'Zero tolerance' for A&E waits beyond six hours proposed by NHSE chief

Cliff Mann’s comments come as 14 trusts are due to trial new A&E standards in the coming weeks, as part of a major review which may lead to the four-hour target being scrapped.

His comments follow official data released this morning revealing four-hour performance in April had fallen to its worst ever level. Just 85 per cent of patients were dealt with within four hours against the 95 per cent target.

Dr Mann said there was no “clinical reason that [a patient] needs to be in an emergency department beyond six hours, so we would be very keen on having a zero per cent tolerance of people being in an emergency department beyond six hours”.

“There is increasing evidence around the analysis of mortality to support that claim,” he added during a presentation at a conference held by the King’s Fund.

The former Royal College of Emergency Medicine president also said he did not think “anyone was driving to give up on the four-hour target”. However, he argued a “one size fits all” approach to the A&E target was no longer viable, because it meant some hospitals “get away with it, [while] others are doomed”.

In answer to a question about whether the four-hour target was being scrapped because it was no longer being hit, he said: ”if you have a department that is admitting 40 per cent of their patients and others on 18 per cent, but they’re managing against the same four-hour standard then it’s clearly very easy for [the latter] to deliver while [the former] have no chance.”

While A&Es “would be indescribably worse than they are now” without the four-hour standard, he added that with attendances rising from around 10 to 15 million, and more importantly, admissions from around 15 to 31 per cent, combined with new pathways like same day emergency care had created new challenges. 

Speaking to HSJ, Dr Mann said data being collected by the A&E stream of the Getting It Right First Time programme supported a zero tolerance of six-hour breaches. He also highlighted a six-hour backstop was set out in the last attempt to reform A&E standards in 2010, which recommended the use of eight clinical quality standards.

“If [a patient in A&E] needs complex imaging done, and it takes four hour 15 minutes, that’s not the end of the world. But if someone comes in at 9am and is still there at 3pm, unless they’re going home, [then that is clearly a problem],” he told HSJ.