If you enter an Accident and Emergency department at a hospital in England, you’re supposed to be treated and then either discharged, admitted or transferred within four hours. This is the target waiting time for 95 per cent of people who arrive at A&E.
As of late, this process may sound a little unfamiliar to you. For the first time last December, every major A&E unit in England failed to hit its four-hour waiting time target, according to NHS figures.
A&E waiting times have been rising alongside record delays for beds, record waiting lists for routine care, and record numbers of cancelled operations. We know this because of targets – when resourcing the health service goes wrong, this is starkly displayed by how many of them are missed. For example, by November last year, key targets for cancer, hospital care and A&E had been missed for over three years: “Hospital waiting times at worst-ever level”, was the BBC’s headline.
You can see why the government would rather scrap the targets than try to ensure hospitals meet them again, as is the plan according to Health Secretary Matt Hancock this week. This would make it less easy to measure, and to report on, slipping healthcare standards. With growing demand, understaffing and cutbacks in social care and the health service proper, it would also be very expensive to bring care back within the targets – £4bn-£5bn for A&E, planned surgery and cancer targets, according to the group that represents trusts, NHS Providers.
“Patients will think Matt Hancock is trying to move the goalposts to avoid scrutiny,” warned shadow health secretary Jon Ashworth in the Guardian. Many groups representing doctors and nurses who work in emergency medicine have also condemned the move for this reason.
While the A&E target system is far from perfect – some hospital doctors feel it attracts patients who should instead be booking a GP appointment – the ulterior motive of sweeping a problem under the data radar is suspected.
Recent Conservative governments have form on this, after all. In 2015, David Cameron’s administration changed the child poverty target by calculating levels using an alternative measure, which allowed ministers to paint a more flattering picture of the situation. Nevertheless, the original measure (official statistics on relative and absolute child poverty) wasn’t scrapped. We can still use those figures to track whether child poverty is truly rising or falling.
There is also the inescapable reality – surging foodbank use over summer holidays among children, for example, and programmes such as Channel 4’s shocking Dispatches last December on child poverty. Equally, even if the government had done away with A&E targets before 8 December 2019, the photo of four-year-old boy Jack Williment-Barr lying on a Leeds hospital floor on a pile of coats would still have made the Yorkshire Evening Post.
Although that election campaign story did little to put voters off Boris Johnson, it remains a risk for the Conservatives to focus on fiddling around with measures and directing funding to electorally popular services.
As we’ve argued before on the New Statesman podcast, the government can repeatedly champion the money it’s spending on hospitals (rather than the less sexy but vital social care system), but as long as beds continue to be unavailable, people will notice. And they will notice even more if ministers are constantly pointing to the services they’re supposed to be improving.
The government can’t seek to move the goalposts without eventually scoring an own goal.