• RCEM says it has seen no evidence a “viable alternative” exists yet to replace four-hour target
  • College’s intervention follows health secretary suggesting target should be replaced
  • Target debate comes in wake of worst ever performance figures last week
  • BMA and Society of Acute Medicine also raise concerns about ditching target

The Royal College of Emergency Medicine has contradicted Matt Hancock’s suggestion that the four-hour target should be replaced, saying there was no evidence yet of a viable replacement.

RCEM president Katherine Henderson’s intervention followed the health secretary suggesting this morning the four-hour standard could be replaced by a more “clinically appropriate” target following NHS England’s ongoing targets review

Dr Henderson said: “So far seen we’ve seen nothing [from NHS England’s clinical review of standards] to indicate that a viable replacement for the four-hour target exists and believe that testing should soon draw to a close.

“Rather than focus on ways around the target, we need to get back to the business of delivering on it.”

Shortly after the college’s statement, the British Medical Association and the Society of Acute Medicine also raised fundamental concerns about scrapping the target.

BMA emergency medicine lead Simon Walsh said: “Targets are an important indicator when services are struggling, and there is a very real concern that any change to targets will effectively mask underperformance and the effects of the decisions that politicians make about resourcing the NHS.”

“Ultimately, replacing targets does not address the fundamental issues of capacity and resourcing within the NHS and the resulting pressure that has led to such poor performance in emergency departments in recent years. The emergency care system is at breaking point and this, above all else, must be addressed.”

The Society of Acute Medicine said it “seems Mr Hancock… has pre-empted and sidelined any possible pending decision from the [NHS England targets review’s] clinical working groups and has now placed them in an invidious position for what appears nothing more than political posturing”.

SAM president Susan Crossland added: “Potentially scrapping the target because it is no longer being met shows the disregard this current government has for improving patient care.

“While the four-hour standard is a single point measure, a bit like a sledgehammer to crack a nut, it does and has helped focus the timely care of acutely unwell patients.

“There have been multiple clinical groups working towards the development of new standards, but this is complex work that is still in its infancy. We fully support improvement in managing unplanned care and understand that measurement and benchmarking is a vital part of quality improvement.”.

The robust statements were prompted by Mr Hancock’s comments on BBC Radio 5 live this morning. 

Asked whether the government should by judged for the NHS’s performance against its core targets, including the four-hour standard, he said: “We will be judged by the right targets. Targets have to be clinically appropriate.

“The four-hour target in A&E — which is often taken as the top way of measuring what’s going on in hospitals — the problem with that target is that increasingly people are treated on the day and are able to go home. It’s much better for the patient and also better for the NHS and yet the way that’s counted in the target doesn’t work.

“It’s far better to have targets that are clinically appropriate and supported by clinicians.”

The debate over potential target changes had been reignited following the NHS posting its worst ever performance against the four-hour target and all its other core standards last week.

Mr Hancock has appeared supportive of ditching the four-hour target since last summer, when he said the measure was “old” and “inappropriate”

Dr Henderson, who is also a well-regarded accident and emergency consultant at St Thomas’ Hospital, told HSJ in October she was open to the idea of potentially replacing the target, but she warned the college would “continue to advocate the four-hour standard… unless there is good evidence of patient benefit from any change”.

She added: “The standard should only be replaced by something that maintains the benefits it has delivered, whilst improving on its failings. In particular, any new metric should reduce the bureaucracy the current performance regime has created.”

Today’s developments follow senior clinicians telling HSJ in December that the new average waiting time target piloted by 14 trusts as part of the standards review was “driving completely the wrong behaviours”.

The review, led by NHSE medical director Stephen Powis, is due to publish final recommendations in March. A previous report by the review said that if it deemed its new A&E standards appropriate, it would seek to roll them out from April.

UPDATES: This piece was first updated to include the British Medical Association’s statement at 16:00 on 15 Jan and then again at 18:05 on 15 Jan to include a a statement by the Society of Acute Medicine.