Daily Insight: Is time up for the four-hour target?

In describing the four-hour A&E standard as the “wrong target,” Sajid Javid has reignited a long-running debate over waiting time objectives for NHS trusts.

The health and social care secretary made the claim in front of the Commons health and social care committee this week, adding that the standard leads to “perverse outcomes”.

He told MPs: “If you look at some NHS trusts, all of sudden when the individual in A&E has got to three hours and 55 minutes, guess what? They just admit it.

“That’s a poor outcome.”

“There may have been a good reason to have that target in the past, but you’ve got to keep these targets constantly under review and that’s something I’m doing.”

NHS England has proposed scrapping the standard in favour of alternative measures, but the government is yet to formally respond.

Meanwhile, Mr Javid insisted it was the “professional duty” of NHS workers to get the covid jab, after being questioned about the government’s covid vaccine mandate for patient-facing NHS staff.

But he added: “I think it is right, in light of omicron, that we reflect on all this and keep all covid policies properly under review because omicron is different to delta.”

Trusts must douse the flames of burnout 

Everyone acknowledges the workforce is suffering widespread burnout and staff need a rest – but little is being done to guide trusts on how they should be creating an environment conducive to that allowing that to happen.

System leaders talk a good game on the need to give staff a rest but it’s always caveated with: “Oh, by the way, here are the activity trajectories you need to hit to avoid a visit from the heavies”.

That is why NHS England director and trust chief Matthew Winn spoke for many when he said this week he “fears [the NHS] will see increasing numbers of resignations” unless more is done to ensure burnt-out staff are given sufficient leave to recover mentally and physically.

Matthew Winn, NHSE’s director of community health and Cambridgeshire Community Services Trust chief executive, set out his concerns in a paper discussed by his trust’s board meeting on Wednesday.

The paper adds: “As the NHS starts to focus on recovering from the current covid pressures, it is vital that the national, regional and local planning must take into consideration that our staff need time to recover and that they cannot (for example) be expected to catch up on the waiting lists that have accrued, without time and resources to support them.”

Acknowledging the problem is no longer enough. Trusts need guidance on how to address it.