The solution to missed targets is never to abolish the target

Therese Coffey has an unenviable task in the new government. The new health and social care secretary has to address the House of Commons on Thursday, setting out her plan to save the National Health Service.

Her predecessor, Sajid Javid, made some fine-sounding speeches about how capacity would be expanded to clear the backlog of patients waiting for treatment that had built up because of the coronavirus emergency. The temporary health secretary, Steve Barclay, sounded thoughtful and sympathetic in his brief tenure.

But the NHS needs more than words from a secretary of state who is inevitably at some administrative distance from the Accident and Emergency departments and care homes that are the pinch points of the crisis. To be fair, The Independent believes that Ms Coffey understands this, and that she is in many ways well qualified for the immense challenge ahead of her.

She has a strong ministerial team. In her previous job, as work and pensions secretary, she oversaw the complex benefits system. The universal credit system in particular responded well to changing employment patterns during the pandemic, and she sealed her reputation for hard work and attention to detail.

Some of that detail, such as her aversion to the Oxford comma, has attracted adverse comment, but it is no bad thing for a new secretary of state to demand clarity and brevity of submissions.

Unfortunately, it seems that Ms Coffey’s statement is likely to reheat some of the irrelevant ideas of the recent past. Her predecessors have considered abolishing the four-hour A&E waiting time target. They did not do so for good reasons, and if she does get rid of it, it will be a bad sign that she can think of nothing better to do.

If an organisation cannot meet a manifestly reasonable target, the answer must be to work out why and fix it, rather than to abolish the target. Our health correspondent reports that there have been a number of ideas for replacing it in recent years, such as a target for the proportion of patients triaged within 15 minutes of arrival and for average rather than maximum waits. A triage target is sensible, but it would also be demanding to meet, and it would not deal with the underlying problem, which is the difficulty of getting frail people out of hospital so that new patients can get in.

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This is a capacity problem and a social care problem. Unless Ms Coffey gets to grips with them with a seriousness of purpose and an urgency copied from New Labour at its best – and it was only after years of New Labour spending increases and reforms that the NHS can ever be said to have “worked” – this government will fail and will deserve to be punished for that failure at the next election.

We are not encouraged by the new prime minister’s abolition of the No 10 delivery unit. Admittedly, Boris Johnson never seemed fully committed to it, but he was briefly persuaded that reviving the New Labour approach of setting a few clear targets and progress-chasing them ruthlessly with the prime minister’s direct authority was the only way to deliver results.

Again, the solution to the lack of prime ministerial focus on delivery is to get the prime minister to focus on it, not to abolish the delivery unit. The total commitment of the deputy prime minister is better than nothing, but it is second best. If Ms Coffey is indeed a close ally of the prime minister, she should persuade Liz Truss that the direction must come from the top.