NHS waiting targets must not be binned to save managers’ blushes

Analysis: Reform would better reflect health service’s priorities, but Alex Matthews-King says it must not be used to cover up pressures that have built up over past decade

The four-hour A&E target has not been met since 2015 (Getty)

Anyone who has listened to those in charge of the NHS in the last few months will not be terribly surprised to hear that a review of waiting times has come back recommending the flagship four-hour target is replaced.

Some in NHS England appear to believe the current standard is such a blunt instrument that sprained wrists and heart attacks are equally likely to be handed a hospital bed when the clock strikes four.

While there is no doubt the target isn’t perfect, the Royal College of Emergency Medicine – which wants the measure preserved alongside new standards – said on Monday it was “dismayed by many of the myths being pedalled”.

The pledge to treat or discharge 98 per cent of patients within four hours of attending A&E was a cornerstone of NHS reforms under Labour in 2004.

Though this target was relaxed to 95 per cent by the coalition government, it has not been met nationally since the summer of 2015.

Inevitably this has led to countless headlines about the worrying decline in performance as the NHS struggles with record high demand amid staff and funding shortages.

It has also led some to question the motivation for the review of waiting times, which announced by Theresa May in June last year.

The outcome of the review, led by NHS England medical director Stephen Powis, proposes three new targets for A&E: one for the most urgent conditions – including mental health crises – to be seen within one hour, one measuring the time it takes to be assessed on arrival and one for the average wait across all patients.

There are similar changes proposed for removing the 18-week standard for planned operations, such as hip and cataract surgery. There could also be an overhaul of cancer treatment standards.

The waiting time changes will be piloted and assessed in a number of hospitals, but health groups said a cautious approach was key, as NHS targets “never work as expected in the real world”.

Nigel Edwards chief executive of the Nuffield Trust think tank agreed the four-hour target was “overdue a check-up” but warned changes could see waits for less urgent matters “drift upwards”.

“Given the history of targets having unintended consequences we will need to watch closely as these trials go ahead,” he said.

“The root causes of poor performance lie in a lack of staff and capacity, which we have barely started solving,” Mr Edwards added.

The final decision on changing the statutory target will have to be taken by ministers who do not necessarily share the health service’s slow and steady ethos.

In one of his first speeches on being appointed health secretary last year, Matt Hancock made clear that he feels the NHS’s “fetish about piloting everything” is stymieing its ability to adapt and innovate.

“Roll out, roll out, roll out,” was the health secretary’s mantra, and he has said he is not opposed to changing waiting targets.

While NHS England stresses the review process is being “clinically led”, those at the top have made their feelings clear.