Four-hour A&E wait limit WILL be scrapped, NHS confirms

NHS unveils plan that could see four-hour A&E target SCRAPPED as it admits ‘now is the right time’ after failing to hit the benchmark since 2015

• NHS England confirmed the policy change today claiming it will improve care
• Life-threateningly ill patients or those in a ‘mental health crisis’ will be seen first 
• The NHS failed to hit its previous target for four years in a row, and has ditched it 

The NHS is taking steps to scrap the four-hour maximum A&E wait target and replace it with new ones. 

In place of its infamous four-hour target, the NHS is now trialling seeing the most seriously ill patients – strokes and heart attacks, for example – within one hour.

Those with less serious conditions, meanwhile, will have to wait longer, and new targets will be drawn up after pilots at around a dozen hospitals later this year.

The announcement comes after A&E waiting times hit their worst ever level in January, with only 84.4 per cent of people being seen within four hours, instead of the 95 per cent target.

Having failed to hit this benchmark for four years in a row – it was last met in July 2015 – the NHS is now rewriting its own goals.

‘Now is the right time to look again at the old targets,’ the NHS’s medical director said today.

NHS England has confirmed it will get rid of its 2004 target to treat most A&E patients within four hours of their arrival at hospital, replacing it with one intended to speed up care for the most serious illnesses (stock image)

Figures for January showed A&E waiting times in England reached their worst level since the four-hour target was introduced in 2004.

Nearly 330,000 patients waited longer than four hours, and 83,519 people were left waiting on trolleys to be admitted to hospital.  

The NHS today confirmed it will now trial recording data differently with a view to setting new A&E targets in future.

This is despite past warnings from emergency medicine experts that scrapping the target could put patient safety at risk. 

Pilots are expected to begin in around a dozen hospitals within the next couple of months, an NHS spokesperson said, but details of where or when are unknown.

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Once the trials have been completed, and if they are a success, health chiefs intend to use the data to set new targets to roll out across England.   

‘Now is the right time to look again at the old targets which have such a big influence on how care is delivered,’ said medical director Professor Stephen Powis. 

‘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.’  

The feeling has been growing that the current A&E target is outdated, with the NHS’s own chief executive suggesting earlier this year it had had its day.

MENTAL HEALTH CRISIS PATIENTS ‘WILL BE SEEN WITHIN AN HOUR’

Part of today’s NHS announcement included plans to treat people experiencing a mental health crisis within an hour.

The health service defines a crisis as someone losing control of their mental state, hallucinating or hearing voices, or contemplating or attempting self-harm or suicide.

A new target of seeing these patients within an hour is a move to try and achieve ‘parity of esteem’ – equal treatment – with physical illnesses, the NHS said.

Paul Farmer, chief executive of mental health charity Mind, said: ‘People now expect that the NHS will help someone with mental health problems with the same timeliness as for their physical health. We know that too often, people with mental health problems find that isn’t the case.

‘We are pleased to see tangible improvements now being proposed.’

‘This target, along with better care in the community, could help people avoid reaching crisis and offer them quick support when they do.’

He added: ‘People with mental health problems deserve to be treated with respect and dignity and to have their views properly taken into account, so we also welcome changes that will give people greater choice and control in their treatment.’

And it could be pushing staff to make rushed decisions to avoid going over the time – around a fifth of all emergency admissions happen in the final 10 minutes before the four-hour deadline.

In January, Dr Taj Hassan, president of the Royal College of Emergency Medicine (RCEM) said: ‘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.’

He said a decision to follow through with removing the target would be ‘poorly thought out’ and implied it would be replaced with another goal the NHS couldn’t hit.

Dr Hassan added: ‘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.’

New targets could change the way A&E waits are recorded.

There could be more focus on recording patients’ individual wait times and outcomes instead of simply measuring how many were treated in four hours.

This, the NHS said, could release pressure on staff to deal with all patients within the same time frame, meaning they could leave less ill patients waiting longer without jeopardising the hospital’s performance against its targets. 

National director of Healthwatch, 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.

‘People’s experience of care can therefore be significantly improved by staff carrying out quick initial assessments to reassure patients, prioritising those in greatest need and concentrating on communication to keep people updated on progress. 

‘This is of course what doctors and nurses working in A&E want to do all the time, but current targets sometimes draw attention away from this.’    

However, removing the target could wipe the NHS’s slate clean in one respect, making A&E data for the past 15 years difficult to compare with how hospitals perform in future.

One branch of the health service has already admitted it may look like bosses are ‘moving the goalposts’.

Deputy chief executive of NHS Providers, Saffron Cordrey said: ‘In order to win public confidence, it will be vital to ensure this process is clinically led and that any changes have been carefully tested and evaluated.

‘Any roll out will need to be incremental and must have the full backing of the clinical community and leadership of NHS trusts.

‘This is particularly important in view of the fact that performance against the current standards has slipped.

‘We must guard against any sense of “moving the goalposts” to bring the standards back within reach.’ 

NHS A&E departments try to see 95 per cent of their patients within four hours but the health service as a whole hasn’t hit the benchmark for an entire year since 2014

The RCEM today expressed a different opinion to its view in January.

Dr Hassan said:  ‘While we are dismayed by many of the myths being pedalled [sic] 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.

‘The measures set out in this document are what we believe are in the best interests of patients and will enhance and refine the four-hour standard as a powerful system measure of flow.’ 

The health service also today announced people suffering a mental health crisis would be seen within an hour of turning up at A&E.

It defines a crisis as someone losing control of their mental state, hallucinating or hearing voices, or contemplating or attempting self-harm or suicide. 

This new target will be introduced to improve emergency care for people with severe mental illness, the NHS said, in a move towards giving them equal status to physically ill people. 

Chief executive of the charity Mind, Paul Farmer, said: ‘People with mental health problems deserve to be treated with respect and dignity and to have their views properly taken into account, so we also welcome changes that will give people greater choice and control in their treatment.’

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