What is the four-hour target?

In 2004 the Labour government required hospitals in England to treat and then discharge, admit or transfer 98% of all patients within four hours of their arrival at an A&E unit. The coalition government cut that to 95% in 2010.

2004 was the first time the NHS had ever come under such a target. Before that patients could, and in some cases did, spend many hours sometimes days waiting for emergency care.

It forced hospitals to prioritise the care provided at their emergency departments and ensure that as few people as possible waited beyond four hours. Publication of each NHS trusts performance figures every month meant none wanted to be named and shamed for missing the target.

As a result, A&Es have got more staff and more resources, reflecting their central importance in hospitals. The four-hour standard is the best-known of the NHSs batch of waiting-time targets. Others cover planned treatment in hospital, cancer care and some forms of mental health treatment.

A&E doctors were initially sceptical or opposed to the target. Some still complain that its existence gives people an incentive to go to A&E because its the one place in the NHS where the lights are always on instead of waiting days or even weeks to see a GP, and this has contributed to emergency departments becoming increasingly overwhelmed in recent years.

A supposed maximum wait of four hours has encouraged some people to use A&E as an anything and everything service, for often minor ailments, rather than just accidents and emergencies, they say. However, A&E specialists accept that it has improved care by ensuring that as far as possible patients with potentially serious illnesses are seen fairly quickly.

NHS England has been looking into replacing the four-hour wait since 2018. It claims that a more clinically appropriate way of measuring A&E performance may well be needed.

As Matt Hancock said on Wednesday: We will be judged by the right targets. Targets have to be clinically appropriate.

But many doctors and NHS experts believe the target may be scrapped simply because of the bad headlines that the increasing inability to deliver it generates every month when the latest performance figures appear.

Last month, for example, some trusts dealt with less than 50% of patients within four hours. Overall, hospital A&Es managed to deal with just 68.6% against the 95% target, which has been missed every month since July 2015.

Because it has succeeded in its original aim, of ensuring that no one has to wait an unreasonably long time which could damage their health. It has played a crucial part in driving improvements in waiting times for patients, said Prof Donal ODonoghue of the Royal College of Physicians.

Also, the public appear to like the fact that they can access urgent and emergency care quickly. If the target disappears there may be a backlash.

Making less sick patients wait longer than four hours while more serious cases get priority which would happen if NHS England did replace the target wait could involve risk, as some of those may also have a more serious condition, such as a heart problem.

NHS Englands review group under Prof Stephen Powis, which is looking at waiting times, is continuing its work. Its recommendations will be influenced by the evidence from the 14 NHS trusts that are trialling an alternative to the four-hour guarantee.

The strong opposition from senior doctors may makes wholesale abolition of the four-hour target harder to do, given that both NHS leaders and Hancock have said that any alternative has to have the support of clinicians.

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Are the Tories about to abolish A&E targets? - The Guardian