Axing A&E waiting time targets will cost lives, warn NHS doctors

Axing A&E waiting time targets will cost lives, warn NHS doctors

March 12, 2019

Axing A&E waiting time targets will cost lives, warn doctors fearful of overcrowded corridors as NHS chiefs announce major review of targets

  • NHS to trial new target where doctors see most serious patients within an hour
  • People with possible sepsis and heart attacks will be put to high priority 
  • A&E doctor said the new trial could ‘lead to an excess of mortality and morbidity’ 

Scrapping the four-hour waiting time target in A&E will lead to avoidable deaths, longer delays and overcrowded corridors, senior doctors said last night.

Their warning came after NHS officials announced a major review of waiting times in the health service that could lead to many of the current measures being replaced.

These include the flagship A&E target under which patients are meant to be seen and either sent home or admitted to a ward within four hours.

NHS England will instead begin trialling new standards whereby doctors will be told to assess the most serious cases – such as possible sepsis and heart attacks – within an hour of their arrival in A&E.

Cancer patient’s eight-hour ordeal 

A pensioner with terminal lung cancer was left ‘screaming in agony’ after waiting eight hours for an ambulance when she broke her hip in a fall.

Susan Key, 70, was in the shower room of the home she shares with her husband Roger in Ipswich, Suffolk, when she lost her footing on February 1.

An ambulance was called at 10.32am but it was not until 6.30pm that one arrived.

Mrs Key’s experience was made worse because she had not taken her medication for her multiple sclerosis.

It took seven calls – including one from her GP and one from her son saying she was having chest pains – before the priority of her case was upgraded and East of England Ambulance Service sent a crew.

The service, rated the UK’s worst for life-threatening category one responses in August last year, said: ‘We were extremely busy on February 1 and it is necessary to prioritise patients with life-threatening injuries and illnesses. We have received a complaint so it would be inappropriate to comment further.’

By Andrew Levy 

Terminal cancer patient, Susan Key, 70, was left ‘screaming in agony’ while she had to wait for an ambulance for eight hours

But those with less serious conditions – including fractures or abdominal pain – will inevitably have to wait much longer, in some cases well over four hours.

The target has not been met since July 2015 and yesterday’s announcement prompted accusations that bosses were simply ‘moving the goalposts’.

Leading A&E doctors, meanwhile, warned that scrapping the measure would hit patients. Dr Taj Hassan, president of the Royal College of Emergency Medicine, said there would be ‘very crowded emergency departments’ with higher rates of ‘mortality and morbidity’.

But NHS England said the target was outdated and encouraged staff to see patients just about to breach the four-hour wait ahead of more urgent cases.

NHS England will begin trialling new standards whereby doctors will be told to assess the most serious cases – such as possible sepsis and heart attacks – within an hour of their arrival in A&E (stock image)

Under the new system, to be piloted from next month, anyone with possible sepsis, heart attacks, strokes, severe asthma or trauma will have a ‘rapid assessment’ within one hour. Patients experiencing a severe mental health crisis will also be assessed within an hour, but everyone else will have to wait their turn.

NHS England is also considering scrapping the 18-week wait for routine operations and the two-week cancer wait, within which patients with symptoms should be seen by a specialist.

Professor Stephen Powis, the NHS in England’s national medical director, said: ‘As we build an NHS that is fit for the future, now is the right time to look again at the old targets which have such a big influence on how care is delivered, to make sure they take account of the latest treatments and techniques.’

But Dr Hassan, a consultant at Leeds Teaching Hospitals, said: ‘The four-hour standard provides the opportunity for the entire system to take responsibility. If you don’t have flow in the system you get a very crowded emergency department. That leads to an excess of mortality and morbidity.

‘The other unintended consequence is that you get more violence towards staff, verbal abuse and potentially physical abuse.’

Saffron Cordery, of NHS Providers, which represents hospitals, warned that current standards had ‘slipped’ and ‘we must guard against any sense of “moving the goalposts” to bring the standards back within reach’.

The new A&E measures will be tested in up to 20 hospital trusts. NHS England is hoping to decide in the autumn whether they will be rolled out nationally to replace the four-hour target. 

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