Published: 07/10/2004, Volume II4, No. 5926 Page 11

Accident and emergency departments face a tough challenge to meet the December 2004 target of admitting, treating or discharging 98 per cent of patients within four hours, according to the Modernisation Agency's emergency care team medical adviser.

Simon Walford told an HSJ conference on emergency care last week: 'We believe all trusts could achieve 98 per cent by Christmas if they really, really wanted to.'

But he added: 'If the organisation itself has doubt or does not want to get there, that would be a serious obstacle.'

He declined to divulge how many trusts were currently achieving 98 per cent in a reliable and consistent way, but said: 'It is not the majority, but the idea that nobody has done it yet is absolutely false.'

He said that most trusts had improved their performance since achieving the March 2004 90 per cent target. 'We are seeing 20 to 25 per cent improvements in quarter.'

Some trusts were hitting 98 per cent 'once in a while', he added.

Similarly, there were some health authorities where the whole area had operated at that level, although not in a sustainable way.

Achieving the target would require action outside the A&E department, he said. For example, wards discharging patients in the morning rather than the late afternoon would smooth the flow of patients.

'There are still places that do not know why patients are spending more than four hours in the system. That is seriously sad.' Lack of commitment from senior management was an issue in some trusts. 'You cannot run a good service if your trust does not want you to, ' he said.

The 98 per cent target would be the last of the time targets, he predicted. 'There will be no more time targets, but the 98 per cent will not go away.'

Home comforts: how paramedics prevent admissions

A project run by Essex Ambulance Service trust in which paramedics are given 21 weeks'extra training has shown that emergency care practitioners can treat 60-70 per cent of people making 999 calls in their own homes.

Of those people transported to hospital, half were referred directly to specialists.The remaining 15 to 20 per cent required treatment in A&E.

ECP project manager in Essex Neil Storey said ECPs made a significant impact on patient care.

'Catheterisation is a classic example of a simple procedure that a trained ECP can do in 20 minutes at home.'

So far, six out of 13 Essex primary care trusts have commissioned ECP services designed to prevent admissions.Another three want to commission services, but the project is struggling to meet the demand for trained practitioners.

A national standard for training and an evaluation of pilot schemes funded in 12 areas by the changing workforce programme is due to be released on 28 October.