January 17, 2020

Will changing NHS targets enable the NHS to target change?

It is no secret that the NHS is facing growing pressure to improve its current performance. However, a recent radio interview with Matt Hancock, the Secretary of State for Health and Social Care, has reinforced just how apparent that mounting pressure is.

The current NHS target is that 95% of patients attending A&E should be admitted, transferred or discharged within four hours of arrival. However, according to the monthly NHS Performance Statistics, which were recently published for December 2019, the organisation clearly struggled to meet this target. Only 79.8% of A&E attendees were admitted, transferred or discharged within the desired four hour period. This is the first time that this number has fallen below 80% and it is the worst result since the target was first set in 2004.

What is more, there is little sign of the NHS’s performance improving. In December 2019 there were 2.18 million attendances just to A&E; a 6.5% increase in the number of attendances to A&E when compared with December 2018, and 400,000 more attendances than November 2019.

What action needs to be taken?

During his interview, Matt Hancock recognised the clear failure on behalf of the NHS to meet its 95% turnaround target; and when asked if this target would be abandoned, he replied that future “targets have to be clinically appropriate”. This has led many to believe that the targets could soon be changing, and that the NHS may have to focus on new goals.

However, attempts to change the longstanding NHS targets is not news to everyone, as waiting time targets have been under review since May 2018, under Theresa May.

But what new targets would the government set if it were to replace the current ones? Fourteen hospitals have already been trialling a system whereby the average waiting time of each patient, and not the time to treat patients, is the metric measured.

Furthermore, in an interim report focussing on the NHS’s performance, Professor Steve Powis suggested that by measuring the time it takes for a patient to be seen “rather than assessing performance on the basis of time for care to be completed” that this will assure patients that they do not need to wait as long as four hours before their treatment begins.

Would a change to performance targets improve performance?

Simply put, and as you may expect: no. Both Professor Powis’s report and recent trials across the country suggest any change to NHS targets would only alter the focus of the organisation without actually resolving the issues that are hampering it.

If the new target was simply an average time for when patients are seen, then this may show patients that the average waiting time is less than four hours, as has been suggested; but it will not necessarily resolve the fact that patient care is taking longer to complete. And, after all, shouldn’t medical performance targets be based on outcomes?

This is a sentiment that seems to be shared across the country, with MPs and Doctors suggesting that “scrapping the four-hour target will have a near-catastrophic impact on patient safety in many emergency departments”. This concern derives from the fact that many emergency departments are already struggling to meet the current nationwide targets. By choosing to redefine what the organisation’s targets are, and by arguably failing to resolve the NHS’s current performance issues, there is a substantial risk that the worst performing hospitals will continue to struggle to provide safe patient care.

What is more, if the targets are altered, a lot data that has been collected since 2004, which focuses on patient treatment as opposed to the speed at which a patient is first seen, will be unrelated and incomparable to the new data.

It is clear from the recent statistics presented by the NHS, and Matt Hancock’s recent interview, that the organisation is under enormous pressure to meet its targets; and worryingly it is succumbing to that pressure. Whilst it is not certainly the case that new targets will be set, and that older targets will be replaced, there is an argument to suggest that this is the way things are going.

If this does end up happening, we have to ask whether a change in focus will help or hinder our National Health Service.

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