Missed NHS targets spell trouble

It was late on a Friday and buried in a technical NHS document with no publicity surrounding it - but this was one of the most important health announcements in months.

The NHS in England says it will not this year hit the key target for treating or assessing 95% of patients in hospital Accident and Emergency departments within four hours.

This is very much at odds with the Health Secretary Jeremy Hunt's repeated assurances that the target could and would be hit in 2018.

In a speech in March 2017, Mr Hunt said "it is absolutely essential that we do get back to the 95% target" and he expected it to happen "in the course of the next calendar year".

Yet now NHS England is talking in its planning guidance document of its "expectation" that the government would "roll forward" its goal.

It states that the majority of hospitals will only achieve the 95% standard by March 2019, with the NHS overall reaching that rate later in the year.

Four-hour target

The four-hour target is designed to reassure patients that hospitals are making every effort to minimise waits in A&E.

Doctors acknowledge that it concentrates minds and acts as a spur to improve performance. It is part of the NHS Constitution.

Each year the mandate set by the Government for NHS England includes a requirement that the 95% target is hit.

The A&E target has not been reached in England since July 2015.

Rising numbers coming through the door and sicker patients have created intense pressure on the system. But the NHS has always been expected to try to hit the target.

Yet now, in early February, health service chiefs are in effect giving up on it for the rest of this year.

So where does the government stand on this? What assurances can it give patients that performance won't deteriorate further because of reduced pressure on hospital managers to try to reach the expected standard?

Health Secretary Jeremy Hunt wants targets to be met

And how does Mr Hunt feel about his predictions and demands this year being shelved by NHS leaders?

Sources indicate that the Department of Health and Social Care has accepted that conditions have become a lot tougher in A&E units this winter, partly because of a higher flu caseload. But there has been no formal press release or statement to Parliament.

Indeed, in the Commons, following an urgent question by the Opposition, the health minister Stephen Barclay did not take the opportunity to explain what was going on.

Labour MPs Jon Ashworth and Luciana Berger pressed him to comment on whether the government's A&E target had been abandoned this year. But he ducked the questions.

NHS England had already sidelined the 18-week target for non-urgent operations. Now the A&E benchmark seems to have been kicked into touch for a year.

Saffron Cordery of NHS Providers, representing hospitals and other trusts, said: "We have reached a watershed moment.

"The NHS is coming through the worst winter in its recent history.

"This is also the first time that we have had to accept, before the year even starts, that the NHS will not meet its key constitutional standards."

Simon Stevens says A&E is under pressure

This feels like a continuation by other means of NHS England's scrap with the government.

The chief executive Simon Stevens did not get the money he wanted in the Chancellor's Budget.

So he is signalling to ministers that he can't deliver on A&E performance even though the Secretary of State has insisted the target is met this year.

In a further embarrassment to the government, the head of the UK Statistics Authority, Sir David Norgrove, has supported the Welsh administration in its criticism of Theresa May's use of A&E stats.

The Prime Minister had said in the Commons that there were far more patients waiting more than 12 hours in Welsh hospitals than in English ones.

Sir David, in a letter to the Welsh First Minister Carwyn Jones, said: "You are right to say that the comparison is not valid.

"The figure used for England refers to the accident and emergency wait time from the decision to admit to admission into another part of the health service.

"The figure used for Wales represents the entire time patients wait from arriving to leaving accident and emergency services, including the time from decision to admit to actual admission."

It's not clear whether Mrs May will correct the record in the House of Commons. It's not clear what Mr Hunt will say about why hitting the A&E target has been postponed for a year.

As the debate over the state of the NHS this winter continues, they won't be allowed to forget these developments on hospital stats and performance.