Broad support for the four-hour A&E target to be axed

St Thomas’ Hospital stock – London
St Thomas’ Hospital stock – London (PA Archive)
17:29pm, Wed 26 May 2021
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There is “wide support” for the four-hour A&E target to be scrapped, health officials have said.

An NHS consultation proposed dropping the four-hour target and replacing it with a series of other measures.

In the past some experts have said that the aim to see, treat, discharge or admit 95% of patients within four hours is a barometer for how the NHS in England is performing as a whole.

But the target has not been met across all types of A&E since 2015.

Coronavirus – Sat Feb 13, 2021 (PA Wire)

Now many clinicians and other experts have said that using a series of measures will provide a greater information about the system as a whole above one single target.

The new consultation proposed a series of performance measures across the urgent and emergency care system from response times for ambulances, to the proportion of NHS 111 calls which are handled by a clinician to how quickly people will get their initial assessment in A&E.

Hospitals will be expected to see and assess patients within 15 minutes under the proposals.

The NHS said that the proposals, which still need to be signed off, would mean that clinically urgent patients could be given the priority they need.

Professor Stephen Powis, national medical director for the NHS in England, said: “Since the previous standards were introduced in 2004, there have been many innovations in urgent treatment and care, so it is right we listen to patients, the public and other experts to ensure NHS services deliver what matters most to patients as well as what is most important clinically.

“Welcomed by the public, NHS staff and patients alike, these new indicators set out how the sickest and most clinically urgent patients could be given priority as well as improving the overall experience of our patients.

“The pandemic has only made this work even more vital – patients need to get the right care, in the right place, at the right time and in a Covid-safe way while they do so.”

The consultation, which ran between December and February earned 354 responses.

The standards have been welcomed by the Royal College of Emergency Medicine (RCEM), Academy of Medical Royal Colleges, the Patients Association, Healthwatch England, NHS Confederation, Mind and the College of Paramedics, among others.

The RCEM said that a series of metrics will provide more information than the single four hour target.

It said that the new measures should help to tackle so-called “corridor care” where patients spent long waits on trolleys in hospital corridors.

RCEM president Dr Katherine Henderson said: ““It is vital that there is a clear programme of implementation (of the proposals) ahead of winter. We are particularly keen to prevent ambulance offload delays and long waits in emergency departments (EDs) for a bed.

“Doing this ahead of winter is vital to help us highlight and tackle ‘corridor care’. Overcrowded EDs with patients being treated in corridors risks the spread of infection and could derail any hope of elective recovery. Measuring and reporting 12-hour from time or arrival may help prevent this.

“There is no justifiable reason for a patient to spend half a day in an ED. This data is already collected, but only reported annually. This must be reported alongside the monthly performance statistics.

“We also welcome the wider recognition that there is a potential need for a six- or eight-hour metric. Long stays are wholly unacceptable and detrimental to patient care. But one metric is not more important than any of the others.”

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