Patient safety

11.03.19

NHS reveals plans to scrap four-hour A&E target to focus on quality

The NHS has unveiled plans to overhaul its four-hour A&E target and announced it will trial new “rapid care measures” which will prioritise treating the most extreme cases quicker instead of treating all patients within four hours.

The NHS review of clinical standards confirms that the NHS’s flagship performance marker may be scrapped with changes to A&E targets accompanied by new plans for waiting times for cancer, mental health and planned operations.

It said the targets, which requires 95% of patients to be seen in time, were becoming outdated and comes as the NHS has not met its four-hour A&E target since July 2015. Last month A&E performance slumped to its lowest level on record.

The review, led by NHS England’s medical director Stephen Powis, sets out proposals for five new accident and emergency targets which will be piloted later this year and could be introduced in 2020.

Patients with heart attacks, acute asthma, sepsis, stroke, and those experiencing a mental health crisis will receive emergency care within one hour – and average times for all patients could replace the four-hour standard.

The target, introduced in 2004, was met by just two hospital trusts last month, and NHS bosses have blamed the model for distorting priorities with a large number of patients being admitted to hospital just before the four-hour mark.

Last month Lord Prior said the targets “have had their day,” signalling plans to abolish the key performance metrics, as some suggest they damage patient care and encourage “gaming” the system amongst NHS trusts.

NHS England said currently one in five admissions to A&E happen in the final 10 minutes before the four-hour deadline and said hospitals are focusing on meeting targets “rather than what is the best approach for each patient.”

NHS England stresses the measures are still proposals and implementation will be subject to the outcome of the trials.

Powis commented: “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.”

Healthwatch national director Imelda Redmond said: “What shapes people’s experiences of A&E is often not how long they wait, but the quality of care they receive and how that care is delivered.

“When the four-hour target was introduced in 2004 it helped to significantly reduce the lengthy waits faced by many patients. But 15 years on the NHS faces different challenges, and from what people tell us it is clear that the time is right to look again at this core measure.”

 Image credit - AmandaLewis

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