A&E waiting time targets face axe

14 June, 2010

The government has pledged to scrap the four-hour waiting time target at accident and emergency departments.

Health secretary Andrew Lansley said the targets would be “abolished” under wider plans to rid the health service of any targets that have “no clinical justification”.

Mr Lansley said focus must be shifted to achieving the “best possible results for patients” rather than simply treating patients quickly in a bid to meet waiting time targets.

Mr Lansley made the comments in the House of Commons, where he also announced a full public inquiry into failings at Mid Staffordshire Foundation Trust.

Mr Lansley said: “I’m going to abolish the four-hour A&E target.

“We are going to look, and we will look constructively, at how we can scrap the four-hour target as it currently exists and work on the basis of what the clinical evidence makes clear directly contributes to delivering the best possible results for patients.

“I will issue guidance to the NHS shortly, the purpose of which - to amend the A&E target alongside others - is in order to ensure that we deliver better quality.”

Shadow health secretary Andy Burnham immediately put Mr Lansley’s plans under scrutiny, saying the government “urgently needs to give clarity to the NHS by explaining what alternative plans he has to stop waiting times rising again”.

A Department of Health spokeswoman said Mr Lansley had always been clear that in order to deliver continuous improvements in patient care, “targets that have no clinical justification will be scrapped”.

She added: “Some more details will be set out in a revised operating framework shortly.”

Readers' comments (39)

Martin Gray | 10-Jun-2010 1:59 pm
HOORAY! If waiting times increase it will only be because patients are being properly prioritised; if those will minor injuries or illness do attend, quite often inappropriately anyway, then they will have to wait longer if more urgent cases present.

This, of course, will cause some dissatisfaction in the patients and tempers will fray occassionaly but I'm sure that, provided the patients are told WHY they are having to wait and may appear to being queue-jumped a lot of this misguided anger will be averted.

However, it is also a problem with bed availability that causes problems in A&E so this also needs to be addressed. Rather difficult if Trusts are going to be penalised if they discharge patients too soon and re-admission is necessary.
Unsuitable or offensive?
Phil Dup | 10-Jun-2010 3:14 pm
I agree Martin - I'm furious that we have to pull out all the stops to see and treat a code blue "sore fingernail for the last 4 weeks" but who cant get to the GP or the local walk in centre (open 12 hours a day 7 days a week).
By wasting time putting medical and nursing resources into making sure this type of patient doesnt "breach" making the Trust statistics look 'bad' we are taking away extra care that could be put into treating the truly ill.
Unsuitable or offensive?
Anonymous | 10-Jun-2010 5:12 pm
I think that every one should pay for there own health care of some sort, unless it is a real emergency for example trauma and this will stop the likes of the drunks and minor injuries and regulars attending a and e and will cut back costs
Unsuitable or offensive?
Anonymous | 10-Jun-2010 6:51 pm
Hooray, hopefully that will relieve some of the pressure wards are facing day in and day out which lead them to discharge patients who the nursing staff know full well are not ready to be discharged. No more hearing that saying 'there's a breach in A+E'. A four hour limit does NOT have clinical justification, it can take longer than that to properly assess a patient.
Unsuitable or offensive?
Anonymous | 10-Jun-2010 7:06 pm
Big Mistake. 4 Hour targets have little to with what happens in A&E. They provide a focus to moving patients to the most appropriate environment within the whole hospital, and discharging them more quickly when they used to languish for weeks while social services saved their budgets for duvet days and team building in the lakes. A measure of their success is the increasing numbers of presentations at A&E departments - we are taking patients from general practice. How we solve that is by calling the G.P. and making an apointment for the patient. Any remember patients lying on trolleys for days?
Unsuitable or offensive?
mike | 10-Jun-2010 10:59 pm
About bloody time!!!!

It should be up to Clinical judgement how and where people are seen and sent to in A&E, not pathetic targets set by government.

I totally agree with Martin too, other problems such as bed space needs to be addressed (impossible if the ridiculous notions of the Darzi report cutting beds in new hospitals comes into force) as does new policies such as penalising hospitals for readmissions (another ridiculous idea).

And I am sorry for those patients who may have to wait longer because of this, but they must be told at the end of the day that it is accident & EMERGENCY, and sometimes we have to prioritise an RTA or a stabbing over a stubbed toe. Now at least they have walk in centres and other avenues for treatment of minor things which should ease that burden, more education is frankly needed here to tell people about the range of services Nurses give.

And I still advocate a fining system for those who abuse the system too, the fines (perhaps on a sliding scale) should be dished out totally at clinical judgement to those who blatantly abuse A&E.
Unsuitable or offensive?
Anonymous | 10-Jun-2010 11:03 pm
At last, I work in an MAU and am sick of seeing patients inapropiatly discharged or transfered to innapropriate wards just to satisfy a government target which exists purely to provide seemingly voter friendly statistics and not for any clinical reason.
perhaps if readmission and failed discharges were trumpeted as loud then the public would see how they have been conned for so long. I have no love for any polititians but maybe, just maybe , this lot could be actually trying to provide a meanigfull Health Service for the country.
Unsuitable or offensive?
mike | 11-Jun-2010 10:24 am
Anonymous | 10-Jun-2010 11:03 pm, hear hear anonymous, the government will never be perfect, but I really believe the conservatives will do a lot of good for this country and the NHS
Unsuitable or offensive?
K W | 11-Jun-2010 11:40 am
About time. I agree with certain targets in A/E but as so many people have said the 'sore finger who can't be bothered to see own gp' so often gets seen before the cat 2 chest pain just because of waiting times.
Unsuitable or offensive?
Anonymous | 11-Jun-2010 2:47 pm
thank goodness, just last night i had an acute pancreatitis put on to my orthopaedic ward,the poor lady was very unwell and would've been safer in resus. meanwhile the acute fractured tibia admitted just after her was sent to the stroke unit,because the sick lady had taken up the last ortho bed...it's all wrong.
Unsuitable or offensive?
adam WILLIAMS | 11-Jun-2010 3:01 pm
I can't believe I'm reading this! Martin Gray et al, have any of you ever worked in A&E?

Before the 4 hour target, it wasn't uncommon for patients to wait in A&E for days on end. Not only is this an unsuitable area to nurse patients, but it has other effects as understated by Martin Gray, 'tempers will fray'. How about more accurately physical violence will ensue, and no we do not live in a utopian era where the police will deal with this, they are already too busy and no patients cannot be banned, as in realistic terms it is virtually impossible to truly ban a patient.

Targets for targets sake are not helpful to anyone. However, what this target did was to galvanise the health service onto providing a focused, team driven intense diagnostic and treatment process. If this target goes then not only will minor ailments wait longer, but so will major illness because no matter how good the publicity is, people will still use A&E for non emergencies and still take time to deal with.

The hundreds of thousands of foreign nationals will still use A&E as they often dont have a GP. Yes there are walk in centres but many don't even know they exist, and still require 'signposting' to them, again which takes time as they have to be appropriately triaged.

I am genuinely shocked and dismayed at this decision. The 4 hour target is clinically based and has been working really well, it is a genuine mistake to remove it. It will be a massive blow to urgent care and I fear we will rue the day this has happened along with financial penalties for readmission to hospital.
Unsuitable or offensive?
Anonymous | 11-Jun-2010 4:38 pm
The target goes we go back to the days patients are in A&E for 12 hours plus and not in the appropriate speciality getting the treatment required and this won't affect the minor injury patients. removing the target a bad idea.
Unsuitable or offensive?
David Macdonald | 11-Jun-2010 5:00 pm
Oh Well done the coalition government. I am soooo excited that we are loosing the 4 hour target...

Now we really can start cutting costs!!!

Lets slash the ENP's first... The MINOR injuries can wait for.... ooh 12 hours.... maybe they will walk out by then.

Lets then increase the Patient:Nurse Ratio... we can spend as long as we like getting them ready for the ward... cos it doesn't matter anymore.

Specialities.... No really... take your time... in-fact just hand it over to the next shift.... no pressure here anymore. We can drop one of your FY1's Yes??

Close Discharge Lounge... no need to clear beds for A&E.... They can wait there.

Just remember!!! When your ward is full.... you are full... When A&E is full... we just have to keep accepting the patients.... causing UNSAFE levels!!

All the money we have saved though.... we can spend on recruiting complaints handling staff.... yay.... more administrators!

WAKE UP.... This really isn't a good idea... you will do to remember this when you are waiting 6 hours for your wound to be stitched!!

Call me what you like... Bitter, Cynical.... but don't call me to complain.... you brought this on yourselves!!!
Unsuitable or offensive?
susan mcconnell | 11-Jun-2010 5:08 pm
The walk in centres could be alongside the A&E wirh reception, portering or 'concierge' staff directing people into the correct department. That way everyone would be seen in the appropriate place.
Unsuitable or offensive?
adam WILLIAMS | 11-Jun-2010 6:47 pm
I can't believe I'm reading this! Martin Gray et al, have any of you ever worked in A&E?

Before the 4 hour target, it wasn't uncommon for patients to wait in A&E for days on end. Not only is this an unsuitable area to nurse patients, but it has other effects as understated by Martin Gray, 'tempers will fray'. How about more accurately physical violence will ensue, and no we do not live in a utopian era where the police will deal with this, they are already too busy and no patients cannot be banned, as in realistic terms it is virtually impossible to truly ban a patient.

Targets for targets sake are not helpful to anyone. However, what this target did was to galvanise the health service onto providing a focused, team driven intense diagnostic and treatment process. If this target goes then not only will minor ailments wait longer, but so will major illness because no matter how good the publicity is, people will still use A&E for non emergencies and still take time to deal with.

The hundreds of thousands of foreign nationals will still use A&E as they often dont have a GP. Yes there are walk in centres but many don't even know they exist, and still require 'signposting' to them, again which takes time as they have to be appropriately triaged.

I am genuinely shocked and dismayed at this decision. The 4 hour target is clinically based and has been working really well, it is a genuine mistake to remove it. It will be a massive blow to urgent care and I fear we will rue the day this has happened along with financial penalties for readmission to hospital.
Unsuitable or offensive?
John RNA AFEN DipHE BA(hons) | 11-Jun-2010 6:51 pm
If the 4-hour target is abolished, which on the balance of probabilities is a good idea, there will need to be a set of local/national standards to ensure patients do not wait uneccessarily and inappropriately.
Thus length of stay is not the target but the standard of care, the time spent in the department would be flexible but not excessive, with an efficient triage system. When the department becomes crowded then there isn't the panic to ensure patients don't breach in favour of newly arrived patients who need to be assessed as a matter of urgency. Of course this will require more nurses and medical practitioners.
Unsuitable or offensive?
adam WILLIAMS | 11-Jun-2010 6:55 pm
In response to Susan Mcconnel, reception staff directing patients to walk in centres! Again this is taking A&E back 15-20 years. Reception staff are NOT medically trained, they cannot and should not triage patients. A recent example of this is a patient with a "sprained ankle" being redirected by a receptionist to a walk in centre, several hours later they finally got seen and had 'critical skin' i.e a cut off of blood supply meaning the tissue died and the patient suffered serious complications.

I seriously worry if people are advocating that admin staff with no medical training are used to direct people. That is what triage is for and that is why even 'minor' ailments need to be triaged, the fundamental aspect of urgent care, so that a trained and qualified nurse can truly assess how urgent they are.

I also completely agree with David Macdonald...I suppose time will only tell.

One slight positive is that on further reading, it seems on being challenged by Labour front benchers who quite rightly met Mr Lansleys comments with anger and dismay, he did somewhat back track and say the target would not be 'abolished' but 'amended'. Lets hope he does some proper research and comes to his senses!
Unsuitable or offensive?
susan mcconnell | 11-Jun-2010 9:04 pm
Hi,
In my comment above I was not suggesting that porters, receptionists or concierge staff have any clinical input. I just gave them a title that may or may not be appropriate for the UK. I am suggesting that someone be available to steer patients towards the correct area where they can then be assessed by trained staff who will then take appropriate action. If as I suggest, the departments in question are side by side then they can then be seen by the department they really need. I work in the US at present and when I arrived at a hospital recently I was immediately directed to the correct department by the valet parking system staff. You cannot get past them anyway before entering the car park. Obviously ambulances and other emergencies go straight to the emergency room but if someone does go astray they are diverted or assisted to the correct area. I realise that it is different in the UK and of course there are still some people who will always abuse the system or go themselves to the wrong area but if these places were designed better with these issues in mind then perhaps everyone could then be seen at the right time in the right place.
Unsuitable or offensive?
maria gough | 12-Jun-2010 0:53 am
The 4 hour wait was no real impediment:

simply have one receptionist on duty who is obliged to check and apply every NHS number to every single patient booking in, who takes money for provided on site medicines, checks nationality for non emergency NHS care and takes the fee for such attendances as they arise, answers the phone which constantly rings, makes follow up appointments and, occasionally, the tea.

Indeed, patients can wait for nearly 4 hour just to book in - and the countdown doesn't start until they do! By which time they are either cured of whatever ails them or bored and gone home. Simpills.
Unsuitable or offensive?
Anonymous | 12-Jun-2010 5:11 pm
the 4 hr target was a good idea but in practice, the way it was rammed into practice actually, ended up as appalling and inhumane. what happens at the moment is that reception staff DO give clinical advice and make medical decisions due to the 4hr target and their lack of awareness that this is what they are doing. I have had several clinical incidents of people calling the OOH service back having been sent away with things like PR bleeds, fever red flags, appendicitis. Now PCAS's are popping up, thank god and people can be signposted appropriately. Today has been a good example of a serious head injury with red flags sent home without assessment due to long waits and inadequate triage.
Unsuitable or offensive?