Currently, all NHS trusts in England are set a target of four hours in which a patient who arrives at A&E must be treated. However, these targets are now likely to be scrapped in favor of new “rapid care measures” which will ensure patients with the most urgent needs are seen quickly.
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NHS England’s long-term plan for ensuring the health service functions well into the future includes scrapping the guarantee that patients at A&E will be treated, admitted, or discharged within a four-hour window.
The news comes after it was revealed that the four-hour A&E waiting time targets have not been met since 2015. Additionally, cancer treatment standards, along with waiting times for planned operations, have all seen a downward slump.
A decade of limited funding and increasing patient numbers has led to an NHS which is unable to meet its targets. For instance, the Statistical Commentary for A&E Attendances and Emergency Admissions report shows that a total of 2,112,000 people visited A&E in January 2019, a 5.6% increase on the same month in 2018.
Analyzing performance statistics, the commentary states in a positive note that the number of attendances admitted, transferred or discharged within the four-hour window was 1.78 million, which is a 4.4% increase on the figures seen in January 2018.
However, there were also 83,519 four-hour delays from the admittance to admission in January 2019, which was up from 81,231 in January 2018. It is the highest number since the commentary began, according to the statistical commentary.
These struggles to admit, treat and discharge patients within the target windows are exacerbated by the 100,000 NHS staff vacancies in England, illustrating the clear pressure being felt by the health care system’s resources.
Professor Stephen Powis, NHS England’s medical director, led the national review of A&E waiting times. He justified the review, saying:
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.”
Professor Stephen Powis, Medical Director, NHS England
The national review came alongside an announcement of new investment in the NHS. Under the new urgent case criteria, those in a mental health crisis, and those suffering life-threatening conditions such as heart attacks, acute asthma, sepsis, and stroke, should begin treatment within one hour in A&E.
Patients with suspected cancer cases should also be given a “definitive diagnosis” within 28 days of an urgent referral by their GP.
A&E departments already prioritize patients according to how severely sick or injured they are. Despite this, the new targets are thought to give a more realistic representation of waiting times and pressure on emergency rooms, and will put an end to “hidden long waits”.
According to the new plans, patients will be assessed by a medical professional when they arrive at A&E, to then be prioritized according to the severity of their condition.
NHS England has said one in five admissions from A&E occur in the 10 minutes before the four-hour deadline, which leads some to believe that hospitals are putting meeting these deadlines ahead of finding the “best approach for each patient.”
Patient groups revealed that the public did not mind potentially waiting longer for less critical cases. However, doctors leaders have expressed concern over a “return to the days of endless waiting” and believe that the four-hour waiting targets are essential for ensuring patient flow through hospitals.
President of the Royal College of Emergency Medicine (RCEM) Taj Hassan has pressed that any modifications to the system should keep patients at heart, saying:
While we are dismayed by many of the myths being pedalled around the four-hour standard, we are keen to ensure that any changes are not imposed due to political will but are developed responsibly, collaboratively and are based upon clinical expert consensus in the best interests of patients.”
Taj Hassan, President, RCEM
Shadow Health Secretary Jonathan Ashworth also expressed concern, saying that the new changes could result in returning to the “bad old days of long waits.”
Final decisions on whether the four-hour waiting time targets will remain in use will be taken before 2020-21, and any changes will be reviewed in pilot areas during 2019. Any successful changes will take effect by April 2020.
A&E Attendances and Emergency Admissions January 2019 Statistical Commentary. NHS England.