Four Hour A&E Wait Targets Not Met

Despite the Governments attempts to introduce the target that 95% of patients should not wait more than four hours to be seen at A&E, the number of patients waiting four hours of more at A&E has risen by more than 300% across some hospitals.

In 2013-2014 one million patients had a waiting time of over four hours at A&E. In 2015-2016 this figure rose to 2.2million patients.

There have been longstanding campaigns to encourage patients to seek alternative care routes because of the pressures being placed on local hospitals but Dr Simon Howse of the Royal College for Emergency Medicine (RCEM) argues that there is “no evidence that people are wrongly using A&E services compared to a decade ago”. Instead he says there is a “large and systematic problem” because hospitals are “being asked to do something they are not resourced to do”.

Four hour waiting target last met across the board in July 2015

Last week NHS England statistics showed that there was a drop in the percentage of patients seen within four hours from 86.2% to 85.1% in January – the worst month ever recorded. Closer examination reveals, worryingly, that almost 80,000 patients who were classed as seriously ill waited more than four hours on trolleys for treatment following admission to A&E. A disappointing record number of 988 patients waited on trolleys for over 12 hours, a huge increase of 830 patients since January 2016.

In attempts to provide treatment sooner, some hospitals are relying on ‘corridor nursing’ to provide treatment to patients sooner where beds are unavailable. A hospital enduring such significant changes is the Royal Blackburn Hospital where, in February 2017 just 33 beds were available for 95 seriously ill patients. John Appleby, Director of Research at the Nuffield Trust said that corridors “have become the new emergency wards”.

Health Secretary Jeremy Hunt has reiterated a commitment from the Government to lower A&E waiting times but taking an alternative approach is Welsh Health Minister, Vaughan Gething. Gething has abolished targets for all calls to ambulance services except for those reporting life-threatening illness or injury to ensure that they remain priority calls. He advised that 65% of these ‘red’ calls should be responded to within eight minutes, which the Welsh Ambulance Service achieved continually over the 17 month trial period, with an average response time of just five minutes. Gething is now able to claim the best ambulance performance in the UK and the approach is now suggested by researchers at Sheffield University to be a new model which would be appropriate and right to move to. Gething believes that his approach is transferrable to A&E and explains that “you can go to A&E and be there for five hours but have high-quality care and a good experience. You can be through and home again in two hours and have a really awful experience”.

A member of the specialist clinical negligence team at Ashtons Legal says: “It is interesting to see the results of the alternative approach being put in to place in Wales and Gething should be praised for reducing the target time pressure on staff. It is important that emergency calls or visits to A&E receive the most appropriate treatment for the presenting systems but there is a large expectation on the NHS to act as a privately funded business to save us the inconvenience of waiting at the hospital for treatment and this is driven by increasing expectations as well as an increase in population. Where a patient is seriously ill, treatment within corridors is not acceptable nor is a long waiting time of any description as this is where the development of complicating factors can arise. As always far more can be done within the NHS to save money on management, furniture or stationery without diverting any funding from the desperately needed front line.”