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England’s NHS is heading into its busiest ever winter “confused” about the government’s priorities for the service, health leaders have warned, urging ministers to be honest about the trade-offs required to hit performance targets.
Prime Minister Sir Keir Starmer last week named as one of his new policy “milestones” the target of ensuring 92 per cent of NHS patients in England wait no more than 18 weeks after referral to begin non-urgent hospital treatment.
Health secretary Wes Streeting has also vowed to go “hell for leather” in meeting all the “broken” service’s performance targets in the next five years while making wide-ranging reforms to how it delivers care.
Yet many targets have not been met for almost a decade and, with waiting lists at near-record highs, Streeting told health chiefs in an emergency meeting on Monday to prioritise the most unwell patients over accident and emergency targets until March.
“There is massive confusion at the moment,” said one hospital chief executive. “There is all this rhetoric about reform, as well as this shift to preventative healthcare, but at the same time we are being told we have to meet these targets.”
Streeting has promised three “big shifts” in this parliament in how the NHS delivers treatment by moving “from hospital to community”, “sickness to prevention” and “analogue to digital”.
But the hospital boss added: “The three wise men with the three shifts are going to turn up and find the stable is bare because everything has been invested in delivering the 18-week target.”
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A record 96,587 hospital beds are on average occupied daily at present, according to the latest official data, as long waits in A&E continue to climb and backlogs in the social care sector drive up the number of delayed discharges.
NHS leaders have also warned about pressure from a “quad-demic” of Covid-19, flu, norovirus and respiratory syncytial virus, with figures showing hospital flu cases up 350 per cent at the end of November compared with a year earlier.
Siva Anandaciva, chief policy analyst at the King’s Fund think-tank, said health bosses were asking “what exactly is the deal on all the targets outside of the 18-week one? It feels confusing and one of the last things you want in a health system going into winter is confusion over priorities.”
In the near term, he added, hospital “finance directors [would be] sitting there thinking, ‘I know I should be investing more in achieving the 18-week standards, but what am I meant to do about my A&E?’”
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Introduced by Tony Blair’s Labour government in 2004, the 18-week target has not been hit since February 2016, when the Conservatives were in power. About 60 per cent of patients have been seen within the timeframe in recent years.
In the same period the health service has also consistently failed to meet a pledge to admit, transfer or discharge 95 per cent of patients within four hours of arrival in A&E. Just 73 per cent of people were seen in this timeframe in October, the latest month for which data is available.
In a government-commissioned review into the NHS this year, surgeon and former Labour health minister Lord Ara Darzi warned that the struggling service was “unlikely” to clear waiting lists and restore other standards during the current parliament.
The latest OECD data shows that the UK invests less in health services than many other advanced economies and has the fewest hospital beds per head of all G7 members.
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Anandaciva said the health sector had seen Streeting’s “big shifts” as “the North Star” but that “the prioritisation of the 18-week target does feel a bit like a handbrake on that reform agenda”.
“I am waiting for the explanation as to how you can transform the model of care and at the same time meet these targets within just one parliament,” he added.
Ministers have said they will publish their 10-year plan for the NHS in the spring, and have so far set out plans to provide 40,000 extra routine hospital appointments a week to help reach the 18-week target.
Mark Dayan, policy analyst at the Nuffield Trust think-tank, said Starmer’s singling out of the 18-week target “obviously has implications for what else the NHS will be able to do”.
“With a 4-5 year timeframe . . . the government will need to confront trade-offs,” he added.
The Department of Health and Social Care said: “Our plan for change sets out the key milestones that people can judge us on by the end of this parliament — this includes reducing NHS waiting times to the 18-week standard that they expect.
“The £26bn provided for the NHS at the Budget means we can drive improvements across the rest of the NHS at the same time,” a spokesperson said.
