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Health service is faced with call for new target

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All nurses working in emergency and urgent care settings should be subject to a new overarching response time target, according to the Healthcare Commission.

Current urgent care targets, which measure only individual parts of the system, should be replaced with a 'whole-system approach' that measures performance from the time a patient seeks care to the time they receive it, the commission said last week.

In a hard-hitting review of urgent and emergency care services in England, the commission called for a 'new drive to improve the system of delivering' emergency care. The review included A&E, out-of-hours, NHS Direct, walk-in centre and ambulance services.

The commission's review rated 40% of emergency services within England's 152 PCTs as 'fair' or 'least well' performing, while 60% were rated as 'best' or 'better' performing. Click here to see the best and worst PCTs

The review also found that people often did not know which services to use and often had to repeat their story as services did not always share information effectively.

However, it noted that demand on such services had increased. In 2007-2008 there were 19.1 million visits to A&E and urgent care centres, compared with 16.5 million visits in 2003-2004.

Speaking on the need for a joined-up target, Commission chief executive Anna Walker said: 'We are asking for a network target similar to the 18-week referral to treatment target or the 62-day cancer referral to treatment target. We need to agree on a measurement that makes sense for this and that does require debate.'

She added: 'We are calling on the government and healthcare organisations to renew their efforts to get the whole system working together so people can get the right care when they need it.'

But Jim Bethel, vice-chairperson of the RCN's emergency care association, told NT that he did not think that such a target would be 'appropriate' or suit all categories of patients who needed to access emergency care services.

'I cannot see how it would be applied and it would also have a resource implication similar to the four-hour A&E waiting time target,' he warned.

However, Mr Bethel said a radical shake-up of emergency and urgent care services was needed, arguing that services should routinely be located 'under one roof'.

'A&E departments should serve as a hub. But GP out-of-hours services and minor injuries units, and other urgent care services people might need to access, should be situated in the same place.'

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