The number of hospital patients in England waiting over the 18-week guarantee has jumped by a third in the past year, figures show.
Of the 300,000 seen in July, over 28,000 had waited beyond the target - a 34% rise from the same month last year, official statistics showed. Those who waited over six months rose by 55% to more than 9,000.
But overall the NHS is still hitting its target to see 90% of patients in 18 weeks as 90.6% were.
Read more at BBC Health.
Hospitals have been told to remain vigilant over hospital waiting times amid concerns standards could slip.
In a letter to staff, NHS chief Sir David Nicholson said there seemed to be “misunderstandings” since monitoring of the target was relaxed last year.
But he said patients still had to be seen within the 18-week target in England despite the move.
It comes as a leading health economist warned patients may end up waiting longer now the pressure was off.
Professor John Appleby, from the King’s Fund, has been charting hospital waiting times since the announcement in the summer that the government would no longer centrally manage hospital waiting.
At the time, ministers suggested this did not mean hospitals should let current standards slip but just that they would not face penalties if they did.
Professor Appleby’s latest analysis - published in the British Medical Journal - does not provide clear evidence that waiting is getting worse.
Read more at BBC Health.
The controversial four-hour A&E waiting time target has been scrapped and replaced by eight new clinical quality indicators.
Hospitals in England will have to publish data on ‘effectiveness of care’, ‘patient experience’ and ‘patient safety’ from April next year, the Department of Health has said.
The data will include the number of patients who had an unplanned re-attendance, the total time spent in A&E, and the number who left A&E after getting tired of waiting. Other standards include ‘time to treatment’ and ’service experience’.
Professor Matthew Cooke, national clinical director for urgent and emergency care, drew up the quality indicators in partnership with the College of Emergency Medicine, the Royal College of Nursing and lay representatives.
Read more at Pulse.
The number of patients waiting more than 18 weeks for treatment on the NHS has risen by 15% since it was scrapped as a target, new figures show. In September some 45,000 patients were treated outside that timescale, up from 39,000 in July.
The coalition scrapped the target in June, a move which was cheered by the BMA.
Andrew Lansley, the Health Secretary, said he wanted “to free the NHS from bureaucracy and targets that have no clinical justification.”
However, the decision appears to have led to more patients being forced to wait longer, even though they must still be treated within 18 weeks of referral under the NHS Constitution.
Dr Chaand Naagpaul, from the BMA’s general practitioners’ committee, said: “We’re getting reports of trusts delaying treatment so they can address financial problems.
“The government is engaging in doublespeak, removing targets on one hand but committed to patients’ rights [through the NHS Constitution] on the other.”
Read more in The Telegraph.
The government has launched a public consultation aimed at defining how the NHS should be judged over healthcare outcomes for patients.
Health secretary Andrew Lansley said the publication, Transparency in Outcomes - a framework for the NHS, would be the first of many in the coming weeks which will consult with healthcare professionals, patients, carers and the public on how to rebuild the NHS and refocus it on measurable clinical outcomes for patients rather than process targets of the past.
The publication aims to establish a new framework for the NHS and a set of national outcome goals which are defined by five separate outcome “domains” that will be used to measure the effectiveness of the new strategy and, where necessary, hold the health service and the government to account.
Read more at HSJ.
There is no evidence that the four hour A&E target benefits clinical care, a group of senior doctors say.
The four-hour standard for processing patients attending emergency departments was introduced at 90% in 2004 and has sat at 98% since 2005.
But a group of doctors, writing in the BMJ, say it has encouraged target led rather than needs led care.
In 2005, the authors showed that patients admitted to hospital from the emergency department were affected most by a ‘spike’ in activity during the last 20 minutes of the four hours, which affected 12.3% of admitted patients and 3.6% of discharged patients in 2004.
They then analysed 12.2 million new patient episodes at English emergency departments in 2008-2009. The data show that the spike is still present and larger than in 2004, affecting 30.7% of admitted patients and 10.5% of discharged patients.
“Although many in the specialty of emergency medicine support the benefits that the four hour target has brought, these results suggest that they are not being experienced by all patients, and that processes throughout the hospital and wider healthcare system may not have improved to accommodate it,” they say.
“Good evidence based indicators of quality in emergency medicine need development,” they add. “We have no evidence that the 98% four hour target benefits clinical care, and our findings suggest that it has encouraged target led rather than needs led care.”
Last week, the coalition government relaxed the four-hour target to 95% of patients.
The letter’s authors include Prof Suzanne Mason, director of health services research, and Prof Jon Nicholl, professor of emergency medicine, both from Sheffield, and Dr Thomas Locker, consultant in emergency medicine in Barnsley.
Read the full letter.
Andrew Lansley, the health secretary, has scrapped two key NHS waiting-time targets and called for management costs to be slashed by almost half, signalling a shake-up of the health service.
Lansley said he was ending the right of patients to see a family doctor within 48 hours and axing the 18-week target covering the period from hospital referral to start of treatment. Both were key planks of the Labour government’s health policy, which had used large cash injections and targets to improve the NHS.
Campaigners expressed concern that abolishing targets without a replacement system could lead to a “free-for-all” in which health providers were not held to account.
The coalition administration says allowing patients access to accurate information on the way a hospital performs will help it make judgments about the quality of services.
Read more at The Guardian.
Pressures over hospital budgets and targets may be damaging safety in operating theatres, a survey suggests.
About one in five of the nearly 600 surgeons questioned by Bournemouth University reported being involved in incidents, during a two-week period, where patients were harmed.
Many complained of having to operate on patients they had not seen before, or a lack of time for complex operations.
The government says “a culture of micromanagement” has endangered safety.
A total of 549 general surgeons responded to the online questionnaire - about one in four members of the Association of Surgeons of Great Britain and Ireland.
Of these 40% said they had been involved in an untoward event where a patient was nearly harmed, and a further 19% where there was actual harm, during the two-week period covered by the survey.
Read more at BBC Health.
The government is to take the controversial and potentially unpopular step of scrapping four-hour waiting time targets in accident and emergency departments and instead focus on delivering the “best possible results for patients”, it said yesterday.
The coalition government had already announced widespread cuts to NHS targets that have “no clinical justification” without stipulating where the axe was likely to fall. But yesterday the health secretary, Andrew Lansley, revealed the plan as he took questions in the House of Commons following his announcement of a full public inquiry into failings at Mid-Staffordshire NHS Foundation Trust.
“We are going to look, and we will look constructively, at how we can scrap the four-hour target as it currently exists and work on the basis of what the clinical evidence makes clear directly contributes to delivering the best possible results for patients,” said Lansley.
Read more at The Guardian.
The next government is being called on to more than double the number of consultants working in emergency departments.
The College of Emergency Medicine says every emergency department needs a minimum of ten dedicated consultants to deal with the growing number of patients presenting in A&E.
The current average is 4.2, while the number of patients averages 70,000 to 80,000 per year.
Increasing the number of consultants would guarantee their presence at evenings and weekends, and promote the highest standards of quality and safety.
The college claims that despite the increase in salaries the move would save money in the bigger picture. It would help reduce inappropriate investigations, unnecessary admissions and unsafe discharges.
Dr John Heyworth, president of the College of Emergency Medicine, said: “Emergency care is currently failing to deliver the service which the public expect and deserve. The single most important factor in providing a high quality, timely and clinically effective service to patients is care led by emergency medicine consultants.
“We are concerned that patient outcomes may suffer if this failure to invest in emergency medicine continues.”
The college has also called for a review of emergency care standards in its ‘manifesto’ A matter of emergency. The current target for all emergency care systems to achieve a target of 98% of patients being seen, treated and discharged within four hours is challenging due to understaffing and compromising patient care.
It also wants patients to have one-stop access to effective emergency care. The college supports co-location of the emergency department with other clinicians to provide unscheduled primary care, mental health and other key health services in one secondary care setting. It’s critical of walk-in or urgent care centres which are “largely unsupported by evidence regarding clinical and cost effectiveness. These initiatives have led to a fragmented system with duplication which evidence shows patients find confusing”.
Read the full manifesto.
