Key A&E and treatment times targets could be replaced under new NHS plans

By Jane Kirby11th March 2019News EnglandAccident and Emergency, Care Quality Commission, Care Standards, Hospitals, News England, NHS

Key targets for patients to be seen in A&E within four hours, or receive an operation within 18 weeks, could be scrapped under new NHS plans.

NHS England announced a series of pilots which could see sweeping changes to targets including on A&E, cancer and planned operations.

At present, patients are expected to be seen and treated, discharged or admitted to hospital, within four hours at A&E.

Under the new plans, those patients in England with the most serious conditions such as heart attacks, strokes and sepsis, would receive rapid treatment within an hour, while people with more minor conditions could expect to wait longer.

Data would be published on how long patients spend on average in A&E.

Other changes mean the current 18-week target for people to start planned treatment, such as hip operations, could also be replaced by one measuring the average time it takes to start treatment.

The proportion of people waiting more than 18 weeks for treatment is currently at its highest level for a decade.

On A&E, the existing four-hour target has not been met since July 2015 and some experts say it is unlikely the NHS could ever hit it again.

Figures for January showed that A&E waiting times in England reached their worst level since records began.

Just 84.4% of patients were treated or admitted in four hours, against a 95% target, meaning nearly 330,000 patients waited longer than they should.

The data also showed that 83,519 people in January endured very long waits, often called trolley waits, to be admitted to hospital.

Under the new plans, patients would receive an assessment by a medical professional when they walk through the door of A&E, and cases would then be prioritised according to the level of urgency.

NHS England has long said that the current four-hour A&E target is outdated, with data suggesting hospitals are being driven to hit the target.

About a fifth of all emergency admissions from A&E happen in the final 10 minutes before the four-hour deadline.

On cancer, the two-week wait to see a cancer specialist could be scrapped and replaced with a target that says people must receive a diagnosis within 28 days of first being referred by their GP.

Four other 31-day cancer targets, which mark the time from diagnosis to first treatment for all cancers, would also be replaced by a single 31-day target.

This would mark 31 days from a decision to treat to a person to them receiving their first treatment.

Patients would also start their first treatment for cancer within 62 days following an urgent GP referral for suspected cancer.

People who arrive at A&E experiencing a mental health crisis will also receive emergency care within one hour.

Professor Stephen Powis, national medical director of NHS England and leader of the review of targets, said: “The NHS is aiming to improve care for patients and save hundreds of thousands more lives over the coming years, with greater access to mental health support, better treatment for the major killer conditions and services which are more joined up, personalised and closer to home.

“So, as we build an NHS that is fit for the future, now is the right time to look again at the old targets which have such a big influence on how care is delivered, to make sure that they take account of the latest treatments and techniques, and support, not hinder, staff to deliver the kind of responsive, high-quality services that people want to see.”

Professor Ted Baker, chief inspector of hospitals for the Care Quality Commission, said: “Emergency departments need a set of standards which gives priority to patients with life-threatening conditions, ensures people get care in a timely way, and puts pressure on the whole hospital to end long corridor waits for those who need admitting.”

The Royal College of Emergency Medicine (RCEM) said that “rather than scrapping the four-hour access standard, it should be supported by a series of complementary metrics that help understanding of the causes of long waits and crowding in emergency departments”.

President Dr Taj Hassan said the College was “keen to ensure that any changes are not imposed due to political will but are developed responsibly, collaboratively and are based upon clinical expert consensus in the best interests of patients”.

Dr Nick Scriven, president of the Society for Acute Medicine, said the organisation had been calling for change since 2016.

“The review of the target is an opportunity to focus on a range of patient outcomes and quality standards to measure pressures and take effective action earlier – a lack of wide-ranging information heaps further pressure on already-stretched hospitals,” he said.

Nuffield Trust chief executive Nigel Edwards said: “NHS targets never work as expected in the real world, so the idea of testing out new proposals and carefully monitoring the effect on patients is a big improvement on the usual directive approach.

“I agree that the A&E target is overdue a check-up: it has started rewarding the wrong behaviours, like moving patients just to stop the clock.

“The new target to treat patients with a mental health crisis within an hour at A&E sends exactly the right message about the urgency called for in those situations.

“Given the history of targets having unintended consequences, we will need to watch closely as these trials go ahead, looking at the actual effect on people’s health as well as access to care.

“There is a risk that getting rid of the 18-week limit on waits for planned procedures could mean the proportion of people going without care for an unacceptably long time drifts upwards.

“And we need to be hard-headed about how much difference fine tuning targets will make – the root causes of poor performance lie in a lack of staff and capacity, which we have barely started solving.”

Baroness Delyth Morgan, chief executive of Breast Cancer Now, said: “The current ‘two-week wait’ for breast cancer has been hugely successful in transforming the experiences of people referred to a specialist to investigate their symptoms.

“With these proposals representing a shift to instead give reassurance of a 28-day wait for diagnosis, it’s vital we ensure they will further improve patient experience and build on years of progress.

“Being referred with breast symptoms can be an incredibly worrying time for thousands of women and their families, and it’s critical that they are given answers and can begin treatment or be given peace of mind as soon as possible.”

Dame Donna Kinnair, acting chief executive of the Royal College of Nursing, said: “Moves to give cancer patients a diagnosis within 28 days are a welcome step forward, and all nurses, not just those working in mental health, will support the plan to provide emergency care within an hour to people who go to A&E with a mental health crisis.

“However, it’s hard to see exactly how it will be possible to meet these new more stringent standards without more staff – or they would already be taking these sensible measures.

“We will need accurate and honest feedback from the pilots to ascertain whether it is possible to roll out these measures nationally with the huge workforce gaps we currently have.”