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NHS to change A&E waiting time target reporting

The NHS is to continue reporting statistics on the four-hour A&E standards but monthly rather than weekly in a major reporting standardisation at NHS England, it has been revealed. 

In a letter to NHS England CEO Simon Stevens, Sir Bruce Keogh, the organisation’s national medical director, has recommended standardising reporting arrangements so that performance statistics for A&E, RTT, cancer, diagnostics, ambulances, 111 and delayed transfers of care are all published on one day each month. 

He said that currently “standards report with different frequencies (weekly, monthly and quarterly) and on different days of the week. This makes no sense - it creates distraction and confusion”. 

Sir Bruce added that mental health waiting times statistics will follow the same pattern once available, and “we will consider whether other data collections can be similarly aligned”.

As well as standardising waiting time reporting, NHS England will abolish the admitted and non-admitted measures relating to 18 weeks Referral to Treatment Times (RTT)  “as soon as practically possible”. 

“It has become increasingly clear that within this confusing set of standards there are in-built perverse incentives. The admitted and non-admitted standards penalise hospitals for treating patients that have waited longer than 18 weeks,” said Sir Bruce. 

“To tackle this situation, the incomplete standard was introduced in 2012, incentivising hospitals to treat patients who have been waiting the longest. The “incomplete” standard measures all patients still waiting at the end of each month – so it includes every patient on the waiting list, not just those treated in that particular month.” 

He said that going forward NHS England would use the so-called incomplete standard – the only measure which captures the experience of every patient waiting – as its main measure. It is hoped this would reduce “tick-box bureaucracy” and “expose hidden waits”. 

On top of this, the current NHS Constitution standards for ambulances encourage the service to respond to urgent calls (Red 1 and Red 2) within eight minutes. However, Sir Bruce said “there is some evidence that the standards are not being as effective as they could be, particularly because in haste to meet the target many non-urgent calls are incorrectly classified as Red 2”. 

To explore whether adjustments to the standard could prevent this problem, a pilot was conducted in the South West where the ambulance service spent up to an additional 120 seconds assessing each call’s urgency prior to assigning it to a category and responding. 

“The pilot’s initial results have been encouraging,” said Sir Bruce. “Therefore I recommend we expand the current ambulance pilot, based on emerging findings from the Urgent and Emergency Care Review. New pilots must be founded on hard evidence and analytical rigour with a sharp focus on safety. I will work with the ambulance services to set out details of the proposed changes and geographies in summer 2015 and I will make a definitive recommendation on national standards by autumn 2016.” 

In a letter to CCG Accountable Officers and Chief Executives of NHS Providers, Simon Stevens wrote: “Having considered these recommendations, and discussed them with the secretary of state, we have decided to accept the recommendations in Bruce's letter in full. Our aim is that these should take effect very quickly, and NHS England will be issuing operational implementation guidance shortly.

During today’s NHS Confed speech, Jeremy Hunt made reference to the new changes which will come into effect as soon as possible. 

Commenting on the announcement on waiting time standards, NHS Confederation CEO Rob Webster said: “Simplifying hospital waiting time measures so that providers are no longer penalised for doing the right thing for patients is a welcome step. 

“Our members have told us that we need targets which are evidence based, reflect what matters to patients and don’t create unnecessary paperwork or perverse incentives. The more we can do to streamline the activity of monitoring delivery the more time our members will have to focus on shaping care around the needs of patients in the 21st century.” 

Dr Clifford Mann, president of the Royal College of Emergency Medicine, said: “There are three key conclusions: One, A&E departments need to be staffed to cope with both new arrivals and patients awaiting admission until hospital bed capacity means that appropriate beds are always available; Two, the four hour standard is a key guarantor of better patient care and so has real value but in and of itself does not reflect quality of care in an A&E department. Our support for the revised reporting period is conditional upon the retention of the four hour standard. And, three, other metrics need to be developed to complement the four hour standard to ensure demand, capacity and outcomes are properly reported.”


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