NHS targets axed in cost-cutting shake-up

Key NHS targets are to be scrapped and management costs slashed by nearly half as part of a major shake-up unveiled by the coalition Government today.

Health Secretary Andrew Lansley said GPs will no longer need to see patients within 48 hours, while the four-hour maximum A&E waiting time is being relaxed.

Central scrutiny of the 18-week referral to treatment target will also be ended.

Patients' campaigners expressed concern that the reforms could lead to a "free-for-all" where health providers were not held to account.

But Mr Lansley insisted people would still have the right to demand high levels of service.

"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 said.

"Doctors will be free to focus on the outcomes that matter - providing quality patient care.

"Patients will still be entitled to rights under the NHS Constitution, and the quality of their experiences and outcomes are what will drive improvements in the future."

Mr Lansley said the changes would help drive down the management bill for Primary Care Trusts and Strategic Health Authorities from its current level of £1.85 billion to £1 billion by 2013-14.

Although NHS spending was set to rise in real terms over the coming years, it was crucial to make "immediate" savings so they could be reinvested in care, he said.

Costs should be cut by £220 million this year, followed by a £350 million fall in 2011/12. By 2013/14 the total reduction will be £850 million.

Katherine Murphy, director of the Patients Association, said: "We have always supported reviewing the targets. They have been so heavily criticised and some had no substantial clinical evidence supporting them.

"But we have never supported abolishing the targets and not putting in place something to replace them.

"The targets focused minds in the NHS, made people start realising services had to get better.

"We might not have agreed with what they focused minds on, but that does not mean we advocate a return to a free-for-all."

Nuffield Trust director Dr Jennifer Dixon insisted central targets had been the most effective way of reducing waiting times in the NHS in England.

"However, too many targets can demotivate and may have perverse effects locally, so only a few should be used," she said.

"The coalition Government's plans to move to outcome targets rather than process targets are welcome.

"But given that waiting for care is such a key part of patient experience on which the NHS is judged by the public, and given the miserable history of long waiting times in the NHS in the past, waiting times should remain firm targets."

Ruth Spellman, chief executive of the Chartered Management Institute, said: "The Government is right to act now, before more bad management costs lives, but the desire to cut costs should not just be about imposing arbitrary reductions at management level.

"As the Government looks to make cost savings, it is an ideal time for PCTs and SHAs to review the standards of leadership within their organisations.

"Now is the time to focus on removing managers whose capabilities fall below the first-class standards that patients have a right to expect."