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The last time there was a major review of the A&E target was in 2010 (I think) when Matthew Cooke proposed adding some extra metrics to enhance the understanding of how well the process was working. These included ways to highlight the extent of gaming and inappropriate clinical behaviour and to provide better insight into the process than the simple 4hr metric could give. He didn't propose abolishing the target.

If that is what happens then it will not be a useless review. But the early comments on what is being considered don't give us any comfort that that is the real thinking going on.

The idea that we don't need a target for minors, for example, is a sign that the thinkers behind the review don't understand how A&E works or the key factors leading to long delays now. slower treatment of minors won't release resources to deliver faster treatment for the sicker patients. Slower treatment for the majority will lead to longer queues in already crowded departments. This will divert more resources away from the majors (queues have to be managed, crowding will clog up the department making rapid treatment for the majors harder). And it won't fix the dominant problem for the sick patient: finding a free bed. In fact no amount of rejigging the available resources in A&E will free up more beds; we could double the staffing in most A&Es without making the process of finding a bed easier or treating the sickest patients any faster.

Other public comments emerging from NHSE have shown a similar lack of understanding of the key problems.

The review needs to be public. Otherwise it seems quite likely that the answers will be based on the opinions of people who don't know the subject well enough to be allowed to have an opinion. Make it public so those experts who do understand A&E can have some chance of influencing the result.