Raft of NHS targets should be axed and best-performing bosses given more freedom to improve ailing £150bn-a-year service, Government-ordered review states
- Report warns system can encourage NHS to hit some targets over patient safety
- Read more: Government halves £500m fund to boost social care workforce
A series of NHS targets should be binned and millions more should be spent on preventing ill health, a Government-ordered review ruled today.
Top-performing bosses should also be given more freedom on how to spend their budgets, the report concluded.
The recommendations came from former Labour Health Secretary Patricia Hewitt, who assessed England’s 42 new integrated care systems (ICSs).
They were set-up by ex-Health Secretary Matt Hancock with the idea of providing a more joined up service to improve people’s health, as well to ‘bust bureaucracy’ in the health and care system.
They bring together GP teams, hospitals, local authorities and other partners under one roof, taking over the responsibilities that trusts and CCGs used to carry.
It comes as the £150billion ailing health service has failed to hit a raft key targets, from A&E waits, ambulance arrivals, and cancer and elective treatment times ever since emerging from the Covid pandemic.
The new report has recommended slashing the NHS’s performance targets down to a maximum of 10 in order to ‘concentrate’ its efforts. The health service has been struggling to meet numerous benchmarks since the Covid pandemic, including A&E waits, ambulance arrivals and cancer treatment times.
Patricia Hewitt, the former Labour Health Secretary who was in post from 2005 to 2007
But, going forward, Ms Hewitt recommended the NHS targets they are set be slashed to a maximum of 10, so that ICSs could focus their delivery.
‘Few targets concentrate minds; the more that are added, the less effective they become,’ she wrote.
Ms Hewitt said the current system of 31 national NHS objectives could potentially endanger patients as managers could put hitting targets above clinical decisions.
‘The higher the performance standards (for instance on emergency department waits), the less they allow room for vital clinical judgement,’ she wrote.
‘The combination of too many targets, performance standards that are not clinically supported and an excessive focus on hitting targets by managers or boards themselves can lead to “gaming” of the targets or even a disastrous neglect of patients themselves.’
Another key recommendation of the Hewitt report is to boost the amount that ICSs spend on preventative health measures.
Preventative health measures are those designed to keep the population healthy so that they don’t need emergency or urgent NHS care later.
Some examples include screening programmes for issues like high blood pressure and supporting people to make healthier choices or stop smoking campaigns.
Ms Hewitt recommended the amount allocated for ICSs to spend on prevention be increased by ‘at least’ 1 percentage point over the next five years.
Read more: Fury as Government HALVES £500m fund to drastically boost social care workforce
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A National Audit Office report in 2022 said the latest data show the NHS had allocated only £97million to prevention.
In comparison, NHS England’s budget is about £150billion.
Ms Hewitt acknowledged that any increase to the NHS’s already massive budget is likely to be controversial in the current spending climate.
‘Given the constraints on the nation’s finances, this is my most challenging recommendation,’ she wrote.
‘But an ambition of this kind is essential if we are to avoid simply another round of rhetorical commitment to prevention.’
She added that such investment in preventing people needing so much NHS care is critical given the increasing pressure on emergency services, which she described as a losing battle.
‘The NHS is, in practice, more of a National Illness Service than a National Health Service,’ she said.
‘The truth is, unless we make the change, the continual focus on improving flow through acute hospitals will simply channel more and more of an older and increasingly unhealthy population into acute hospitals, which will never be large or efficient enough to cope,’ she said.
She also broadly recommended the public health grant give to local authorities should be increased after eight years of ‘real-term squeeze’.
Data from NHS England shows that the number of people waiting for routine hospital treatment jumped by 13,000 in January to 7.21million. The record figure means there is 64 per cent more people stuck in the queue, often in pain, compared to before Covid struck
NHS figures show that cancer performance plummeted to a record low in January. Just 54.4 per cent of cancer patients started treatment within two months of an urgent GP referral. The NHS’s own rulebook sets out that at least 85 per cent of cancer patients should be seen within this timeframe but this figure has not been met since December 2015
NHS data on A&E performance in February shows that just seven in 10 A&E attendees (71.5 per cent) were seen within four hours of showing up at A&E (red line). Meanwhile, 34,976 patients who sought help in emergency departments were forced to wait more than 12 hours — equivalent to more than 1,000 patients per day (yellow bar)
Ambulance data for February shows that heart attack and stroke patients in England, known as category two callers, had to wait 32 minutes and 20 seconds, on average, for paramedics to show up. This is 14 seconds slower than January and nearly double the 18-minute target
What do the latest NHS performance figures show?
The overall waiting list grew by around 13,000 to 7.21million in January. This is up from 7.20 in December.
There were 1,122 people waiting more than two years to start treatment at the end of January, down from 1,149 in December.
The number of people waiting more than a year to start hospital treatment was 379,245, down from 406,035 the previous month.
Some 34,976 people had to wait more than 12 hours in A&E departments in England in February. The figure is down from 42,735 in January.
A total of 126,948 people waited at least four hours from the decision to admit to admission in February, down from 142,139 in January.
Just 71.5 per cent of patients were seen within four hours at A&Es last month, the worst ever performance. NHS standards set out that 95 per cent should be admitted, transferred or discharged within the four-hour window.
In February, the average category one response time – calls from people with life-threatening illnesses or injuries – was 8 minutes and 30 seconds. The target time is seven minutes.
Ambulances took an average of 32 minutes and 20 seconds to respond to category two calls, such as burns, epilepsy and strokes. This is nearly twice as long as the 18 minute target.
Response times for category three calls – such as late stages of labour, non-severe burns and diabetes – averaged 1 hour, 42 minutes and 39 seconds. Nine in 10 ambulances are supposed to arrive to these calls within two hours.
Some 485,956 patients were waiting more than six weeks for a key diagnostic test in January, including an MRI scan, non-obstetric ultrasound or gastroscopy. This is the highest level since summer 2020.
Ms Hewitt also recommended that some of the best performing ICSs should be given greater freedom from NHS England’s general oversight on how they spend their budgets.
She claimed this would enable the NHS as a whole to focus on ‘financial performance management’ of those that need the most assistance.
The recommendations for change come as the latest NHS data shows there were 7.21million patients queuing for operations in January — nearly 3m more than pre-Covid levels.
A Department of Health and Social Care spokesperson said ministers will review the recommendations of the Hewitt report in full course.
While the number waiting more than a year for elective procedures has fallen, one in 20 people stuck in the mammoth backlog are forced to wait this long.
And for the first time ever, nearly half of cancer patients didn’t start treatment within two months of an urgent GP referral — marking the worst figure since records began over a decade ago.
Top oncologists said the ‘devastating figure’ means more than 7,000 cancer patients were let down in January and warned the figure will ‘continue to swell’.
Separate NHS data on A&E performance in February showed that just seven in 10 A&E attendees (71.5 per cent) were seen within four hours of showing up at A&E.
NHS standards set out that 95 per cent should be admitted, transferred or discharged within the four-hour window.
The figure is down by one per cent in a month — though it is higher than levels logged earlier in the autumn and winter, during the emergency care crisis.
Meanwhile, 34,976 patients who sought help in emergency departments were forced to wait more than 12 hours — equivalent to more than 1,000 patients per day.
The figure is the lowest logged since September but is around 30 times higher than pre-pandemic levels, when around 1,200 patients had to wait half a day in A&E.
Ambulance data for February shows that heart attack and stroke patients in England had to wait 32 minutes and 20 seconds, on average, for paramedics to show up.
This is 14 seconds slower than January and nearly double the 18-minute target.
One in 10 of these callers, known as category two, had to wait at least 1 hour, eight minutes and 45 second.
Meanwhile, response time to category one calls — those from people with life-threatening illnesses or injuries, such as a serious allergic reaction — took eight minutes and 30 seconds, on average, last month.
The health service’s own handbook sets out that 999 crews should take no longer than 7 minutes, on average, to respond to these calls.
Response times for category three calls – such as late stages of labour, non-severe burns and diabetes – averaged 1 hour, 42 minutes and 39 seconds.
Nine in 10 ambulances are supposed to arrive to these calls within two hours.
Miss Hewitt, who held four frontbench roles under Tony Blair, faced a tumultuous two years as health secretary due to the introduction of a controversial junior doctor application scheme and slashing NHS spending to balance the books. Her achievements included implementing the ban on smoking in public places.
She was also suspended from the Labour Party in 2010 over political lobbying irregularities, and was forced to apologise over her links to a paedophile lobby group in the 1970s.
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