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A&E waiting time changes will have ‘near catastrophic’ impact on patient safety, warn doctors | UK News

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Changes to the four-hour waiting time target in accident and emergency departments will have a “near catastrophic” impact on patient safety, emergency doctors have warned.

NHS England is currently reviewing its clinical targets including the requirement that 95% of all patients attending A&E are treated, admitted or discharged within four hours – considered the benchmark for hospitals for a decade.

Chief executive Simon Stevens told the House of Commons health and social care select committee on Monday that a new “clinically appropriate” target to replace the four-hour metric would be trialled and introduced next year.

Mr Stevens said it would see a shorter waiting time target for treating those with serious conditions such as stroke, heart attack and sepsis, while those with less critical needs could expect “same day” treatment rather than within four hours.

The Royal College of Emergency Medicine (RCEM), which represents 8,000 emergency medicine clinicians, reacted angrily to Mr Stevens’ comments, warning changes will harm patients and complaining of a lack of consultation.

“In our expert opinion scrapping the four-hour target will have a near catastrophic impact on patient safety in many emergency departments that are already struggling to deliver safe patient care in a wider system that is failing badly,” said RCEM president Dr Taj Hassan.

Simon Stevens
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Simon Stevens said a new “clinically appropriate” target to replace the four-hour metric would be trialled next year

He added: “We will be seeking urgent clarification from NHS England and NHS Improvement on their position and describing the likely unintended consequences of such a poorly thought out strategic policy shift. We will also make our position and concerns clear to the Secretary of State Matt Hancock.

“Let’s be very clear. This is far from being in the best interest of patients and will only serve to bury problems in a health service that will be severely tested by yet another optimistic reconfiguration.”

Other doctors, many of whom said they were unaware of a review process that began last year, offered a range of reactions.

Dyfrig Hughes, an emergency medicine consultant writing on Twitter as @DyfrigH, said the four-hour target “drove emergency care to new heights in the UK. Most of us in the speciality, especially those old enough to remember the days before it, would say it has been a very good thing”.

Will Lawson, a doctor in Birmingham, said the four-hour target has “never been clinically relevant”, and has always been “an arbitrary figure used for political gain”.

Writing on social media as @willvillalawson he said: “In my experience, especially among juniors, the 4 hour target simply induces stress and damages morale. It does not motivate, and in an era of increasingly busy A+E departments is becoming increasingly outdated (but no less clinically (ir)relevant!)”

The current performance targets were not included in the recent Long Term Plan for the NHS, and both health secretary Matt Hancock and Prime Minister Theresa May declined to commit the NHS to hitting them in future.

Theresa May and Matt Hancock meet NHS staff
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Theresa May and Matt Hancock (L) meet NHS staff

The target culture, introduced under a Labour government 15 years ago, has both shaped the way the NHS delivers services to patients and become the primary means by which hospital services are judged, by politicians and the public.

They were designed to cut huge waiting times, but with all three prime targets, for A&E waits, cancer treatment referral and elective surgery, being routinely missed for several years, NHS England began a review of the system last year under medical director Steve Powis.

NHS England says the intention is to replace the A&E target with a measure that reflects changes in medicine, and avoids some of the unintended consequences of the four-hour measure.

Currently patients are triaged in A&E with the most seriously ill always seen first.

Anyone who requires investigation that may take longer than four hours, for example blood tests, technically has to be admitted to avoid breaching the target.

While Mr Stevens said offering “same day” treatment to the less seriously ill would be more appropriate, it would also be more realistic for emergency departments dealing with rising demand. The 95% A&E target has not been hit nationally since May 2015.

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