NHS England’s Four-Hour A&E Target Likely To Be Scrapped Under New Plans

In Healthcare, In The Press, Industry News by Raina Dhillon

If a new pilot scheme launched by NHS England this year at a small number of hospitals is successful, the four-hour A&E waiting time target could be scrapped as early as 2020, as NHS bosses look to overhaul outdated standards.

Under the pilot scheme, patients coming in to A&E departments with sepsis, stroke, heart attacks and acute asthma will be prioritised, receiving treatment within one hour. Under the new plans, patients with a mental health crisis will also be seen within an hour.

Furthermore, the length of time each patient waits at an A&E department will be recorded and an average waiting time calculated. This new average time measure will then replace the current four-hour target that has been used for 15 years.

Why is the four-hour target being replaced?

For a start, the four-hour A&E target – which says 95% of A&E patients should be seen, treated and admitted or discharged in under four hours, and is a used as a measure of hospital performance – has not been hit since July 2015. In fact, last month, just two NHS trusts met it.

Moreover, NHS bosses say the four-hour A&E target is distorting priorities, with hospitals tending to focus on hitting the target rather than doing what was ultimately best for patients.

Right now, the target treats every patient equally, with heart attack patients and patients with a sore thumb, in theory, receiving the same urgency when it comes to care. However, in reality, hospital staff do not necessarily do this, with systems in place in A&E departments to prioritise the sickest patients.

How will the change affect patients?

That depends what you are going to an A&E department for. Obviously, if the sickest patients are going to be actively prioritised going forward and receive care faster, that’s a good thing. But, patients with less urgent needs could end up waiting longer than they do now. That’s why the average time to wait measure is being introduced.

Nobody would argue that prioritising patients with urgent medical issues, like strokes, heart attacks, acute asthma and mental health crises, is wrong. But what about patients with medical issues that are deemed “less important”? For example, while someone with a sore thumb might expect to wait longer for treatment, what about a patient with a broken limb who is in a lot of discomfort?

What has been the reaction to the proposed changes?

On the whole, reaction to the proposed changes has been positive, with medical royal colleges, regulators and patient groups welcoming the plans.

Prof Stephen Powis, NHS England national medical director, said: “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.”

There are currently no plans to change the similar four-hour A&E targets in Scotland, Wales and Northern Ireland.

Prioritising patients with life-threatening conditions is obviously sensible. However, there could be a knock-on effect that sees patients with less serious conditions waiting longer than they do now.

I have over 15 years client facing experience in the Employee Benefits industry having worked for Mercer HR Consulting and The Willis Group in London. Bringing my expertise to mid and large corporate clients, I joined Premier Choice Healthcare in December 2015, with the aim of advising and developing a varied Corporate client portfolio.