Revised operating framework to pave way for abolition of waiting targets

HSJ has learned that senior NHS staff have been briefed that the revised framework will make the following changes to NHS targets:

• The four hour accident and emergency target will be reduced to cover 95 per cent of patients with immediate effect (down from 98 per cent) with plans to abolish it by 2011.
• The 18 week elective waiting target will be replaced immediately with an average waiting time target with plans to abolish it by 2011.
• Forty eight hour GP access target will be abolished immediately.

An acute trust source said some of the changes would be welcomed due to concerns they had led to perverse behaviour by hospitals and GPs – for example making it near-impossible for some patients to book advance appointments at GP practices.

But the source said the introduction of a yearly average wait target for hospital procedures could “take us all the way back to when the Tories were last in power”.

Such an adjustment would mean it would be possible for a hospital to pass the target despite having a “very long tail” consisting of a minority of patients waiting months and months for an operation.

DH plans to abolish the 18 week wait target will likely require legislation as the target is established as a right in the NHS constitution.

HSJ understands the framework will also clarify the current 30 per cent management cost reduction target for strategic health authorities and primary care trusts by setting the baseline as 2008-09.

That will mean organisations which have increased their management costs since then will have to make even greater cuts.

The revised document will also confirm the provider arms of PCTs should continue to be separated off as separate entities with community foundation trusts – previously sidelined as an option – positively encouraged alongside other “John Lewis-style” staff ownership models.

The framework is due to be published at the end of next week.