NHS England is looking to develop accident and emergency standards that are “far more meaningful” than the current target of treating, admitting or discharging 95 per cent of patients within four hours, it has been disclosed.
At a Commons health committee meeting last week, NHS England’s director for acute episodes of care Keith Willett - who is leading the urgent and emergency care review alongside the body’s medical director Sir Bruce Keogh - said emergency department targets needed to be “broader and more medically sensible”.
Several committee members questioned the relevance of the four hour target. Conservative MP Charlotte Leslie asked Sir Bruce if the target was “meaningless”.
Sir Bruce admitted that the target has “become a source of pejorative discussion at times” but said he was proud that the NHS had the “most exacting targets for A&Es and ambulance services in the world”.
Ms Leslie asked if the targets were “beating hospitals with a stick” and failing to deal with the underlying problems emergency departments faced.
Sir Bruce said: “I think it certainly introduces an element of stress for people who are working in A&E departments and I think whereas that stress was primarily felt by managers previously it’s now become felt by medical and nursing staff.”
In the most recent statistics, exactly half of trusts with major A&Es failed to hit the 95 per cent target.
However, Professor Willett said that the target was “a very valuable way to focus the whole hospital on making sure that A&Es are the priority”.
He said that the “difficulty” in measuring performance against the four hour target was that the focus on attendances rather than admissions meant it was easier to hit the target in summer compared to winter when the number of attendances traditionally falls but the complexity of admissions increases.
Professor Willett said: “It’s relatively easy to hit the 95 per cent [in the summer]…in the winter the number of elderly patients climbs so the denominator has gone down but the numerator has climbed a lot”.
He said the urgent and emergency care review would seek to devise standards for A&Es that are “far more meaningful and important to patients and clinicians other than a single target”.
Professor Willett said he was keen to remove “perverse incentives” to deal with patients “in a way that doesn’t feel right”.
He added: “Clinicians will always do what’s right for patients but [the target] does create pressures and I would fully accept that.”
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