NHS targets
The Major Conservative government first set public targets for the NHS in the 1990s – for example, guaranteeing a maximum two-year wait for non-emergency surgery and reducing rates of death from specific diseases.
[5] NHS England under the Conservative governments reduced the number of targets, in particular removing most of those relating to health inequality, and encouraged a system wide approach.
[9] According to Jeremy Hunt the Stafford Hospital scandal showed that concentrating on national targets led to managers deprioritising the safety and well-being of patients.
Non-acute crisis response waiting time targets are to be introduced by NHS England for integrated care systems from April 2022.
[12] Targets in Northern Ireland are set by the Health and Social Care Board and are less demanding than in the rest of the UK.
[14] The Welsh Government has taken a different approach to some areas of care, such as becoming the first nation in the UK to have a single waiting times target for cancer treatment.
However a Full Fact report by the Chief Executive of the Nuffield Trust Nigel Edwards acknowledges that the two nations targets are not directly comparable because "the Welsh population is older, sicker and more deprived than the English population—so its NHS has to work harder".
The original target was set at 100%, but lowered to reflect clinical concerns that there will always be patients who need to spend slightly longer in A&E, under observation.
The new “bundle of ten standards” includes In September 2022 Thérèse Coffey said: “I can absolutely say there will be no changes to the target for four-hour waits in A&E.”[26] The Labour government (1997-2010) had identified a requirement to promote improvements in A&E departments, which had suffered under-funding for a number of years.
[28] Government figures show that in 2005–06, 98.2% of patients were seen, diagnosed and treated within four hours of their arrival at A&E, the first full financial year in which this has happened.
[30] Although the four-hour target helped to bring down waiting times when it was first introduced, since September 2012 (after the introduction of the Health and Social Care Act 2012 and top-down reorganisation of the NHS) hospitals in England struggled to stick to it, prompting suggestions that A&E departments may be reaching a limit in terms of what can be achieved within the available resources.
[42] In March 2022 average waits for an ambulance for stroke and heart attack patients (category 2) reached as long as two hours in some regions.
[42] Targets in Northern Ireland are set by the Health and Social Care Board and are less demanding than in the rest of the UK.
[47] A&E waits when considered using the NHS measure of 4 hours to discharge show that performance in Northern Ireland has dropped 13% between May 2018 and September 2019.
[42] According to the BMA[28] the main reasons for not reaching this target are: In 2014, research conducted by QualityWatch, a joint programme from the Nuffield Trust and the Health Foundation, tracked 41 million visits to A&E departments in England in order to better understand the pressures leading to increased waiting times and breaches of the four-hour target.
Researchers identified a rise in older patients and related increase in long-term conditions as key factors, alongside extremes of temperature (in both summer and winter) and crowding at peak times.
[21] Problems at Lancashire Care NHS Foundation Trust led to more than 1,000 cases of patients waiting over 12 hours for admission in 2018–19.
[51] In December 2019 trusts in London were told to set up dedicated spaces to care for three mental health patients in every A&E department.
[55] Measured in this way February and March 2022 show around one in five admissions through ED waited more than 12 hours from arriving until being admitted to a ward – equating to around 158,000 cases, 22% of attendances.
[42] The Welsh NHS Confederation responded to the figure by stating its disappointment but acknowledging numbers of patients attending with complex needs were increasing in Wales.
The Royal College of Surgeons together with other medical groups fear patients are waiting longer in anxiety and pain for hospital procedures.
The proportion of people waiting more than the six week target for diagnostic tests was at its highest since records began in September 2018.
[66] The clinical commissioning group joint committee for mid and south Essex in December 2019 reported that local hospitals were “now working” to a 40-week referral to treatment target.
[42] Between January and March 2018 25,475 operations were cancelled at the last minute for non-clinical reasons by NHS providers - 20% more than the first quarter of 2017, and the highest number since records began in 1994–95.
[76] The 2019 NHS Long Term Plan proposed a two-hour standard for urgent community response services in England.
These include prescribing and reviewing medication, access to physiotherapy and occupational therapy, and help with nutrition and hydration.
Offering 'watch and wait' could provide similar results as surgery, avoid surgical risks and free up resources in healthcare.
However research shows that when feasible one-stage surgery is as affective as two-stage and even results in less complications and speedier recovery.
[83] Acute gut conditions such as diverticular disease, cholelithiasis, appendicitis, abdominal wall hernia and blocked bowel often result in emergency hospital admission.
These treatments might not be less effective than emergency surgery and for some, for example older people with severe frailty, they might even provide better outcomes.
