Proposed changes to A&E response time targets

20 Mar 2019

Under the Government’s NHS Mandate, 95% of people attending Accident & Emergency departments should either be admitted, transferred or discharged within 4 hours of their arrival. However, following a recent review conducted by the national medical director of NHS England, Stephen Powis, the target could be dropped.

The target was first introduced in 2004 but has not been met nationally for a number of years, and in February 2019 only two NHS Trusts met this target. The exact reason is unclear, however an increasing number of patients attending A&E, continued real-terms budget cuts over the previous decade and an ongoing ‘workforce crisis’ (the NHS currently has over 100,000 staff vacancies) are all thought to be contributory factors.

Under the proposed changes, patients arriving in A&E departments would be rapidly assessed and then those with the most critical conditions identified. These patients would then receive the treatment they need quickly. Patients with critical conditions such as heart attacks, strokes, severe asthma or sepsis would therefore be prioritised, and targets would be focussed on the time taken to assess patients on arrival, waiting times for the most urgent patients and average waits across all patients arriving at A&E.

Reactions to proposed changes to A&E response times

There has been a mixed reaction to the proposed changes, which will be piloted in some Trusts this year and then be fully introduced by April 2020 should they be successful.  The Royal College of Emergency Medicine has called for the target to stay, saying that they are keen to ensure that changes are not introduced “due to political will”. There is concern that the target is being abandoned because it has not been met for so long, and the deputy Chief Executive of NHS Providers has said “we must guard against any sense of moving the goalposts to bring the standards back within reach”.

Some have suggested that dropping the four hour target distracts from the real issue, namely the crisis in recruitment the NHS is currently facing, with the chief executive of the King’s Fund commenting that “Without enough staff and resources to care for patients, targets both new and old will continue to be missed”.

Despite the concerns outlined, some groups have welcomed the changes, with the Care Quality Commission being a notable supporter. The patient group Healthwatch has also said it will support the pilots over the coming months whilst monitoring the changes to see if patients’ experiences improve and if safety and quality increase.

Healthwatch’s national director Imelda Richmond said the ultimate aim of the changes should be to “free up hard working A&E departments so they can concentrate on delivering the best possible care for their patients”. This reflects the concern that the current four hour target takes the focus away from patient care and safety towards simply meeting the four hour threshold, an argument which has considerable weight in light of the finding that around one fifth of all emergency admissions from A&E happen in the final ten minutes before the four hour deadline.

Pilot schemes established

Ultimately the findings from the pilot schemes, which will be implemented in around 15 NHS Trusts throughout 2019, will help to determine whether the scrapping of the four hour time limit is in patients’ best interests. Should responses from doctors and clinical staff be positive, the changes will be implemented in full in 2020 in an attempt to improve the services that critically ill patients receive.

The impact on patient care

It is critical the primary focus must be to ensure a high quality of care for all patients. An issue which can only be addressed, over the longer term, by addressing the NHS funding and recruitment crisis.

At Osbornes Law we care about how you are treated by medical professionals when attending A&E and also following any hospital admission, as well as under the care of private providers of health services. If you think that the care you or a loved one has received fell below the standards expected of a reasonably competent medical professional, then please do not hesitate to contact Partner and specialist medical negligence lawyer Stephanie Prior on 020 7681 8671. You can also fill out an online enquiry form here.

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