Letter from Andy Burnham to Jeremy Hunt:

Dear Jeremy

NHS England guidance on ‘major incidents’

As you will recall, in the first week of January, at least 14 Trusts in England declared major incident status due to pressure on A&E services.

Official figures show that hospital A&Es were under similar pressure during the second week of January:

• Only seven out of 140 hospital A&E departments hit the 95 per cent target
• Four hospital A&E departments saw less than 70 per cent of patients within four hours
• There were 14 ‘A&E diverts’ and one ‘A&E closure’

However, it would appear that there have been no further major incidents declared or reported since the first wave in the first week.

It has now been brought to my attention that new guidance was issued to some of England’s largest trusts in the West Midlands area setting out the ‘enhanced criteria’, covering 17 detailed points, which must be met before a major incident can be declared. It would appear from correspondence I have seen that this guidance was developed by an office of NHS England earlier this month and issued to CCGs shortly afterwards.

Procedures for declaring major incidents are long-established in the NHS and it is a highly unusual move for new guidance to be issued in the middle of a difficult winter. This had led some in the NHS to question the motives behind it. I have been shown correspondence from NHS staff referring to the guidance, in which the Head of Operations at a major Trust says:

“This is the enhanced criteria that have been introduced by NHS England (to effectively stop trusts from calling a major incident). Worth sharing with the ED consultants as our hands will be tied in most cases if they wish to all a major incident for capacity reasons.”

As I am sure you will agree, this is a very serious matter and raises a number of important questions:

• Has the same guidance been issued in other English regions?
• Were you aware or NHS England at national level aware of this change to the criteria and did you/they approve it?
• Can you explain why a decision was taken to introduce it so abruptly in the middle of January?
• Do you acknowledge the risk that trusts could perceive this as an attempt to stop them declaring major incident status even though it might be necessary?
• Are you fully satisfied that this new guidance will not make it harder for Trusts to declare a major incident and put patient care at risk?

It is clear from the emails I have seen that clinicians and managers at the front-line have interpreted this guidance as a move to keep A&E pressures out of the news. I am sure you will agree that is a worrying perception and will want to take steps to answer the questions I have set out as a matter of urgency.

I look forward to your response.

Best wishes,

Rt Hon Andy Burnham MP