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A&E performing better than last year but missed targets an ongoing concern, say medical leaders

BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l184 (Published 11 January 2019) Cite this as: BMJ 2019;364:l184
  1. Gareth Iacobucci
  1. The BMJ

Clinical leaders have urged the NHS to renew its commitment to meeting key performance targets after figures showed that the service remained in breach in most areas.

Latest NHS England performance statistics1 show slightly improved emergency department performance compared with last winter, with 86.4% of patients seen in four hours in December 2018 compared with 85% in December 2017. The NHS also saw 3.9% more people within the four hour target in December 2018 compared with last year. This followed extra preparation ahead of winter, coupled with mild weather and low flu rates in December.

But the service continues to be in breach of most key targets. In December 2018, only five major emergency departments met the target to see 95% of cases within four hours. Overall, 79.3% of people attending major emergency departments were seen within the target.

And with the NHS’s long term plan2 containing no information about when the service will get back to meeting statutory waiting time targets, some have questioned NHS England’s commitment to them.

President of the Royal College of Emergency Medicine Taj Hassan said that while the slight improvement in emergency department waits was positive, figures for the third quarter of 2018-19 show “the second ever worst four hour performance at major emergency departments, record attendances, and the highest ever number of emergency admissions, with nearly a third of patients attending emergency departments requiring a bed.”

He warned: “With average bed occupancy in December around 91%—an unsafe level—patient flow is still clearly a problem, and we worry that January will be much worse.”

Nick Scriven, president of the Society for Acute Medicine, said: “We are now in a situation where targets are perpetually being missed so it has become normalised. That is dangerous territory.

“Services are on a knife edge with bed occupancy consistently well above safe levels. My hope is that the mild weather has not lulled our leaders into a false sense of security. Things are better than 12 months ago, but key targets in preparing for winter were not achieved.”

It is not just emergency targets that are being consistently breached. The King’s Fund noted3 that the NHS is currently missing five out of eight targets for cancer diagnosis and treatment.

And the Royal College of Surgeons (RCS) expressed concern that only 87.3% of patients were seen within 18 weeks, meaning the government’s 92% referral to treatment target has not been met since February 2016. RCS president Derek Alderson said, “The government must renew its commitment to reducing waiting times and ensuring patients are seen quickly.”

Nuffield Trust chief economist John Appleby said: “We must remember that nearly all key targets have been missed for years now. With the new long term plan, those in charge of the NHS must now answer the big question of whether it is going to start actually meeting its commitments, or scrap and replace them.”

An NHS spokesperson said: “Thanks to the hard work of NHS staff, monthly figures show the health service performed better for emergency services this December than last, despite successfully caring for 3.9% more people within the current four hour target. This week’s statistics also show lower hospital bed occupancy than the same week last year. We are now in what can be the most pressured time of year; flu, other winter bugs, and adverse weather conditions can all increase, so the situation is being closely monitored.”