But while hospital beds clog up with thousands of patients who cannot be discharged for lack of services to support them, and the queues for beds back up into Emergency Departments, NHS England has resorted to desperate tactics in their efforts to force an apparent improvement in A&E performance.
The HSJ revealed that on the last day of February trust CEOs and chief operating officers were instructed to sign declarations that their hospitals would meet the target of seeing and treating 76% of A&E patients within 4 hours during March.
It was already nigh on impossible for this to happen, given that only 13 trusts in England had met this target in January, and almost all major targets have been missed for the whole of 2023/24. Definitions of bullying include setting unreasonable or impossible deadlines and setting unmanageable workloads.
The HSJ further reveals that to add further pressure trust bosses were required to give the direct phone numbers and emails of the senior officers responsible for performance. This would facilitate more NHS England bullying.
This latest brazen effort to bludgeon trust bosses into line despite resource constraints follows on NHSE instructions earlier in February to focus on speeding the treatment of the least serious ‘Type 3’ A&E patients to boost the headline figures on A&E performance.
Ever since the onset of the austerity regime in NHS funding in 2010 the much easier and rapid handling of the most minor Type 3 cases has helped hold up the overall figures, while the delays have grown in handling the most serious Type 1 patients (many of whom need beds).
In February 2011 for example (with residual benefit from a decade of investment) the average for all A&E attendances was 97.1% treated and admitted or discharged within 4 hours. This included 95.6% of Type 1 and 99.9% of Type 3.
By February 2024, after almost 14 years of real terms cuts, the latest figures show an overall average of just 70.9% within 4 hours, within which 95.2% of Type 3 cases were treated within 4 hours, but only 56.5% of the most serious Type 1 cases. That’s why the number of 12-hour plus trolley waits for beds has rocketed from just 3 in February 2011 to 44,417 in February 2024.
To focus on Type 3 cases when the situation is so bad for Type 1s indicates that NHS England is not only seeking effectively to falsify the picture by devoting more resources to the patients with the least serious needs, but they are mathematically illiterate, since the existing performance on Type 3 patients is already so good there is little room for significant improvement.
Trusts have also been instructed not to close beds in March as part of their cash-saving plans.
The latest scam has been accompanied by financial incentives that would hand extra cash from a £150m ‘incentive fund’ to the best-resourced trusts that achieve the highest 4-hour performance and/or the biggest percentage improvement between January and March. The winners could gain handouts of up to £4m – while those up against the greatest pressure and most lacking in resources would get nothing.
This follows on the promise of extra cash handouts to the tiny minority of trusts that can exceed “stretching” targets of 80% performance on the 4-hour target and completing at least 90% of ambulance handovers within 30 minutes during the final half of the financial year. Only five acute trusts recorded performance above 80 per cent in the three months to June
The NHS England approach has been criticised by NHS bosses as brazenly political, seeking to curry favour with ministers for delivering the superficial illusion of progress at the end of a year of failures and broken government promises, and skewing the priorities of emergency services to accelerate the care of patients with least needs while neglecting the more challenging needs of the most seriously ill.
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