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NHS and Social Care: Targets, Priorities and Pressures Debate on 6 February 2020

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NHS and Social Care: Targets, Priorities and Pressures Debate on 6 February 2020 Library Briefing NHS and Social Care: Targets, Priorities and Pressures Debate on 6 February 2020 On 6 February 2020, the House of Lords is due to debate a motion moved by Lord Hunt of Kings Heath (Labour) that “this House takes note of the National Health Service’s performance in relation to its priority area targets; and the impact of adult social care pressures on patients of the National Health Service, and their safety”. Summary NHS England’s performance against the four-hour A&E waiting time targets in November 2019 was the worst since the figures started being collected in 2010. NHS England was also below its operational standards for elective referral and cancer referral and treatment waiting times in November 2019. The 62-day maximum waiting time target between urgent GP referral and first cancer treatment was last met in 2013/14. NHS England is currently reviewing changes to these targets. In addition to targets, NHS England also set out care priorities, and other priority areas of focus for the NHS, in its Long Term Plan. These cover clinical areas such as maternal health, mental health, diabetes and learning disabilities. They also include efforts to improve efficiency within the NHS as a whole; for example, the better use of land and equipment. An additional pressure on its services cited by NHS England is adult social care. It has been reported that delayed transfers of care, where a patient is unable to leave NHS care for some reason, can impact upon other areas of the service, including A&E departments. In addition, some claim that reduced funding for social care can lead to increased hospital admissions. In a recent survey of NHS leaders, the majority agreed that issues in social care were affecting the NHS and patient care. The Government has stated that it intends to publish plans to reform the adult social care system later this year. This briefing summarises NHS England’s performance against particular targets, including accident and emergency (A&E) waiting times and cancer treatment targets and highlights some of NHS England’s priorities, as set out in the January 2019 Long Term Plan. The briefing also summarises pressures in the adult social care system and how this can affect those in the health service, and lists further reading on proposed reforms to adult social care. Both health and social care are devolved matters, and this briefing covers the situation in England only. Russell Taylor ǀ 30 January 2020 ____________________________________________________________________________ A full list of Lords Library briefings is available on the research briefings page on the internet. The Library publishes briefings for all major items of business debated in the House of Lords. The Library also publishes briefings on the House of Lords itself and other subjects that may be of interest to Members. Library briefings are compiled for the benefit of Members of the House of Lords and their personal staff, to provide impartial, authoritative, politically balanced briefing on subjects likely to be of interest to Members of the Lords. Authors are available to discuss the contents of the briefings with the Members and their staff but cannot advise members of the general public. Any comments on Library briefings should be sent to the Head of Research Services, House of Lords Library, London SW1A 0PW or emailed to [email protected]. 2 1. NHS Targets and Priorities 1.1 Accident and Emergency Targets NHS England operates a target for 95% of patients at accident and emergency units (A&E) to be admitted, transferred or discharged within four hours.1 The four-hour target has been in operation since 2004; however, until 2010, the target was set at 98% of patients.2 The latest set of statistics, covering December 2019, showed that 79.8% of all patients seen in A&E in that month were seen within four hours. This figure was a reduction from 81.4% in November 2019 and 86.5% in December 2018.3 It is the lowest performance since the collection began in 2010. The 95% standard was last met in July 2015. Chart 1: Performance Against Four-Hour Target Since November 20104 100.0% 95.0% 90.0% 85.0% 80.0% 75.0% 70.0% 65.0% 60.0% Jul-12 Jul-17 Jan-15 Jun-15 Oct-13 Oct-18 Apr-11 Apr-16 Sep-11 Feb-12 Sep-16 Feb-17 Dec-12 Dec-17 Aug-14 Aug-19 Nov-10 Nov-15 Mar-14 Mar-19 May-13 May-18 In addition, the statistics found:5 • Only one out of the 118 reporting trusts with a major A&E department met the 95% target in December 2019. • December 2019 saw the highest number of over four- and over twelve-hour delays from decision to admit to admission since the statistics collection began. 1 NHS England, A&E Attendances and Emergency Admissions: December 2019 Statistical Commentary, 13 December 2019. 2 Nuffield Trust, ‘A&E Waiting Times’, 26 April 2019. 3 NHS England, A&E Attendances and Emergency Admissions: December 2019 Statistical Commentary, 13 December 2019, p 1. 4 NHS England, ‘Adjusted: Monthly A&E Time Series December 2019’, accessed 30 January 2020. 5 ibid. 3 There was also a general increase in A&E attendances and emergency admissions compared to the previous year. The total number of attendances in December 2019 was 2,181,024, an increase of 6.5% on the previous December. Emergency hospital admissions numbered 560,801 in December 2019, 2.9% higher than the same month in the year before. Reviewing the A&E Targets NHS England is currently reviewing the A&E targets, with fourteen trusts piloting a new system of “rapid care measures”. Explaining how this would apply, NHS England stated: New standards to be trialled include a rapid assessment measure for all patients arriving at A&E, coupled with faster life-saving treatment for those with the most critical conditions, such as heart attacks, sepsis, stroke and severe asthma attacks. The proposals will support staff to focus on what matters most to the public and saves lives, including early assessment of everyone coming to A&E, the rapid start of treatment for those with the most serious illnesses and injuries. A new measure of time in emergency department will also be tested, with the aim of ending hidden long waits and providing a more accurate view of hospital performance by recording how long every patient spends in A&E, not just whether their discharge or admission time breached the target.6 Progress of the Review In a progress report on the trialled changes, NHS England described the initial results as “promising”. It stated that the number of patients spending over 12 hours in A&E had “fallen faster in trial sites than a control group”, and there were “signs that more people are getting the help they need to return home the same day”.7 It also reported possible public support for the changes, citing research conducted on behalf of Healthwatch England. It said the research showed the public “place the highest priority on A&E teams providing early initial assessment on arrival for everyone”, allowing staff to “prioritise those patients with the greatest need”, as well as “ensuring that patients with critical conditions get the right standard of care quickly”. The research suggested “the current measure was not well recognised” by the public and that “more people would find an average wait time understandable and useful”.8 NHS England stated that it would continue to trial the scheme and hoped to consult on proposed changes in early 2020, before making a decision whether to proceed. On 15 January 2020, the Health Secretary, Matt Hancock, confirmed that changes to the A&E targets were being considered. He stressed the need for targets that are “clinically appropriate” and 6 NHS England, ‘NHS to Test New Rapid Care Measures for Patients with the Most Urgent Mental and Physical Health Needs’, 11 March 2019. 7 NHS England and NHS Improvement, Measuring What Matters, November 2019, p 1. 8 ibid. 4 “supported by clinicians”.9 He said the targets were being looked at by clinicians. Responding to these reports, the Shadow Health Secretary, Jonathan Ashworth, said that changing the targets would not “magic away the problems in our overcrowded hospitals, with patients left on trolleys in corridors for hours and hours”. 1.2 Cancer and Elective Referral Targets NHS England has a range of targets for cancer treatment and waiting times and for other medical referrals. In 2019, a House of Commons Public Accounts Committee report considered three key waiting times for elective and cancer treatment. These were: • 92% of patients should wait no more than 18 weeks for their elective treatment from the date of their referral (if treatment is needed); • 93% of patients should be seen by a cancer specialist within two weeks of being urgently referred by a GP for suspected cancer; and • 85% of patients who are subsequently diagnosed with cancer should be treated within 62 days of the date of their original referral.10 Elective Referrals This section discusses referrals for elective treatments—that is, non-urgent treatments planned and agreed in advance. The NHS England target of patients not having to wait longer than 18 weeks for referral to elective treatment (RTT) was initially introduced in 2004.11 The duty for this to apply in 92% of cases was then legislated for in 2012.12 The latest figures showed that 84.4% of RTT patients started treatment within the 18-week target in November 2019, below the 92% target.
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