Is this the end of NHS waiting time targets?

HOSPITAL waiting times have created a toxic culture where targets are put before patients, a health chief has warned.

In the clearest sign the four-hour target for A&E will be scrapped, Lord Prior of Brampton said the performance measures were ‘deeply damaging’ and have ‘had their day’.

The chairman of NHS England said doctors were being forced to ‘run around like headless chickens’ to either treat or discharge patients within the time limit.

He said desperation to meet targets had led to ‘game-playing’ and ‘bad behaviour’ by hospitals which was ultimately risking patient safety.

The former health minister said the NHS has become a ‘dysfunctional’ organisation with a culture of ‘learned helplessness’.

Lord Prior said the recentlyannounced ten-year plan was an opportunity to rebuild and ‘create a culture of working together’. ‘You could not design something which had inherently at its heart more dysfunctionality,’ he told a health think-tank yesterday.

‘I think it’s pretty remarkable, in fact it’s very remarkable, that the NHS has been able to create this ten-year plan when, at its heart, it has been so deeply, deeply fragmented. We’ve had 15 years of this top- down, target- driven culture that’s riven the NHS.

‘The unnuanced level of these targets and of course the gaming that has developed around these targets, the bad behaviours that have developed around these targets.

‘Go to any A&E department, everyone measures the time. You get to 3 hours 55 minutes, all hell hits. Everyone runs around like headless chickens to get them through or discharged before the four hours.

‘They encourage this kind of topdown, hierarchical control in the NHS, which has been very damaging for the culture and very bad for getting clinicians involved and engaged in improving.’

His comments come as A&E waiting times in England reached their worst level since the fourhour target was introduced in 2004. During January, just 84.4 per cent of patients were treated or admitted in four hours, against a 95 per cent target, meaning 330,000 patients waited for longer than they should.

More than 80,000 patients had ‘trolley waits’ meaning they were kept waiting an extra four hours or more to be transferred to a ward after their wait in A&E. The last time the target was hit was in July 2015.

Dr Nick Scriven, of the Society for Acute Medicine, said it was further evidence hospitals were experiencing significant over- crowding and many intensive care units completely full.

He said this had had a knock-on effect on ambulances, which were being delayed dropping off patients at A&E.

‘Although there is less minor illness associated with flu this year, there are more severely ill people than last year, which is putting an even bigger strain on the critical care facilities in our hospitals,’ he added.

‘Any NHS worker will tell you that the stresses and strains are very real and ongoing with no let-up in sight.’

Dr Taj Hassan, president of the Royal College of Emergency Medicine, said: ‘Sadly the situation afflicting our emergency departments has become seemingly normalised with a “chronic crisis mode” that does not allow staff to deliver the quality of care they would wish and patients should rightly expect.’

NHS England admitted that while there were significant pressures, more patients were going to A&E this year – with numbers rising year on year. The trend has led to appeals to the public to only visit A&E in genuine emergencies.

Last month, Simon Stevens hinted that the A&E target may be replaced with a two-tier system at the launch of the ten-year plan. The head of NHS England suggested less serious cases could face longer waits, claiming the current policy failed to distinguish between the most and least serious cases.

‘Run about like headless chickens’