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| NHS considers scrapping four-hour A&E waiting time targets | NHS considers scrapping four-hour A&E waiting time targets |
| (8 days later) | |
| NHS leaders are preparing to risk a backlash by relaxing long-established key treatment waiting time targets, including hospitals’ duty to deal with A&E patients within four hours. | NHS leaders are preparing to risk a backlash by relaxing long-established key treatment waiting time targets, including hospitals’ duty to deal with A&E patients within four hours. |
| Simon Stevens, the chief executive of NHS England, admitted it was considering changing the system under which 95% of A&E arrivals were meant to be seen and admitted, discharged or transferred within four hours. | Simon Stevens, the chief executive of NHS England, admitted it was considering changing the system under which 95% of A&E arrivals were meant to be seen and admitted, discharged or transferred within four hours. |
| The shake-up could see people with only minor ailments, such as a sprain, forced to wait longer, while priority is given to those with more serious conditions. | The shake-up could see people with only minor ailments, such as a sprain, forced to wait longer, while priority is given to those with more serious conditions. |
| What is the NHS long-term plan and can it achieve its aims? | What is the NHS long-term plan and can it achieve its aims? |
| Theresa May also hinted at a new approach to targets at the launch of the NHS long-term plan when she said that doctors needed to decide what were “the right standards for the future”. A “clinical review” of existing targets, led by NHS England’s medical director, Prof Steve Powis, and which the prime minister ordered, is expected to recommend changes when it reports in the spring. | Theresa May also hinted at a new approach to targets at the launch of the NHS long-term plan when she said that doctors needed to decide what were “the right standards for the future”. A “clinical review” of existing targets, led by NHS England’s medical director, Prof Steve Powis, and which the prime minister ordered, is expected to recommend changes when it reports in the spring. |
| Hospitals’ growing inability to give patients A&E, cancer care and planned operations within the prescribed maximum waiting times has regularly yielded bad headlines for ministers and NHS managers since performance slipped significantly in 2015 and has since got worse. | Hospitals’ growing inability to give patients A&E, cancer care and planned operations within the prescribed maximum waiting times has regularly yielded bad headlines for ministers and NHS managers since performance slipped significantly in 2015 and has since got worse. |
| For example, the obligation to give 92% of patients non-urgent surgery within 18 weeks has not been met since February 2016. Similarly, the NHS has proved unable to give cancer patients urgent treatment within 62 days of referral by a GP in all but one month since April 2014. | For example, the obligation to give 92% of patients non-urgent surgery within 18 weeks has not been met since February 2016. Similarly, the NHS has proved unable to give cancer patients urgent treatment within 62 days of referral by a GP in all but one month since April 2014. |
| NHS Providers, which represents trusts, has estimated that it would cost the health service £4bn-£5bn to get back to delivering care within the targets in all three areas of care. NHS leaders privately believe that chronic understaffing and growing demand mean it is unlikely that hospitals will be able to recover their previous levels of performance in the foreseeable future. | NHS Providers, which represents trusts, has estimated that it would cost the health service £4bn-£5bn to get back to delivering care within the targets in all three areas of care. NHS leaders privately believe that chronic understaffing and growing demand mean it is unlikely that hospitals will be able to recover their previous levels of performance in the foreseeable future. |
| Any unwinding of the four-hour target would provoke a row. The Royal College of Emergency Medicine, which speaks for A&E doctors, is opposed to any rowback. It believes the target is not only popular with patients but helps to concentrate the minds of NHS staff and ensure no one needing care is left untreated for too long. | Any unwinding of the four-hour target would provoke a row. The Royal College of Emergency Medicine, which speaks for A&E doctors, is opposed to any rowback. It believes the target is not only popular with patients but helps to concentrate the minds of NHS staff and ensure no one needing care is left untreated for too long. |
| However, some hospital managers believe the duty – introduced by the last Labour government – has encouraged some people with only minor ailments to view A&E as a service that will treat “anything and everything” within four hours rather than just deal with accidents and emergencies. | However, some hospital managers believe the duty – introduced by the last Labour government – has encouraged some people with only minor ailments to view A&E as a service that will treat “anything and everything” within four hours rather than just deal with accidents and emergencies. |
| Stevens told BBC Radio 4’s Today programme that the NHS planned to bring in quicker treatment for the most seriously ill and injured A&E patients. Sources said this could lead to those with only small problems no longer being dealt with inside four hours. | Stevens told BBC Radio 4’s Today programme that the NHS planned to bring in quicker treatment for the most seriously ill and injured A&E patients. Sources said this could lead to those with only small problems no longer being dealt with inside four hours. |
| He said: “The problem with [the target] is it doesn’t distinguish between turning up at A&E with a sprained finger versus turning up with a heart attack. What senior doctors are telling us is that they think that the standards should focus particularly on those major conditions – like sepsis, heart attack and stroke. “The top doctors in the NHS are looking at what are the most appropriate clinical standards to improve outcomes in emergency care. They will make their recommendations and, on the back of that, we will meet them.” | He said: “The problem with [the target] is it doesn’t distinguish between turning up at A&E with a sprained finger versus turning up with a heart attack. What senior doctors are telling us is that they think that the standards should focus particularly on those major conditions – like sepsis, heart attack and stroke. “The top doctors in the NHS are looking at what are the most appropriate clinical standards to improve outcomes in emergency care. They will make their recommendations and, on the back of that, we will meet them.” |
| The referral-to-treatment (RTT) target, which guarantees that 92% of people awaiting a non-urgent operation will have their surgery within 18 weeks, could also change as a result of Powis’s team considering switching to a policy known as clinical prioritisation. | The referral-to-treatment (RTT) target, which guarantees that 92% of people awaiting a non-urgent operation will have their surgery within 18 weeks, could also change as a result of Powis’s team considering switching to a policy known as clinical prioritisation. |
| The prime minister fuelled speculation that the RTT target could be relaxed when, helping Stevens to publicise the new NHS plan, she said: “We do need to look at performance against existing targets but, as we look ahead for the NHS, let’s make sure we are setting standards that are the right standards for the future.” | The prime minister fuelled speculation that the RTT target could be relaxed when, helping Stevens to publicise the new NHS plan, she said: “We do need to look at performance against existing targets but, as we look ahead for the NHS, let’s make sure we are setting standards that are the right standards for the future.” |
| Derek Alderson, the president of the Royal College of Surgeons, said it would not support any change to the “increasingly forgotten” 18-week target. | Derek Alderson, the president of the Royal College of Surgeons, said it would not support any change to the “increasingly forgotten” 18-week target. |
| “Patients in pain needing a heart, brain, or any other type of operation will wonder how a longer wait fits with today’s vision of an improving health service. While we support plans to review the existing targets, particularly to see whether those in greater clinical need can be treated more quickly, we would not support changes that do not assure patients that they will be seen quickly,” he said. | “Patients in pain needing a heart, brain, or any other type of operation will wonder how a longer wait fits with today’s vision of an improving health service. While we support plans to review the existing targets, particularly to see whether those in greater clinical need can be treated more quickly, we would not support changes that do not assure patients that they will be seen quickly,” he said. |
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