the same period last year as the system faced what NHS Providers said was the “toughest month to date for NHS” on all standards.

NHS Providers said in addition to the A&E pressures, this was the also the first time that all three of the key core cancer standards have been missed – two-week referral; 31-day treatment from decision to treat and 62-day from referral to treatment. Overall, the NHS is now missing seven out of the nine cancer key standards.

The number of A&E attendances admitted, transferred or discharged within four hours was 1.65 million, a 6.3 per cent increase on the equivalent figure for February 2018. Of these, 934,000 were type one attendances, an increase of 5.4 per cent.

Two trusts hit the type one target, Luton and Dunstable University Hospital and Yeovil District Hospital Foundation Trusts, while one trust, Lancashire Teaching Hospitals FT, recorded type one performance below 50 per cent.

The data comes just days after NHS bosses set out controversial plans to ditch the four-hour target – despite concerns removing the uniform benchmark could lead to quality standards being watered down.

Several senior NHS chief executives have since raised fundamental concerns about the proposals, warning scrapping the four-hour target would be a “disaster for patients”.

The manner in which the much anticipated review was published on Monday and the tight implementation schedule for the proposals also drew criticism from managers. One NHS figure told HSJ that it felt like “a process is following a decision”, a view echoed privately by others.

Meanwhile, NHS Providers stressed the process should not be rushed, following concerns being raised about the timetable set out in the proposals which involves pilots from next month and a full rollout by April 2020.

NHS Providers deputy chief Saffron Cordery told HSJ: “The current targets are deeply rooted in the way the NHS works. Moving to a new approach could mean redesigning pathways and clinical practice, with knock-on effects for staffing, logistics and IT.

“That will take time. Trusts will need to be closely involved to work out what can be delivered, and when. And it mustn’t be rushed.”

She added: “There may be great clinical and operational gains to changing the standards, resulting in what we all want, which is better care for patients and service users. But we have to balance that against the risks of moving too far and too fast without bringing people with us.

“We need to build a solid clinical consensus behind any changes, and – to retain public confidence – we must ensure that trusts are able to deliver what people have been told to expect.”

The Nuffield Trust said it was in “favour of testing the radical overhaul of A&E targets… because there is a risk that the current one is driving poor behaviours”.

But chief economist John Appleby added: “It will be hard for managers to implement them and for the public to have faith that this isn’t just lowering the bar while queues continue to go out of the door of A&E. In short, it is hard to fix when the ship’s steering in stormy waters.”

The review, led by NHSE medical director Steve Powis, set out five new metrics to test.

HSJ understands that, of the five new metrics, the “mean time in A&E” is the one the review team see as the most comprehensive lead measure, albeit one which will not work without supporting indicators.

The metrics are:

  • Time to initial clinical assessment in A&E to “identify life-threatening conditions faster”;
  • Time to emergency treatment for critically ill/injured patients (including heart attack, major trauma; sepsis, severe asthma and mental health presentation);
  • Mean waiting time for all patients and strengthened reporting of trolley waits;
  • A same-day emergency care target; and
  • New call response standards for 111 and 999.

For full details, see page 27 of the review.

A statement issued by NHSE said: “NHS staff across the country have been working incredibly hard throughout winter to provide the best care for patients.

“Despite significant increases in demand, almost a quarter of a million more people have been seen and treated within four hours in A&E this winter compared to last year.

“Ambulance services are responding to life-threatening calls faster, with fewer ambulance handover delays at A&E, and significantly more people have got the support they needed to avoid a long stay in hospital. Meanwhile, tens of thousands more people are benefiting from timely tests or treatment, including for cancer and mental health.”