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RCN warns axing A&E waiting targets could put patients at risk

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Axing the four-hour waiting time target for accident and emergency care would have an “adverse effect” on patient safety, a leading nurse unionist has warned.

The government is currently reviewing a series of NHS treatment waiting targets to see if they are still fit for purpose. The target that requires 95% of patients attending A&E to be admitted to hospital, transferred to another provider or discharged within four hours is among those under review.

“Axing it or loosening it without evaluating alternatives puts patient safety at risk and sends a terrible signal”

Anna Crossley

Hospitals across the country often struggle to meet this standard as demand has increased. While the review was announced by prime minister Theresa May in June 2018, the issue has been brought to the fore this week because it was raised at the Health and Social Care Committee on Monday.

Committee member Dr Philippa Whitford, a Scottish MP and a breast surgeon, asked NHS England boss Simon Stevens if the revised standards would be “as challenging” as those previously and added that people were particularly “concerned” about changes to the four-hour A&E target.

Mr Stevens noted that early feedback from the review, which is being led by NHS England national medical director Stephen Powis, was that the standards needed to be altered to “reflect changes in clinical practice”.

For example, he noted that it was now considered best practice to treat patients of sepsis, strokes and heart attacks within an hour, while those with less serious conditions may not need to be dealt with as quickly. 

Simon Stevens

Simon Stevens

Source: Peter Searle

Simon Stevens

He said: “We want to lock in short waits for emergency and urgent care, as well as for planned and routine care, but equally what Stephen Powis is telling us is we need to reflect changes in clinical practice.

“And, since those administrative targets were promulgated in some cases 15 years ago, actually the practice in medicine – in relation to sepsis, to strokes, to heart attacks – has changed meaning that the ‘golden hour’ requires actually a very early clinical focus on those rather than an averaging out across a four-hour experience for a whole variety of patients,” he said.

Mr Stevens also highlighted ambitions laid out in the new NHS Long Term Plan to boost “same-day emergency care”, in which patients who were seriously ill or injured received the treatment they needed on the same day without needing to be admitted to hospital.

“Therefore, three hours, 59 minutes is not a clinically relevant bifurcation point to decide whether or not they have to be admitted,” Mr Stevens said.

The comments from Mr Stevens sparked concern from Dr Taj Hassan, president of the Royal College of Emergency Medicine, who said scrapping the four-hour target in A&E would have a “near catastrophic impact on patient safety”.

Today, Anna Crossley, professional lead for acute and emergency care at the Royal College of Nursing, has spoken out to send a similar message.

She said: “It is imperative that hospitals have the staff and resources to give timely care within current guidelines – tinkering with targets to make them easier to hit is the wrong approach. 

“Axing it or loosening it without evaluating alternatives puts patient safety at risk and sends a terrible signal that waiting times do not matter,” she added. 

“In fact, what matters most right now is that we guarantee the safety of our patients by committing to their health and the four-hour target,” said Ms Crossley.

“This evidence-based measure isn’t arbitrary and we agree with other royal colleges that its removal would have an adverse effect on patient safety,” she said.

Anna Crossley

Ms Crossley stated that nurses must be involved in any substantial reconfigurations of the standards which they were worked towards.

However, she said “more importantly” leaders needed to first solve the nurse workforce crisis that lead to missed targets in the first place.

The results of the “clinically-led review” of operational standards for physical and mental health relating to planned, unplanned urgent or emergency care, as well as cancer, are due to be released in March.

Any recommended changes will then be “field tested” across the NHS, before they are implemented.

Professor Powis said: “The clinically-led review of standards is working with the Academy of Medical Royal Colleges, Healthwatch England and others on what matters most to patients, on the clinical issues with the current administrative target regime, and what they believe will help NHS staff provide the best quality care for patients.”

He added that it was “worth remembering” that more than a third of attendances covered by the four-hour target did not actually take place in hospital A&Es.

Other types of A&E units in England include minor injury units and walk-in centres, as well as consultant-led facilities but for single specialties such as eye treatment.

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