Published: 14/10/2004, Volume II4, No. 5927 Page 9

The NHS has delivered a 'goodnews story' on accident and emergency waiting times by meeting government targets with minimal financial investment, the National Audit Office has said.

NAO report Improving Emergency Care found that the NHS had achieved the targets, succeeded in modernising A&E departments and increased patient satisfaction.

It said the achievements were sustainable and that the NHS looks likely to meet the target of treating, admitting or discharging 98 per cent of patients by December 2004.

The central funds used to achieve this amounted to£142.4m over five years, including capital investment, modernisation funds, extra nurses and pilot IT programmes.

This compared to annual running costs of A&E services of£1bn.

NAO director of health valuefor-money studies Karen Taylor said: 'Essentially this is a goodnews story. The NHS, supported by the Department of Health, has made significant reductions in waiting times.'

She added that central investment, supplemented with local funds, was 'a small amount' compared to the overall A&E budget and scale of the achievement.

The success reflected reengineering of services rather than financial investment, said Ms Taylor. In particular, the report highlighted initiatives such as see and treat, clinical decision/observation units and improved access to diagnostics.

Clinicians who were initially sceptical of the targets in 2002 had been won over, she added. 'It has been clinically driven. It has given them better ways of working and given them a voice on trust boards which in many places they did not previously have.'

But the NAO warned that variations between trusts and between groups of patients remained.

While children and 'minor' patients rarely waited longer than four hours, it was a different story for elderly people and those with mental health problems: 'It is not because they are elderly but because they have complex needs, ' explained audit manager Antonia Gracie.

The biggest reasons for prolonged waits were waiting for a bed to admit a patient (24 per cent); waiting for a specialist opinion (27 per cent); and waiting for authority to admit a patient.

More than half the 117 A&E units surveyed were short of medical staff, the NAO found. Only nine trusts were funded for the number of consultants recommended by the British Association for Emergency Medicine and only two of these had the full number in post. On average, trusts were funded for 4.3 consultants but have only 3.7 in post.

Target practice:98 per cent

The NAO said the NHS is 'looking likely' to meet the December 2004 target of 98 per cent, but warned of three risk factors:

an unexpected flu epidemic;

changes to out-of-hours services;

the working-time directive.

The target will then become a 'standard' - although NAO director of health valuefor-money studies Karen Taylor said: 'We do not yet know how the Healthcare Commission will monitor this.'