Hunt’s ‘managed breach’ points to need for new thinking on targets

Jeremy Hunt’s speech about waiting times on Monday came as the planned care list stood at a six year high, with key targets expected to be breached.

Such difficulties may not seem an obvious focus for a politician but the health secretary managed, to some extent, to paint the situation as a noble “managed breach” of normal requirements to give the service space to treat long waiters.

• Also this week: Bailouts show trusts need a better way to fail
• Hunt: care targets to suffer ‘managed breach’
• Concern grows over tight timetable for waiting list cuts
• Michael White: When you stimulate demand Mr Hunt, that’s exactly what you get
• Rob Findlay: We’ll have to wait and see what Hunt’s waiting time intentions will bring

The approach being taken in the service, though it has come a bit late and is not quite as presented by Mr Hunt, is fairly sensible.

How it will wash with the public and media will depend on whether activity can be rapidly ramped up, allowing targets to be hit as quickly as September, as is hoped.

Lists will grow again

The tight timetable has provoked reasonable complaints from providers about the difficulty of getting staff and patients in place at short notice over the summer. These are met, equally understandably, with the response that they should not have allowed lists to grow so long in the first place.

‘While acknowledging some of the shortcomings of targets, Hunt steered clear of a debate about how they could change’

That said, what is under way is a rapid performance turnaround plan and nothing more. The service also needs more sustainable solutions.

It needs to grapple with the reality that, next year, the pattern of referrals exceeding numbers treated can be expected to resume, meaning lists will grow again.

As management is cut even more deeply and NHS England narrows its focus, hierarchically driven initiatives like the current one could soon stop working. Performance will have to be more self-sustaining.

Better use of expertise

Meanwhile, Mr Hunt’s speech, while acknowledging some of the shortcomings of targets, steered clear of a debate about how they could change.

The service should consider how the rules could evolve to better serve patients who need planned specialist care.

‘Politicians may cast around for new or upgraded “pledges”, “guarantees” or “standards” for patients’

Under the current system, for example, many have an urgent need to be seen much more quickly than 18 weeks, but a mechanism for delivering this exists only in the case of suspected cancer patients. The Royal College of Surgeons has called for waits to be shorter where necessary, and longer where not.

System rules could also better exploit, for example, the potential for expansion of specialist services outside hospital, and to make more use of expertise that already exists in primary care, for example GPs with special interests.

With the election approaching, politicians may cast around for new or upgraded “pledges”, “guarantees” or “standards” for patients, and this might come with the opportunity for new thinking. They will undoubtedly want rigorous delivery of the current targets too.