But Government nanny state targets are about to put the great British breakfast under threat.

Butchers and other food retailers say health diktats to reduce salt levels could ruin the taste of some of our favourite dishes, with producers of bacon and sausages facing the greatest difficulties.

More than 60 food firms and supermarkets have pledged to meet salt reduction targets agreed by the Coalition.

But as the deadline grows closer, they fear compromising the familiar tastes valued by customers unless extra additives are introduced. They also fear risking safety, because of the role of salt as a preservative.

Some independent butchers have said they have no intention of changing cherished recipes to meet the demands of the “salt police”.

At least 80 per cent of sausages sold in Britain currently fall short of the government’s 2012 target, which allows 1.13g of salt per 100g of food. Popular brands such as Richmond contain twice that amount.

Own brand packs of bacon on sale at Sainsbury’s, Tesco and Waitrose all contain more salt than the future 2.88g per 100g limit for bacon.

Andrea Martinez-Inchausti, Deputy Food Director for the British Retail Consortium (BRC) said it was “pointless” to put huge efforts into reducing salt if only left consumers adding large amounts themselves at the dinner table.

“Our members have made fantastic progress reducing the levels of salt in food in recent years,” she said. “In some cases we’ve come as far as we can without help from science. If salt is reduced further there’s a danger that products will no longer taste the way customers want them to.”

The BRC and the Food and Drink Federation have drawn up a list of eight foods for which it is proving difficult to reduce salt content without losing flavour or risking safety. In addition to bacon and sausages, the list also includes soft cheeses, cakes, and sauces such as pesto.

Research will be conducted from next month to see if any new processes or ingredients can be found to overcome the problems.

In total, 62 retailers and manufacturers, including Sainsbury’s, Tesco, Marks & Spencer, Waitrose and Asda have pledged to meet dozens of salt reduction targets by next year.

Their promises were part of a ‘public health responsibility deal’ set by the Coalition before it handed responsibility for nutrition policies from the Food Standards Agency (FSA) to the Department of Health.

It is aimed at helping consumers follow health advice to limit their salt intake to 6g a day, in order to prevent high blood pressure that can lead to strokes and heart disease.

Previous targets, brought in last year, have provoked a backlash from fans of HP sauce who said their favourite brand had been left tasting “bland” and “disgusting” after a drastic cut in salt content.

The sauce used to contain 2.1g of salt per 100g, as well as malt vinegar, molasses, dates and tamarind, but the content was reduced to 1.3g to meet last year’s targets.

Internal FSA documents, dated May 2009, state: “Maintaining product binding and succulence in sausages has proved challenging whilst reducing levels of sodium.”

It says some reductions had been achieved, though they fell well short of next year’s commitment.

The same analysis warns of the difficulties of attaining an even dispersal of salt in bacon, and the impact of laws restricting the use of nitrates as a preservative.

Maureen Strong, nutrition manager for the British Pig Executive, said: “When the work first started on these targets, it was led by statisticians, not microbiologists.

“Research showed that the initial targets they drew up would have caused a rise in salmonella, botulism and E.coli.

“They have been altered since then, and we have all tried to work together, but some of the targets for next year are nigh on impossible – at least without too great a compromise.”

She added: “If you want to reduce the salt in sausages, that often means a whole lot more additives. I don’t know if that is what customers are asking for.”

Those most affected by the changes are food suppliers to major retailers. Independent butchers not signed up to the responsibility deal do not have to meet hit the targets, but some feel failure to meet the new standards could be viewed badly by health-conscious customers.

Mick Norkett, founder of the East London Sausage Company, based in Walthamstow, said he would try to meet next year’s targets.

“We do our best to keep the levels low, but salt is a preservative, and in sausages, it is in the skins as well as the sausage meat,” he said.

“If you are having a fry up, and trying to be keep salt levels down, I think the best thing is to stop adding salt at the table, and to avoid slathering on ketchups and beans that are packed full of the stuff.”

Mr Norkett, a butcher for almost 40 years, said reaching the targets would be more difficult for supermarkets that need a long shelf life for their products.

Stuart Higginson, from Grange-over-Sands, Cumbria, has run his butchers with his wife Pauline for 28 years.

His sausages meet current Government limits of 1.4g per 100g, which came in last year, but he is not prepared to sacrifice flavour in order to meet next year’s demands.

Mr Higginson, 61, from said: “I’ve never had anyone come in and ask for sausages or bacon with less salt in them.

“I think the government are overdoing this; most of us don’t have bacon and sausages every day, and we want to get some enjoyment from our food when we eat it, not just eat to live.”

From: http://www.telegraph.co.uk/Whitehall-targets-threaten-the-Great-British-Breakfast

The trusts that replied carried out 1,227 fewer knee replacements, a drop of six per cent, and 531 fewer hip replacements.

And they carried out 2,041 fewer hernia operations, down 7.25 per cent, and 1,770 fewer tonsillectomies, a drop of 11 per cent.

The figures are from Freedom of Information requests to England’s 170 NHS hospital trusts, made by the Patients Association, of which 62 responded.

The pressure group described the figures as “a disgrace” while doctors labelled them “worrying”.

The Patients Association also found that, on average, waiting times for hip replacements rose from 80 to 88 days and for knee replacements from 82 to 90 days.

The organisation undertook the research after receiving triple the number of calls in 2010 from patients saying they were having problems getting the surgery they needed, compared to 2009.

In December The Daily Telegraph reported how some trusts were postponing lower-priority procedures to save money.

Although the NHS is receiving a 0.5 per cent above inflation increase each year between now and 2014, critics say a commitment to make internal savings of up to £20 billion by then means front-line services are being affected.

Katherine Murphy, chief executive of the Patients Association, said: “It is a disgrace that patients are being denied access to surgical procedures that they would have had if they had needed them a year ago.”

She added: “With the NHS needing to make £20 billion of savings by 2014, we are worried that this situation is only going to get worse – how many more thousands of patients are going to be denied operations this time next year?

“This research backs up what patients are telling us every day on our helpline, less operations are being carried out, and those fortunate enough to get an operation are having to wait longer for it to take place.”

John Black, president of the Royal College of Surgeons, described the figures as “worrying”.

He said: “Patients must be seen on a clinical need, rather than a financial basis. Any cost savings this may bring in the short term will be negated as these patients present with more serious conditions further down the line.”

However, the Department of Health said official hospital statistics for all trusts in England indicated that NHS activity went up in 2010, not down.

For example, from April to October 2010 there were 41,863 hip operations, compared to 39,114 for the corresponding six months in 2009; while the figures for knee operations were 45,463 and 43,454 respectively.

A spokesman said: “There is no justification for asserting that quality of care is slipping. Official figures show that the NHS is delivering more for patients and that waiting times are stable.”

From: http://www.telegraph.co.uk/Hospitals-cutting-operations-while-waiting-times-rise

The cuts in after-hours budgets led to warnings of a repeat of the case of Daniel Ubani, the incompetent German locum who killed a Cambridgeshire man with a morphine overdose in 2008.

About 78 of England’s 152 primary care trusts released information on their out-of-hours spending after Freedom of Information Act requests by the magazine GP. Twenty said they had cut their budgets.

The cuts, made in the trusts’ 2010-11 budgets, come before the start of the next four-year spending round, which will require the NHS to find efficiency savings worth £20 billion.

Across the remaining trusts that released information, total spending on out of hours care rose by only £3.6 million.

Health experts said some trusts might have been able to make savings without affecting services, by renegotiating inflated contracts.

However, doctors and patients’ groups said that in many cases lower spending would add to concern about the quality of care.

A study commissioned by the Department of Health last year found wide variations in the quality of care provided by out-of-hours contractors, including GP groups and private health care firms.

Katherine Murphy, the chief executive of the Patients’ Association, said the latest cuts would reduce the quality of care, risking “a repeat of the case of Dr Ubani”.

She said: “By pressuring providers to look for ever cheaper options, the Government is forcing them to enter a race to the bottom.

“Out-of-hours services need to be staffed by doctors who are as trained and experienced as their colleagues who work during the day. Cutting funds to pay for them will mean fewer and possibly less able doctors.”

Dr Fay Wilson, who chairs an out-of-hours group in Birmingham, said cutting out-of-hours care was a “false economy” for trusts because more patients would be forced to seek care from accident and emergency wards.

“If you are going to reduce the cost, then you will be reducing the number of clinicians you have on,” she said. “That leaves gaps. You also don’t get the same level of supervision and support.”

Richard Vautrey, of the British Medical Association, said cutting costs could harm services.

“There is a concern that you can pare a service down to such a level and reduce funding to such a level that you put patient safety issues at a higher risk,” he said.

The Department of Health said the Coalition was improving out-of-hours care. A spokesman said: “This is not about cutting costs – we are investing an extra £10.7 billion in the NHS – it’s about ensuring GPs, not bureaucrats, are responsible for securing safe and appropriate out-of-hours care.”

The BMA also published a poll which it said showed that most GPs opposed government plans to give them control over £80 billion of NHS budgets.

About 65 per cent of family doctors believe competition between providers, including NHS and private companies, will reduce the quality of patient care, while 61 per cent said the Government’s reforms mean they will spend less time with patients.

The Department of Health said the survey showed some doctors had “misconceptions” of the planned reforms. Andrew Lansley, the Health Secretary, said there was no alternative to his reforms to make the health service more efficient.

“Unless we modernise, every year the relative costs of running the NHS will go up,” he said. “Demand will grow, the bureaucracy will expand and inefficiencies will become entrenched.

“There is no easy option. Sticking with the status quo and hoping that a bit more money will be enough to meet the challenges ahead is a complete fiction.”

From: http://www.telegraph.co.uk/Patients-at-risk-as-health-trusts-trim-out-of-hours-care

Legal experts warned the rise could leave GP consortia at risk of being sued by patients when they take over commissioning, since being treated within 18 weeks remains a right under the NHS Constitution.

Department of Health statistics show the proportion of people treated within 18 weeks increased steadily from 2007.

Numbers peaked this July, when 93.3% of admitted and 98.1% of non-admitted patients were treated within target, just after the NHS Operating Framework removed it.

By September, the proportion of admitted patients missing out jumped from 6.7% to 7.5%, and of non-admitted patients from 1.9% to 2.2%.

Overall, 45,000 patients missed out on treatment in 18 weeks during September, up 15% from 39,000 in July. Some 12.6% of patients awaiting orthopaedic or trauma treatment, and 10.6% awaiting oral surgery, waited more than 18 weeks.

Ben Troke, partner in health and social care at Browne Jacobson solicitors, warned: ‘When commissioning passes to GP consortia, it’s hard to see responsibilities [for applying the NHS Constitution] not going with it. There’s a real risk of legal challenge.’

‘Whether a claim would be successful is hard to say, but being dragged through the courts can be damaging even if you win. Courts are starting to rely on the NHS Constitution as a ground for decisions and every consortium can expect to keep their lawyers busy.’

At least one SHA has admitted waiting times are slipping.

NHS South Central said health systems in Oxfordshire, Southampton and south-west Hampshire had been assessed as failing ‘principally due to financial issues and concerns on workforce and 18 weeks’.

Dr Jennifer Dixon, director of the Nuffield Trust, said: ‘Once you scrap hard targets, it’s likely actions to achieve them will wane. I guess that’s what we’re starting to see.’

Dr Chaand Nagpaul, GPC negotiator, said PCTs were already taking advantage of the target’s removal: ‘We’re getting reports of trusts delaying treatment so they can address financial problems. The Government is engaging in double-speak, removing targets on one hand but committing to patients’ rights on the other.’

From: http://www.pulsetoday.co.uk/NHS waiting times increasing after targets scrapped

Emergency patients are being let down by the health service because managers are more concerned with meeting targets by treating those with appointments, the heads of Royal Colleges warn.

In a letter to The Daily Telegraph, some of the country’s most senior doctors say they are “deeply frustrated” at the low priority given to Accident and Emergency.

Targets concerning waiting times and cancelled operations, introduced under Labour, result in managers pushing doctors to operate on patients whose care has been pre-planned, in order to avoid financial penalties. But they can also mean that those who come in as emergency cases are stabilised and admitted but then left to wait for surgery.

Studies have shown that elderly people with fractured hips who do not undergo surgery within 48 hours are less likely to regain full mobility. Younger patients with shattered pelvises, from motorcycle or horse-riding accidents, are less likely to walk again if their operations are delayed.

A report published on Thursday criticised care for the elderly, finding that two thirds of those who died within a month of surgery had not received proper care and that they had often been left in pain.

Most of those patients were being treated for bowel conditions or broken hips, which are usually admitted as emergency cases.

John Black, president of the Royal College of Surgeons, said the report echoed concerns that surgeons had been raising for some time.

In the letter, Mr Black said: “It is a source of deep frustration to our members that hospitals have become organised to deal quickly with elective operations at the cost of properly managing emergency care.”

The Coalition’s reforms of the NHS could help by making hospitals more accountable to GPs for the care they provide, he said.

The letter was signed by Peter Nightingale, president of the Royal College of Anaesthetists; Peter Kay, president of the British Orthopaedic Association; Finbarr Martin, president of the British Geriatric Society; Mike Horrocks, president of the Association of Surgeons; and Clare Marx, the Royal College of Surgeons’ lead representative in matters of patient safety.

Mr Horrocks said: “In recent years, the NHS has been set targets for elective operations to bring down waiting lists.

“This has been fantastic for patients with non-emergency conditions, but came at the detriment of those who require urgent treatment as hospitals focused on hitting those targets.

“The new government has committed to moving away from targets and towards measuring and rewarding hospitals who deliver good outcomes and this report should provide further evidence that this approach is correct.”

Under Labour, patients had to be treated within 18 weeks of a referral by their family doctor.

Surgeons have told the Telegraph that this resulted in extreme pressure to operate on any patients in danger of failing to meet that target, ahead of cases that came in as emergencies.

Any pre-planned operation that was cancelled was recorded and the data published. The patient then had to be rescheduled within 28 days, adding to the pressure to give elective operations priority, doctors have said.

Mr Black added: “Surgeons have been saying for some time that emergency surgery is a Cinderella service in the modern NHS.

“We will only solve these problems if focusing on emergency care becomes a priority in the boardroom as well as the ward.”

Katherine Murphy, director of the Patients Association, said: “It can be so debilitating for someone who has a fracture to be left for a couple of days or longer, waiting for an operation when the trust is focused yet again on meeting these pernicious targets. It is an appalling way to determine who gets care. An emergency should be an emergency.

“The financial rewards for elective surgery are more lucrative for the trust than for emergencies and that is why trusts continue to focus on elective treatment. We cannot make savings by putting patients through unnecessary pain and suffering.”

From: http://www.telegraph.co.uk/Emergency-patients-let-down-by-targets-say-surgeons

The latest inquiry, being held at the offices of Stafford Borough Council, began with an opening statement by its chairman, Robert Francis QC.

Mr Francis, who begins hearing expert evidence next week, also chaired the previous independent inquiry into failings at Stafford Hospital.

That inquiry, which published its findings last February, identified systemic failings at the hospital, where managers were preoccupied with cost cutting and labour Government targets.

Launched after a Healthcare Commission report published last year, the previous inquiry revealed a catalogue of failings at the trust, which also runs Cannock Chase Hospital.

Appalling standards put patients at risk and between 400 and 1,200 more people died than would have been expected in a three-year period from 2005 to 2008.

The previous Labour government rejected calls for a full public inquiry into events at the hospital, instead ordering the independent inquiry.

Mr Lansley said in June that the new inquiry would be held in public in order to combat ”a culture of secrecy” and restore public confidence.

When he announced the latest inquiry, Mr Lansley told Parliament: ”We know only too well what happened at Mid Staffordshire, in all its harrowing detail, and the failings of the trust itself.

”But, we are still little closer to understanding how it was allowed to happen by the wider system.

”When this inquiry has completed its work and I return to this House to present its report, I am confident that we will, for the first time in this tragic saga, be able to discuss conclusions, rather than questions.”

In a statement issued last month, Mr Francis said he was committed to carrying out an independent, evidence-based and transparent process, to identify the broader lessons to be drawn for the wider health system.

Mr Francis said: ”I believe this is an important opportunity to contribute to the improvement of standards in the NHS and the protection of the public, building on the lessons from Mid Staffordshire.

”My aim is that, through an open, candid and reflective consideration of the events at Mid Staffordshire, the inquiry will be able to make recommendations which will assist to shape the regulatory, supervisory and commissioning structures of the NHS of the future.”

From: http://www.telegraph.co.uk/Mid-Staffordshire-hospitals-inquiry-to-hear-of-failings-at-Trust

Lawyers for the victims said the failings of Stafford Hospital left patients degraded and humiliated, and amounted to human rights’ abuses.

The trust has offered a total compensation settlements of £1.1 million, which the families are expected to accept, and apologies in each case. It did not accept the failings were breaches of human rights.

A public inquiry into the worst hospital scandal in more than a decade opens next week.

Last year, inspectors found that hundreds more patients died than would have been expected at the hospital between 2005 and 2008, amid “appalling” conditions.

Dehydrated patients were forced to drink out of flower vases, while decisions about treatment for Accident and Emergency patients were left to receptionists.

Up to 1,200 patients may have died needlessly over the period, as managers attempted to cut costs and hit targets.

The settlements for the group of 97 cases, including 84 deaths, covers failings as recent as this year, and dating back to 2002.

Among those to receive a payment is Heather Wilhelms, 55, who lost her mother, father, and husband at the hospital in the space of 18 months.

Her mother’s ovarian cancer was missed, while her father was sent home without treatment days before he died, after blood poisoning went undetected.

Nine months later, her husband died from lung disease in wards which his widow described as “filthy”. She told how her loved ones went to hospital for treatment and one by one, came out in their coffins.

The compensation payouts range from £1,000 to £27,500, with an average payment of just over £11,000 for bereaved relatives and those who survived failings in care.

Emma Jones, from lawyers Leigh Day & Co, which represented the families, said the action was believed to be unprecedented, with the 97 cases representing the largest group to be offered payouts by one hospital.

She said lawyers argued that the hospital’s failings were so basic and substantial, that they amounted to breaches of patients’ fundamental human rights.

Miss Jones said: “This was about basic neglect; food and drink placed out of reach, buzzers unanswered, people left after soiling themselves.

“In some cases we argued that the poor treatment caused the deaths – in many, the argument was that basic fundamental human rights were being denied – that people were being degraded, neglected and humiliated.”

Often, when elderly people die following failings in hospital, compensation is low, especially if no spouse is bereaved.

The lawyers said the case was significant because the arguments had centred on how badly patients had been treated, rather than proving their deaths had been hastened.

“For the relatives it was never about the money but more a recognition that their mum, or dad should never have been left to suffer in that way,” said Miss Jones.

She added: “We don’t know of any bigger group claim against any one hospital, we think this is unprecedented.”

The Labour Government refused to hold a public inquiry to find out what went wrong, and to prevent a repeat of the scandal.

Since taking power, the Coalition Government has ordered such an investigation – one of the key demands of The Sunday Telegraph’s Heal Our Hospitals campaign – which is due to start taking evidence next week.

On Saturday an inspection report revealed that the hospital is still failing to meet most basic standards of patient care.

The Care Quality Commission said it had concerns about the care and welfare of patients, and respect shown to them, its safeguarding of patients from abuse, the management of medicines, the safety of premises and equipment, staffing and complaints.

Inspectors said the trust had made progress, and that some of the concerns involved changes which would take time to “bed in”.

Last week it emerged that the trust had paid a locum Accident & Emergency doctor more than £5,000 to work a single 24-hour shift, in response to a sudden staffing crisis.

Julie Bailey, who founded local campaign group Cure the NHS as a response to the standard of care given by the hospital to her own mother, who died in 2007, said: “The size of the group exposes the scale of this crisis; it is an absolute disgrace that in the 21st century, the most vulnerable people were treated so appallingly.”

She added: “For relatives who have gone through this, no amount of money can ever compensate for what happened to their loved ones.”

Mrs Bailey said there were many more relatives and victims who had never received a penny. “Every day, someone comes to me who has never even spoken before about what they went through.

“There are so many people suffering as a result of this scandal, and no one has been held to account for what we are going through.”

Antony Sumara, Chief Executive of Mid Staffordshire NHS Foundation Trust, said: “As always, I offer our sincerest apologies to the families concerned, for the distress caused by the poor care their relatives received at our Trust in the past.

“We have made a lot of progress over the last year in improving the care for our patients and will continue to focus our efforts on building on these improvements and making sure that they are sustained.”

From: http://www.telegraph.co.uk/Almost-100-victims-of-Staffordshire-scandal-receive-payouts-after-unprecedented-group-claim

More than eight thousand breaches of Labour’s pledge to “virtually eliminate” mixed wards were reported in just half of England’s Strategic Health Authorities in the first quarter of this year, new figures show.

If the same level existed across the rest of the country it would mean there were more than 16,000 breaches in three months, equating to 64,000 cases a year.

Andrew Lansley, the Health Secretary, announced yesterday that the “indignity” of men and women sharing accommodation would be abolished, almost 15 years after Tony Blair made the same promise.

But men and women may still have to share wards, provided the hospital ensures that male and female patients sleep in separate areas and have their own washing facilities.

Labour committed in two manifestos to provide separate accommodation for men and women, except where it was in the interests of the patient not to do so.

They later decided to divide wards into same-sex “bays”, meaning same-sex accommodation could include men and women sleeping in separate partitions of the same ward.

But the new figures reveal that one in ten patients is still admitted to a mixed ward, while a third have to share bathrooms with members of the opposite sex.

The information suggests data is not being recorded consistently across the country and NHS organisations are continuing to place patients in mixed sex accommodation for “operational reasons”, the government claimed.

Under new steps announced by Mr Lansley, NHS organisations can be held accountable for failing to guarantee same-sex accommodation where there is no clinical justification.

From next January, any breaches of the guarantee will be reported regularly and commissioners will sanction NHS bodies which admit failing to meet the pledge.

For the first time the reports will be made publicly available, meaning patients receiving elective treatment can choose to avoid the worst-performing hospitals.

Mr Lansley told BBC Radio 4′s PM programme: “It should be more than an expectation, it should be a requirement that patients who are admitted should be admitted to single-sex accommodation.

“Patients should be in single-sex accommodation, meaning that all of their period that they are admitted they should be in a bed or a bay which only consists of people of the same sex.

“And they should be able to come and go, for example to all their washing and toilet facilities, without having to pass through a part of the ward or another ward where there might be people of a different sex… so to that extent they would have the kind of privacy and dignity people have a right to expect.”

He added: “Patients should not suffer the indignity of being cared for in mixed sex accommodation. I am determined to put an end to this practice, where it is not clinically justified.

“In the future, NHS organisations will have clear standards, spelling out when they should report a breach. Where NHS organisations fail to meet this standard, we will let the public know they have failed and we will strengthen the fines which may apply.”

Chief Nursing Officer Christine Beasley added: “Protecting the privacy and dignity of patients by eliminating mixed sex accommodation must be a priority for the NHS.

“Driving this change will be the publishing of statistics on mixed sex accommodation breaches by NHS trusts. This measure will allow patients to make better informed decisions about their care.”

From: http://www.telegraph.co.uk/Thousands-of-patients-still-forced-to-stay-in-mixed-sex-wards

Mr Lansley, who has scrapped several of Labour’s key targets, including the guarantee of a GP appointment within 48 hours, insisted the new standards were not just another set of targets.

Speaking at the launch of the standards, which have been developed by the National Institute for Health and Clinical Excellence (Nice), Mr Lansley said they were not mini-targets as they were ”evidence-based” measures identified by the NHS itself.

”These are standards, not diktats. It is not politicians establishing these, I am not picking them out. ‘If I started doing that, I would be distorting clinical standards.”

The latest standards from Nice are drawn from various sources, including existing Nice guidelines, and reports from the Royal Colleges, the Department of Health and the National Audit Office.

It will be up to local managers – or possibly GPs in the future – to check if the NHS is meeting them.

If trusts fail to reach the standards, they could face losing contracts to carry out services, such as stroke care, which could be commissioned from other hospitals instead.

It is unclear how data will be collected nationally so patients can assess whether standards are being met.

Dr Tim Kendall, who led development of the dementia standard, said it would help transform the experience of dementia patients but also support carers.

”Some carers suffer far more than they should. People with dementia effectively die while the person caring for them watches them disappear,” he said.

The stroke standard sets out how patients can expect to receive a minimum of 45 minutes, five days a week, of therapies to help them improve, such as speech therapy or help with movement.

From: http://www.telegraph.co.uk/NHS-quality-standards-set-out-by-Andrew-Lansley

Nursing and doctors’ leaders welcomed the greater flexibility they have been given to treat patients according to clinical need rather than being forced to stick to strict central guidelines.

But patients’ groups expressed concern that the reforms could result in a “free-for-all,” and that without targets long waiting times could return to the NHS.

GPs will no longer be forced to see patients within 48 hours of them seeking an appointment.

The requirement for 98 per cent of patients attending Accident and Emergency wards to be seen within four hours has been relaxed to 95 per cent.

And the target for patients to be given a hospital appointment within 18 weeks of being referred by their GP has been abandoned altogether.

Andrew Lansley, the Health Secretary, insisted that people would still have the right to demand high levels of service from the NHS, but that this would be done locally rather than dictated from the centre.

“I want to free the NHS from bureaucracy and targets that have no clinical justification and move to an NHS which measures its performance on patient outcomes,” he added.

“Doctors will be free to focus on the outcomes that matter – providing quality patient care.”

Katherine Murphy, director of the Patients Association, said: “The targets focused minds in the NHS, made people start realising services had to get better.”

But Dr Laurence Buckman, Chairman of the BMA’s GPs Committee, welcomed the relaxation in targets.

He said: “Patients should have good access to GPs. However, while this target may have been intended to improve access it has in fact had adverse consequences.

“At the moment practices need to have enough appointments available on the day or the following day to meet the target, so those who want to book in advance find there are fewer appointments available.”

Under the changes to the NHS Operating Framework, Mr Lansley has also ordered health bodies to reduce management costs from £1.85 billion to £1 billion by 2013.

While spending on the health service will continue at current levels, he said it was crucial to make “immediate” savings which could be reinvested in patient care.

From: http://www.telegraph.co.uk/NHS-waiting-times-are-relaxed-and-abandoned

New figures reveal the time spent by crews waiting outside hospitals for their patients to be admitted last year was the equivalent to funding 31 fully staffed ambulances to do nothing for 24 hours a day.

The statistics released by NHS ambulance trusts show the amount of time ambulances are forced to remain idle is increasing each year. In the first nine months of 2009 the total so-called “dead time” in England reached 284,000 hours — more than the whole of 2007.

The four hour target was introduced in 2004 in an effort to end the scandal of patients left on trolleys overnight waiting to be seen by doctors.

However, it has led to hard-pressed casualty departments refusing to admit patients until they can be sure they can be seen within the four hour limit. Waits of more than two hours occur in hundreds of cases each year.

Mike Penning, a shadow health minister, said: “It is a scandal that desperately needed frontline paramedics are trapped at hospitals around the country because of Labour’s fixation with the target culture.

“It can’t be right that bureaucracy has taken over from clinicians being able to put patients first, rather than watching the clock. Millions of pounds are being wasted and patients are suffering.”

The Conservatives have promised to slash the number of NHS targets and hand more power to doctors.

From: http://www.timesonline.co.uk/tol/news/politics/article7078867.ece

The College of Emergency Medicine says the target, at English hospitals, puts staff under “incredible pressure”.

It says it supports having a target in principle, but that doctors sometimes need time to make the right decision.

The government says safety and good quality care should always take priority over targets.

The NHS target in England to deal with patients in A&E within four hours has been highly controversial. Critics say it forces clinical staff to put deadlines before quality of care.

The chairman of the College of Emergency Medicine, Dr John Heyworth, says the target has helped to make emergency care a priority for the NHS. But he says staff are being forced to meet it at almost any cost.

“We’ve had nurses reduced to tears. We’ve had very senior consultants in emergency medicine threatened with a disciplinary process.
 
Patient safety and good quality care should always take priority over administrative targets where a doctor believes that is necessary
Department of Health spokeswoman

“This is an outrageous misuse of the standard.

“It’s not what the clinicians are in the emergency departments for. But it’s representative of the immense pressure being put on chief executives and all managers downwards from there to comply with the target.”

The four-hour target is just one of a range of centrally imposed standards, most of them designed to speed up treatment.

They have been used in other parts of the UK but have been much more heavily enforced in England.

Politicians now dislike the language of centrally-imposed targets in the NHS.

The Conservatives and Liberal Democrats say they will scrap them. Labour now prefers to talk about “standards”, “entitlements” and “guarantees”. The issue promises to be an important dividing line in the general election.

Professor Julian Le Grand, who was senior policy adviser to Tony Blair between 2003 and 2005, says many patients did benefit from targets – but he recalls that the then-PM was troubled by complaints from doctors about the targets regime.
 
“I remember sitting in a meeting once where the prime minister said ‘do we have to just keep beating up on the consultants – in A&E for instance – endlessly to achieve this? Or is there some way we can think of building in incentives within the system so that we’ll get these quality improvements on their own, without always having to crack the whip?’”

That led to a shift towards encouraging more patient choice and competition between hospitals, rather than relying on targets to improve standards.

The trust’s director, Dr Jennifer Dixon, says they are a potent way of achieving quick results.

“I think there’s widespread consensus that targets have resulted in immediate benefits, for example in reduction in waiting times.

“It’s highly unlikely that those other reforms could have had that impact so quickly and so precisely on the waiting times. So it’s really ministerial “diktat” almost that’s produced the goods.”

The Department of Health said that, in England at the beginning of 2003, almost a quarter of patients spent more than four hours in Accident and Emergency. It argued that since then there has been a “revolution in patient care”, reducing that figure to less than 2%.

A spokeswoman said: “The funding for hospitals has risen dramatically and targets are minimum standards which taxpayers have a right to expect from NHS hospitals.

“Patient safety and good quality care should always take priority over administrative targets where a doctor believes that is necessary.

“Despite his concerns over the four-hour standard, Dr John Heyworth from the College of Emergency Medicine said he had nothing against targets in principle. But he said he wanted a more sophisticated measure that accounts for quality of care, as well as speed.

From: http://news.bbc.co.uk/1/hi/health/8580761.stm