09.02.2020

On target for disaster

James Linney looks at the ever growing waiting times.

You could be forgiven for thinking that the announcement this month by Matt Hancock, secretary of state for health, that accident and emergency waiting time targets within the national health service are to be abolished would have been welcomed by A&E staff. The four-hour target was introduced by Labour in 2004, setting as an operational standard the aim that at least 95% of patients attending A&E should be assessed, treated and then either admitted, transferred or discharged within four hours.

This has, to a large extent, always been an arbitrary, bureaucratic burden on emergency care staff - who have often been pressured by hospital managers to keep within the target or face disciplinary measures. Of course, it is generally a good idea to attend to people coming to hospital in an emergency as quickly as possible, but why four hours? There has never been any attempt to demonstrate that the four-hour target will provide an acceptable quality of care. Plus, it takes no account of the reason for the person attending A&E, meaning absurdly that someone with a broken toe and someone involved in a major, life-threatening, road traffic accident are both expected to be dealt with within the same time limit. Wherever you find top-down, punitive, arbitrary red tape, you will no doubt find workers able to invent ways to circumnavigate it in the name of common sense. A&E targets are no different and so patients are often officially booked in way after their assessment and treatment has started - or they are ‘discharged’ to holding rooms, whilst awaiting further investigations.

So why hasn’t Matt Hancock’s announcement been welcomed with cheers? Because, clearly, if the four-hour target is abolished, this will have nothing to do with trying to reduce NHS red tape - nor, as Hancock claims, will it be to set the “right targets” that are more “clinically appropriate”. Any new targets will be set so as to try and make the government look good - or at least minimise further embarrassment. As Dr Simon Walsh, the British Medical Association’s ‘emergency medicine lead’, said, “Targets are an important indicator when services are struggling, and there is a very real concern that any change to targets will effectively mask underperformance and the effects of the decisions politicians make about resourcing the NHS.”

So the real and obvious reason - and why we should oppose scrapping the target currently - is because the consistently falling number of patients being seen within four hours acts as a red flag for how a decade of Tory government is affecting the NHS as a whole. Since 2012 the number of A&E departments meeting the 95% target has been steadily falling - it has not been met since 2013. The latest set of performance statistics reveal the worst situation since the recording began in 2004, with only 68% of people attending major A&E departments being seen within four hours.

A&E waiting times are a pretty good barometer for the health of the NHS generally, so it is no surprise that other performance measures are equally dire. For example, today the highest proportion of people are waiting over 18 weeks for non-urgent (but essential) hospital treatment since 2008, the target for treating cancer patients within 62 days of urgent referral by a general practitioner has not been met for over five years and for the first time ever the average waiting time to see a GP has breached two weeks. GP surgeries and hospitals are like slowly sinking ships - despite all hands on deck working frantically to keep them afloat.

So these are worrying times, but things are only going to deteriorate, now that the NHS faces at least another five years of Tory government. Despite how it felt, the recent Tory general election campaign was not just an endless repetition of the phrase, “Get Brexit done”. There was also some attempt to win over traditional Labour voters by peddling the idea that austerity is over. Never mind that the Tory government has spent the past 10 years shifting the burden of the financial crisis onto the working class - including by imposing huge cuts on the NHS budget and using the opportunity to open up large parts of it to privatisation. We are now expected to believe that the NHS is in safe hands and be grateful it is going to get an increase in its annual budget of £34 billion by 2023-24. We are also being promised 6,000 more GPs and 50,000 extra nurses by 2024. However, during a bizarre interview on Good morning Britain, reminiscent of Orwell’s ‘doublethink’ (where Tory MP Nicky Morgan pretends not to understand what the term ‘more’ means), we learnt that 19,000 of these new roles are actually already filled by nurses.

Either way, the recruitment pledges are a fantasy and any extra money will come with the usual strings attached - namely that crippling ‘efficiency savings’ continue, along with the ever expanding privatisation of NHS services. So, for example, in order to meet its £1million deficit for the coming year, the clinical commissioning group where I work is shamefully considering restricting all elective surgery (apart from cancer treatment) for patients with a high body mass index or who smoke. And, even if the extra money was handed over condition-free, at this point it is a drop in an increasingly stormy ocean.

Meanwhile the queues of trolleys outside A&E departments will continue to grow, staff will become more despondent and patients will suffer and die. There are, however, small glimmers of hope - as the crisis in the NHS deepens the staff and patient resistance to the attacks on it will grow more radical, as witnessed by the 15,000 striking nurses in Northern Ireland last month - the first time the Royal College of Nursing has ever called for a strike. Of course, these are important developments, but the NHS can only be saved by a strong, organised working class - the immediate goal being to repel the post-Corbyn rightwing resurgence within the Labour Party.

The role of the left is to expand the issues beyond achieving NHS targets or getting a slightly bigger budget - the health of the working class is not ultimately a medical issue. The surge in mental health issues, obesity, increasing liver disease secondary to alcohol use, falling life expectancy, drug deaths and so on - all are a symptom of free market capitalism: an ideology that has always sacrificed working class health at the altar of profit.

Notes

. www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2020/01/Statistical-commentary-December-2019-v2-l9sh7.pdf.

. www.health.org.uk/news-and-comment/blogs/nhs-performance-and-waiting-times.

. www.youtube.com/watch?v=CpcY6HsGmAM.