NHS England set to up four hours target despite current standard not being hit

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A&E target set to be raised, despite NHS missing lower bar

By Matt Discombe 5 January 2024​

• NHS England set to up four hours target despite current standard not being hit
• New target could be 80 per cent – up from 76 per cent this year
• Majority of trusts falling well short of current target

NHS England and government are set to raise their target for four-hour A&E performance, despite most hospitals failing to meet the current ask.

HSJ understands officials are likely to use 2024-25 planning guidance to raise the “interim” target for four-hour performance from the 76 per cent which trusts were asked to hit in 2023-24.

A new objective of 80 per cent by March 2025 has been discussed, several sources said, but is not confirmed.

The 76 per cent target has not been met during any month of 2023-24 so far, and most acute trusts are consistently falling well short of it.

Discussions on the new “interim” four-hour target are ongoing amid a delay to the publication of the planning guidance, which sets the service’s objectives for the year, as agreed with government. Usually published before Christmas to allow time for planning, it is now expected later this month.

Well-placed sources told HSJ  the target was likely to be increased despite “some doubts” among senior NHSE officials. One senior NHSE source said: “The target should be increasing incrementally as overall NHS A&E performance improves, [but] it hasn’t really improved this year.”

Neither NHSE nor the Department of Health and Social Care commented by time of publication. 

Royal College of Emergency Medicine president Adrian Boyle told HSJ  the 76 per cent four-hour target was “unambitious and has failed to drive flow for admitted patients, but diverts effort onto the least ill”.

Dr Boyle said that while increasing the target to 80 per cent could be helpful, “poor performance” at trust level “is being masked” by “bundling” data from facilities such as urgent treatment centres with that of type 1 [major] emergency departments.

He called for A&E performance to be published at individual department level – data which HSJ revealed for the first time in an investigation last year.  

The 76 per cent target was introduced in planning guidance for 2023-24 — and at the beginning of this financial year was the closest the NHS nationally has come to meeting it, delivering 74.6 per cent in April 2023.

The latest data, for November, shows 69.7 per cent of all emergency patients were admitted, transferred or discharged within four hours in November – dropping to 55.4 per cent for patients at major A&E departments only.

In November, 109 of 119 trusts with type 1 A&Es failed to hit the 76 per cent standard measured across all emergency patients, with Nottingham University Hospitals Trust and Hull University Teaching Trust reporting the lowest performance (45 per cent and 45.4 per cent respectively).

Of the 10 trusts which were hitting the 76 per cent target across all patients, three trusts were below the national average for type 1 performance – North Tees and Hartlepool Foundation Trust, Blackpool Teaching Hospitals FT and Royal Cornwall Hospitals Trust; reporting type 1 performance of 50.9 per cent, 53.9 per cent and 44.8 per cent respectively.

Royal Cornwall Trust said it has one of the highest proportions of type 3 urgent care facility use in the country, and that its main emergency department faces challenges around patient flow and a high volume of ambulance arrivals. North Tees and Hartlepool FT, which operates two urgent treatment centres, said it has a ”successful whole-system approach to emergency care.” Neither of the other trusts highlighted above provided any comment. 

Top and bottom 10 A&E four hours performers in November

Bottom 10

Name	Percentage in 4 hours or less (all)	Percentage in 4 hours or less (type 1)
England	69.7%	55.4%
Nottingham University Hospitals Trust	45.0%	39.5%
Hull University Teaching Hospitals Trust	45.4%	45.4%
Airedale FT	48.1%	45.6%
The Princess Alexandra Hospital Trust	50.0%	40.3%
The Shrewsbury And Telford Hospital Trust	50.1%	41.2%
Kettering General Hospital FT	51.0%	51.0%
Countess Of Chester Hospital FT	51.4%	48.9%
University Hospitals Of Leicester Trust	51.9%	48.1%
University Hospitals Plymouth Trust	52.6%	36.0%
East Cheshire Trust	52.7%	52.7%

 Top 10

Name	Percentage in 4 hours or less (all)	Percentage in 4 hours or less (type 1)
England	69.7%	55.4%
Northumbria Healthcare FT	87.0%	73.1%
North Tees And Hartlepool FT	85.0%	50.9%
Maidstone And Tunbridge Wells Trust	84.1%	82.4%
Homerton Healthcare FT	81.7%	81.7%
Dorset County Hospital FT	80.3%	65.6%
Blackpool Teaching Hospitals FT	78.9%	53.9%
Norfolk And Norwich University Hospitals FT	78.1%	62.5%
The Royal Wolverhampton Trust	77.3%	66.8%
Royal Cornwall Hospitals Trust	77.2%	44.8%
Chelsea And Westminster Hospital FT	76.3%	71.7%

 

Source

Information provided to HSJ, HSJ analysis of NHSE data