Matt Hancock should focus on meeting NHS targets, not abolishing them

Editorial: The health secretary thinks he can curry favour with doctors and nurses by suggesting that the four-hour target is no longer ‘clinically appropriate’. But they will not thank him in the end

It is no use Matt Hancock, the health secretary, abolishing targets when the NHS fails to meet them. Last week he hinted at changing the target of 95 per cent of A&E patients being seen within four hours, as the proportion being seen in time in December fell to 69 per cent.

Abolishing the indicator will not improve the NHS’s performance (on the contrary, it will make it worse). Nor will it prevent the public from knowing about poor performance.

For example, we report today that the number of people paying for private hospital surgery has soared in the past six years. This is not entirely caused by longer waiting times for NHS treatment. Some of the increase comes from cheaper technology and higher disposable income, as people without health insurance choose to pay for one-off procedures.

But most of it is driven by the failure of the NHS to treat people as quickly as they should be treated. These kinds of indicators will be available in a free society whether or not the NHS itself compiles statistics about its performance. The answer to excessive waiting times is not to abolish the targets or cover up the information. It is to combine higher public spending with better management – and that requires information about performance.

It may be tempting for Mr Hancock to think that he can curry favour with doctors and nurses by suggesting that the four-hour A&E target is no longer “clinically appropriate”. But they will not thank him for it in the end.

Of course many NHS staff find the four-hour target onerous. It is intended to put pressure on them. But if it cannot be met, hard questions have to be asked about the management of A&E, not about the target itself. Who could possibly say that, yes, patients with non-life-threatening conditions ought to expect routinely to wait longer than four hours?

This is not a question of targets. It is primarily a question of resources, and secondarily a question of organisation. The target should help focus minds on the causes of increased pressures on A&E departments, especially on the difficulty of getting an appointment to see a GP.

The government has responded with some of the right solutions, with the promises in the Conservative manifesto taking the form of intermediate targets designed to achieve the better outcomes that everybody wants. The targets of 50,000 more nurses, 6,000 more doctors and 50 million more GP appointments a year are all designed to deliver an NHS that is capable of hitting the four-hour A&E target 95 per cent of the time.

And if those extra medical staff are recruited and the extra funding for the NHS is spent wisely, then the number of patients going private is likely to fall as well. Mr Hancock needs to focus on meeting targets, not abolishing them.