The must-read stories and debate in health policy and leadership.

That the four-hour target had come to the end of its use – at least in the eyes of regulators – has been clear for some time. But a report from NHS England and Improvement has only partially revealed what will replace it.

A complex group of metrics – incorporating elements of the pre-hospital pathway as well as what happens in the emergency department – is being consulted on until February. Some of these will be basically system targets while some will relate more directly to how emergency departments are run and who they prioritise.

But there is little information yet on how they will be presented in monitoring performance reports or whether there will be thresholds NHS organisations are expected to meet.

In an ideal world, all patients will be initially assessed within 15 minutes. But will 90 per cent achievement be frowned upon? Or 80 per cent? What about the average times in accident and emergency? Will the monthly statistics released from NHSE include all the measures and – if so – how easy will it be to judge how well a hospital is doing? Will one measure come to acquire a greater prominence than others – not least in the media – and become the de facto new four-hour target?

Poor performance on the four-hour target in the past has led to more than one chief executive walking; not surprisingly many of them will want to understand more about how the new performance measures work and what the centre views as the most important.

Infection control under fire

Among the unprecedented number of challenges facing the NHS in 2020, infection control has remained a constant near the top of the list.

This has been particularly the case in the North West region, which has seen the highest rates of hospital-acquired covid infections over the last four months.

There will be multiple factors in play there, such as the quality and density of the hospital estate, as well as the general prevalence of the virus in the community. Once covid occupancy reaches a high level, it is more difficult to stop it spreading.

But research by a group of doctors suggests there have also been “major deficiencies” around infection prevention and control in orthopaedic services.

They surveyed orthopaedic trainees across 23 hospitals, in a report published in the Journal of Hospital Infection.

The study found patients were routinely being allocated to hospital beds before they had been confirmed as covid-negative, “thus allowing spread of covid-19 not only between patients but also between nursing and medical staff”.

Meanwhile, fewer than half of patients were nursed with the appropriate screens in place, while it was uncommon for doctors to be tested regularly, the authors added.