NHSE pushing for four-hour target to be scrapped in April

Well-placed senior sources said the NHS is seeking to persuade the government that a new package of measures can be introduced from the start of 2022-23.

The new package of targets, which include ambulance response and handover times, as well as arrival to admission times, have some traction among ministers but have not yet got the green light from the top of government (see box below for full list of metrics).

The news comes amid warnings from the Royal College of Emergency Medicine that the NHS was currently “in limbo… in a performance vacuum” because trusts were paying less attention to their four-hour performance, as they expected it would soon be axed, but have not migrated onto the new standards. 

NHS England and the RCEM initially wanted the new standards rolled out before winter last year.

But there is wide consensus that implementing any changes before this winter would be counterproductive and place a new burden on an already overloaded system.

Another component holding up the process, according to senior sources familiar with the discussions, is the Treasury and Number 10 are yet to be fully convinced by the fundamental change to the NHS’ performance regime.

NHS leaders must convince ministers the new system will allow government to able to hold the NHS to account for its performance, and that the public will be able to do so too, if they are to overcome this major hurdle.

However, senior NHS managerial and emergency care figures have admitted to HSJ that while the pilots suggest the new standards appear to have clinical benefits, working out how they can be used as a performance measure by both ministers and the public is not yet clear.

Katherine Henderson, president of RCEM, told HSJ the college was not aware of a timetable and urged system leaders to set one out.

She added: “We must see what the plan is for the new metrics. Monthly performance figures are getting worse and worse but there is very little attention on what these figures tell us about patient experience and patient safety.”

The college was “heartened” that NHS England’s guidance ordered the use of a ‘12 hour data from time of arrival’, which was now being collected, but that the college was “not seeing significant efforts to use that data to improve patient care”.

She said: “This must be published with the other performance metrics so that action is taken. This would drive a much-needed improvement in patient flow which is critical to getting through this challenging winter,” Dr Henderson added.

She admitted however that how the data could be used as an accountability measure for the public was “complicated”, because no single measure would ever capture the complexity of the emergency care system “in a way that now could drive improvement – hence our support for a bundle”.

She added: “We support having a bundle of metrics over the single four-hour access target but the current limbo is the worst of all worlds.”

NHS Providers chief Chris Hopson said there was “broad support” among trust bosses for changing the standards after winter, but added: “We need to reassure patients that any changes to measuring A&E waiting times is not simply about moving the goalposts”.

He also cautioned that the new targets would “not magically increase capacity and deliver the increased workforce”.

Matthew Cooke, the former national clinical director for urgent and emergency care for the NHS in England, urged leaders to opt for a slower, staged role out of the new targets.

He said: “Perhaps we need to learn from the past. The four-hour target was introduced over a few years with the level of achievement ramping up over that time and with appropriate investment (time, money and people) to achieve that improvement.”

Neither NHSE nor the Department of Health and Social Care had responded to an invitation to comment at the time of publication.