News portal digitalcameranews.co.uk

A&E four-hour target to be scrapped except for most serious cases 

It follows claims from the chairman of NHS England that 'targets have had their day'

 

NHS targets for A&E patients to be seen within four hours, and those needing surgery to have it within 18 weeks look set to be scrapped under new plans.

Health officials have drawn up proposals which they say will mean speedier treatment for the most critical cases.

But senior doctors last night accused them of attempting to “move the goalposts” because the flagship targets have been repeatedly missed.

The Royal College of Emergency Medicine (RCEM) said the plans were likely to mean longer waiting times for the vast majority of NHS patients.

The proposals from NHS England say those with life-threatening conditions – such as heart attacks, sepsis and strokes – should receive treatment within an hour.

However, the plans will see most A&E cases given no deadline for treatment.  

Instead, units will be measured on their average waiting times, under the proposals, which will be rolled out across the country by next year if pilot schemes are deemed successful.

The review also suggests ditching the 18 week waiting target for operations.

It says this could be replaced with either a new maximum waiting time – as yet undefined – or by one which measures the average time to start treatment.

 

Why is the NHS under so much pressure?

Neither the four-hour nor 18 week target has been hit for three years, with more than 4 million people now on waiting lists, and A&E performance the worst for 15 years.

Dr Taj Hassan, President of the RCEM, which represents A&E doctors, said dropping the four-hour target could cost lives.

“If these proposals go through there is a much greater likelihood of more crowded emergency departments and that means greater risk to patients – there is clear evidence it means higher mortality,” he said.

He said A&E units already prioritised the most critical cases, meaning a new one hour standard would bring no benefit.

“Waits are going to be worse for the majority of patients,” he added. “This is just moving the goalposts.”

Officials suggested the current four hour A&E target distorts priorities, putting pressure on doctors to admit patients before the “cliff edge” target is missed, rather than doing what is clinically best. One fifth of emergency admissions from A&E happen in the last 10 minutes before the deadline, they said.  

Professor Stephen Powis, the NHS in England’s national medical director and leader of the review, said: “The NHS is aiming to improve care for patients and save hundreds of thousands more lives over the coming years, with greater access to mental health support, better treatment for the major killer conditions and services which are more joined-up, personalised and closer to home.

“So, as we build an NHS that is fit for the future, now is the right time to look again at the old targets which have such a big influence on how care is delivered, to make sure that they take account of the latest treatments and techniques, and support, not hinder, staff to deliver the kind of responsive, high-quality services that people want to see.”

The proposals also suggest the axing of a 2 week target for urgent referrals with suspected cancer. Instead all patients with an urgent referral should receive a definitive diagnosis within 28 days of urgent referral,  they say. 

The new plans also say patients suffering mental health crises should receive treatment within an hour of arrival at A&E.

Nuffield Trust chief executive Nigel Edwards said the pilot schemes needed to be watched closely, given the potential dangers to patients.  

He said: “There is a risk that getting rid of the 18 week limit on waits for planned procedures could mean the proportion of people going without care for an unacceptably long time drifts upwards.”

Joyce Robins, from Patient Concern, accused health officials of “giving up” on targets simply because the NHS was unable to meet them.

She said: “The situation is disastrous, the whole system seems to be breaking down.”

 

Add comment