• Fourteen trusts to pilot new A&E standards which could replace four-hour target
  • Cohort includes wide range, from top performer Luton to struggler Portsmouth
  • NHSE plans wider rollout of new standards regime from April 2020

NHS England has selected 14 hospital trusts to test new accident and emergency standards which could replace the four-hour target.

NHSE confirmed the participating trusts for the trial, which will start next month, in an operational update sent today. It said the cohort represents “a range of geographies and performance against the current A&E standard”.

They include top performers like Luton and Dunstable University Hospital, and North Tees and Hartlepool foundations trusts, which ranked first and third respectively for four-hour performance in the last fully reported quarter (quarter three of 2018-19).

They also include poor performers, like Portsmouth Hospitals and Nottingham University Hospitals. The full list is:

NamePercentage in 4 hours or less (type 1)Percentage in 4 hours or less (all)Ranking out of 135 trusts on four hour (all) target in Q3 2018-19Total Emergency Admissions via A&ENumber of patients spending >12 hours from decision to admit to admission
Luton And Dunstable University Hospital NHS Foundation Trust 97.2% 98.0% 1st 8,431 1
North Tees And Hartlepool NHS Foundation Trust 89.7% 97.1% 3rd 6,649 0
Chelsea And Westminster Hospital NHS Foundation Trust 92.8% 94.6% 13th 12,888 0
West Suffolk NHS Foundation Trust 92.6% 93.1% 19th 6,268 0
Poole Hospital NHS Foundation Trust 88.9% 91.4% 30th 5,806 0
Imperial College Healthcare NHS Trust 76.3% 89.7% 44th 10,248 14
England 81.2% 87.7%   1,222,245 751
Frimley Health NHS Foundation Trust 87.4% 87.4% 58th 18,887 0
The Rotherham NHS Foundation Trust 87.3% 87.3% 60th 4,856 1
Cambridge University Hospitals NHS Foundation Trust 80.6% 85.2% 80th 10,401 0
Mid Yorkshire Hospitals NHS Trust 80.6% 83.6% 89th 12,504 0
Kettering General Hospital NHS Foundation Trust 82.6% 82.6% 97th 8,251 0
University Hospitals Plymouth NHS Trust 73.0% 81.5% 104th 9,153 1
Portsmouth Hospitals NHS Trust 72.5% 78.1% 121st 10,484 0
Nottingham University Hospitals NHS Trust 61.2% 69.8% 133rd 21059 2

The trusts will pilot the four new targets set out in the NHS review of clinical standards, published last month and led by NHS England medical director Stephen Powis, which confirmed reports the NHS could ditch the four-hour standard. Although the four-hour target is currently the main performance metric, it has not been hit since July 2015.

The four new main A&E standards being trial are:

  • Time to initial clinical assessment in A&E to “identify life-threatening conditions faster”;
  • Time to emergency treatment for critically ill and injured patients (including heart attack, major trauma, sepsis, severe asthma and mental health presentation);
  • Mean waiting time for all patients and strengthened reporting of trolley waits; and
  • Better utilisation of same day emergency care (also known as ambulatory care).

The review also contained a supplementary target around call response standards for 111 and 999 to better match patients to the most suitable services.

NHSE plans a wider rollout of the new regime across all trusts from April 2020. The results of the trial will determine how many and which targets are taken forward.

An NHSE operational update said: “These trusts have been selected because they represent a range of geographies and performance against the current A&E standard.

“NHS England and NHS Improvement will be working with their clinical and operational leads in order to design a testing process which can begin from May.

“Where applicable, those trusts will also be working on an operational level with their local mental health trust colleagues, and there’ll also be national contact with them.”