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Even best hospitals struggling to hit waiting time targets

Nuffield Trust report warns that fundamental problems affecting the NHS will make it harder still in the future

Ingrid Torjesen

Friday, 13 March 2015

While in the past a handful of ‘poorly performing’ hospital trusts has struggled to hit waiting time targets, a study* by the Nuffield Trust has found marked deterioration on some measures over the past year even at the best performing hospitals.

This casts doubt on the idea that poor performance is the result of local or managerial failings, and suggests instead that it is likely to be a more systemic problem.

The Nuffield Trust’s analysis looked at how all 156 hospital trusts in England performed against six national targets over the course of this Parliament. The targets were: the four-hour A&E target; the 18-week target for a hospital bed (inpatient treatment); the 18-week target for an outpatient appointment; the six-week target for scans and other diagnostic tests; the two-week target for urgent cancer referral; and the 31-day target for cancer treatment.

While national performance against the target for 90 per cent of inpatients and 95 per cent of outpatients to start treatment within 18 weeks held up between 2010/11 and 2013/14, it has deteriorated over the past year, as has performance against the target for diagnostic tests.

Although the top hospitals are still meeting the 90 per cent inpatient target, they too have seen a decline in their performance recently, whilst the bottom 10 per cent have seen a marked deterioration.

There has been considerable deterioration across the board since 2010 in performance against the four-hour A&E target with even the top 10 per cent of hospitals breaching the target in the most recent quarter.

Targets for urgent cancer referral and cancer treatment have fared better and are still being met at a national level. Performance has declined at the poorest performing hospitals, but the top-performing ones are retaining their past performance.

The majority of hospitals breached one or two targets – usually the A&E four-hour target and inpatient treatment or diagnostic tests. In 2013/14, no hospitals breached five or more targets.

Holly Dorning, research analyst and report author, said: “We’ve known that hospitals have been struggling to meet the four-hour A&E target for a while. But the fact that we are starting to see problems in other areas, like access to planned treatment, is a real concern. As this study makes clear, warning lights are now starting to flash across the wider hospital system.”

Rob Webster, chief executive of the NHS Confederation, said:

“The NHS is often viewed as a single organisation when it is not - the NHS is in fact a complex system. The Nuffield Trust is absolutely right to highlight that target delivery and performance reflects system issues and that system solutions are needed.”

He added: “Our members tell us the whole system is under more pressure than ever. Tackling this requires commissioners and providers to work together across the whole system to help drive down waiting times. They will do this by working to change the way care is delivered. They will need support to make this a reality.”

* Holly Dorning and Ian Blunt. Access to hospital care: is the NHS on target? Nuffield Trust, March 2015.

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