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Emergency targets scrapped in favour of performance measures


A new range of performance measures for emergency care will replace existing NHS targets, the government has announced.

The “indicators” will come into force from next April - seeing the end of the four-hour waiting time target for patients in accident and emergency.

The requirement for ambulances to attend serious but not life-threatening cases within 19 minutes has also been scrapped and replaced with a set of 11 new indicators.

Ambulance services will still be required to respond to 75% of all category A (immediately life-threatening) calls within eight minutes, but will also have to perform against a new set of measures, such as how well patients do who have suffered a cardiac arrest or stroke.

The GMB union said the plan was a “shocking scaling back” of ambulance services currently provided to patients.

However, health secretary Andrew Lansley said the government wanted to provide a “balanced and comprehensive view” of how emergency care works and stop the “isolated” focus on faster care.

Mr Lansley said some parts of the NHS feel pressured into meeting process-led targets for A&E and ambulances that “distort” priorities and lack clinical justification.

The set of eight indicators for A&E care will cover issues such as timeliness, patient satisfaction, outcomes and safety.

Five of the indicators have “performance management triggers” - meaning hospital managers will investigate if an A&E unit is failing to maintain good performance.

However, central government will not monitor or deliver sanctions to those units that fall behind.

While the four-hour A&E target has officially been scrapped, managers will be expected to investigate if more than 5 per cent of patients wait more than four hours.

A similar investigation would occur if more than 5 per cent of patients leave A&E before being seen, while ideally people should wait no longer than 20 minutes for an initial assessment.

If more than 5 per cent of patients wait more than 15 minutes for such an assessment, managers should look into why, the government says.

There will also be a focus on prioritising patients that require rapid treatment instead of those who have been waiting the longest.

Another indicator says staff should treat people with some urgent conditions - such as deep vein thrombosis - in community settings, including their own home, rather than in hospital.

This would provide “better patient care” and lead to a reduction in emergency admissions to hospital which are “costly” and can expose patients to other infections.

A further indicator relates to patients being readmitted to hospital through A&E within a week of being discharged, which affects more than 30,000 people every year.

If more than 5 per cent of patients are readmitted this way, a performance management trigger should occur as it may reflect poor quality care, the government said.

Patient experience of emergency care is another indicator while a further one says high-risk patients should be seen by a consultant to ensure safer care.

How units perform against the new indicators will be published on publicly accessible websites.

Mr Lansley said: “The new measures will focus on the quality of care and what matters most to patients - giving a better indication of patient care than the previous process-led targets ever could.

“By putting patient safety and outcomes at the heart of the health service, A&E departments and ambulance trusts can demonstrate they provide safe and effective clinical care in a timely manner rather than meeting a specific target.

“This is not about hitting targets - importantly, it is about giving the NHS more freedom to deliver quality care.”

The Royal College of Nursing’s emergency care association worked with the Department of Health on developing the indicators.

RCN chief executive and general secretary Peter Carter said: “We were pleased to have had the opportunity to work jointly on these indicators which we believe will help ensure quality care. We called for the old 98 per cent four-hour A&E target to be relaxed, as we believe some clinicians were coming under pressure to meet the target, sometimes to the detriment of patient care.”

He added: “Maintaining a service which ensures that at least 95 per cent of patients are seen within four hours will allow clinicians to concentrate on making the best decisions for patients, rather than worrying about the clock.”




Readers' comments (2)

  • then perhaps we wont have all these unnecessary admissions to the wards if the drs can assess these patients thoroughly before making a decision to admit. over the past few months i have witnessed patients that are not acutely unwell being admitted to the wards wherever there is an empty bed because of these targets that a&e have to achieve. its not about patients anymore but targets.

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  • Whilst the 98%, '4 hour' target has been seen as a millstone around the neck of many EDs there is no doubt that it focused attention on the deficits within the hospital, in most cases relating to in- patient teams and not the ED itself.

    Relaxing the target to 95% would have been quite acceptable and happliy agreed to by the College of Emergency Medicine and the Faculty of Emergency Nursing. My fear is that removing the target all together may result in slippage back to how EDs were about ten years ago - corridoors stacked with trolley waits, ambulances waiting an entire 8 hour shift to 'offload' patients, horrific experiences for patients and intolerable of clinical staff.

    Much has been achieved thanks to the sensible interpretation of the target - but this has been down to individual Trusts and their management team, not all Trusts have responded well,eg North Staffs.

    The introduction of specific 'clinical outcomes and quality care standards' should be welcomed and will hopefully provide meaningful comparisons with EDs. Mr Lansley and his team will I hope continue to listen to the best clinical advisors.

    Mike Paynter,

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