Published: 20/03/2003, Volume II3, No. 5847 Page 6 7

Performance on end-of-year accident and emergency access times will be judged on just one week's figures, the Department of Health has confirmed.

Trusts are struggling towards the end of March milestone that 90 per cent of patients should be admitted, transferred or discharged within four hours.

Last week, situation-report compilers were sent guidance telling them their performance will be measured over just seven days, starting on Monday.

But some critics have warned that the short timeframe could see trusts throwing unsustainable resources - in the shape of staff, money and cancelled elective work - at A&E in an attempt to achieve the ambitious milestone.

According to the latest figures, for the quarter ending in December, less than one-fifth of acute trusts managed to deal with 90 per cent of their A&E patients within four hours.

The DoH's presentation of the results showed the aggregate figure across all trusts, which indicated that 78 per cent of patients were dealt with in under four hours.

But HSJ's analysis of trusts' performance over that quarter demonstrates the size of the task facing A&E managers and staff.

A breakdown of the figures shows that only 30 trusts - out of 158 - dealt with 90 per cent of arrivals within four hours, just seven more than in September 2002.And 53 trusts - one-third of all trusts - had still not reached last April's national target of 75 per cent of patients waiting less than four hours.

Although individual trust figures had improved slightly, nine were still dealing with less than 60 per cent of their patients within four hours - no different to the situation in September 2002.

NHS Confederation chief executive Gill Morgan said: 'People are working really hard. This is the top priority. But many organisations are on top of the waiting lists and there is a sense of optimism.'

Asked about the short timescale over which trusts will be assessed, she said: 'The concern is around sustainability and whether trusts will be able to deliver over a longer period.'

Don MacKechnie, an A&E consultant and chair of the BMA's A&E committee, said he had heard unsubstantiated rumours of trusts cancelling elective surgery to free up beds for A&E cases.

'What is certain is that we are going to be relying an a huge amount of goodwill over the assessment week if the target is going to be met.

'Extra money has been made available, but I do not think people working on the front line have seen any difference at all. [The money] doesn't seem to have reached them.'

University Hospitals of Leicester trust hit just 49 per cent in December, but said it expected to make 'significant' improvements towards the end of year milestone.

UHL director of operations Ron Calvert insisted the changes being made were ultimately sustainable - even if the target was not met this month.

He said an enormous amount of work had been carried out since serious problems were recognised at the trust around 18 months ago. The trust has opened a temporary ward staffed by private agency nurses, introduced minor-injury services and carried out a£7.5m revamp of its A&E department.

Whipps Cross University Hospital trusts, which achieved 55 per cent in December, reached 86 per cent two weeks ago and is hoping to hit the target.