It has recently been announced that NHS England plans to remove the four-hour waiting time target for A&E patients, in an effort to reduce time spent in emergency departments.
Since its introduction in 2004, the four-hour target, which requires 95 per cent of A&E patients to be seen within the set time frame, will be replaced by more considered targets. The 4 hr target has not been officially met in the UK since 2015, and many clinicians now believe the time is right for sector-wide changes to be implemented.
The chart below reflects the failure to meet the 4-hour target throughout the UK, with a drop in achieving the target between 2010-11 and 2018-19 for all four countries of the UK.
Since the target was introduced, in 2004, December 2019 has seen the worst A & E delays with just 79.8% of patients being admitted, discharged or transferred within four hours.
According to figures published by the Kings Fund, approximately 330,000 people in England spent 12 or more hours in A&E in 2018/19.
Recent statistics indicated that the period of time patients spend in A&E depended on the type of A&E unit visited. Generally it was determined:
- Patients visiting minor A&Es, also known as types 2 and 3, have a very high rate of treating patients in less than four hours. These units are often single specialty departments or minor injury facilities.
- Patients visiting major A&Es, or type 1 facilities, often fail to meet the four-hour target as they deal with a much higher number of patients who commonly have much more severe cases.
The NHS is committed to publishing A&E attendance and emergency admissions data every month, and real-time data can be found on their website.
New A & E Measures
New measures will monitor how quickly patients are seen for an initial assessment, with hospitals aiming to see new patients within fifteen minutes of their arrival. Thereafter, hospitals will be monitored based on the average time within the department, rather than the four-hour wait time. According to a 2019 Clinically-led review of NHS Access Standards, there will likely be four critical areas specified by the new target:
- Time taken for an initial assessment to be conducted;
- Time for emergency treatment for patients with the most severe injuries;
- Mean waiting for time target calculated across all A&E units;
- Review of ‘Same Day Emergency Care’ to avoid overnight admissions where possible.
The percentage of patients waiting more than 12 hours will also be monitored, as well as the percentage of ambulances able to hand over patients within fifteen minutes. Local health systems may be given a performance rating alongside the new proposed measures. These changes represent the NHS’s desire to improve the quality of care provided to patients across the board and is in-keeping with the evolving challenges facing the provision of healthcare in the UK.
The outbreak of COVID19 and the subsequent pandemic has put the NHS under unprecedented pressure and has disrupted operations within hospitals throughout the UK. Therefore the revision of the four-hour A&E waiting time target set out in the Handbook to the NHS Constitution will be initiated at a time in which serious A & E delays are to be expected.
The 4 Hour A & E Target Was Reduced
The four-hour target was relaxed from 98 per cent to 95 per cent in 2010 after it was deemed too difficult for A&Es to meet. In the years that followed the relaxation, performance remained close to or above the target, but by the middle of 2019, data across the board showed that performance had slipped to 72%, which was the worst level since the introduction of the four-hour target. Interestingly, by April 2020, performance had increased to 90%, but this is a direct result of the reduction in admissions due to the lockdown enforced as a result of the coronavirus outbreak.
It’s also important to examine the median amount of time patients spent in A&E in recent times, to get a clear picture of just how efficient departments are at seeing patients in a timely manner. Looking back to May 2011, the median waiting time was 129 minutes, which increased to 174 minutes in December 2019, when the NHS was under pressure. Over a nine-year period, there has been a steady increase in median wait times, which has contributed to clinicians reviewing the wait-time target.
Will This New Initiative Improve A & E Waiting Times?
The fact that the four-hour target has not been met in recent times has undoubtedly prompted the NHS to consider changes. But according to IFS, the four-hour wait time target saves lives, and the government needs to be careful before replacing it with other policies. In a 2020 report, IFS showed that the target led to significant reductions in patient deaths.
Chief executive of NHS Providers, Chris Hopson, commented on the new initiative:
“Delivery of the required changes and returning performance to the levels we saw when the NHS was meeting what will become the old 95 per cent four-hour standard will require significant investment. It’s therefore vital that we agree what funding will be needed and that the government then meets these funding requirements in full. Changing the way we measure performance will not, by itself, deliver the improvements to urgent and emergency care that patients need.
“If implemented, these changes must be seen as metrics for the whole urgent and emergency care pathway, indicating how well patients are moving between primary care, ambulance, hospital, community, and social care settings. For the transformation of the urgent and emergency care pathway to succeed, we need concerted action, appropriate funding and complete support for this approach across all the different organisations providing urgent and emergency care.”
Whatever changes are implemented, we are likely to hear more by the end of February, as the initial consultation phase ended on Friday 12th February 2021. This concludes a period dating back to June 2018, during which the NHS National Medical Director sought to review access standards across the NHS in England. Any changes are likely to occur in the coming years, depending upon how the health service recovers from its collective response to the ongoing coronavirus pandemic.
Negligent Care in Accident and Emergency (A & E)
1n 2018/19 the NHS received 10, 6781 compensation claims, with a large number of claims following negligence in A & E.
If you visited an A & E department and sustained further injury or harm due to mistakes made in the diagnosis or treatment of your condition or injury you could be entitled to compensation for your pain and suffering. These mistakes also include the failure of a nurse, doctor, consultant or other medical professional to refer you to specialist care or further treatment or tests.
Our A& E compensation claims service provides:
- A free no-obligation case evaluation
- Advice on the probability of success for an A&E claim and the amount of compensation you could potentially obtain
- Friendly, compassionate and experienced claims experts
- A No Win No Fee agreement i.e. you will not incur any costs if your claim is not successful*.
- Access to a network of medical experts and specialist barristers
Our experts work hard to secure victims of medical negligence the justice and compensation they deserve.
To start your A&E negligence claim contact our experienced solicitors today. Call us on 0333 577 9444, email email@example.com or complete our online form. There are time limits as to when you can claim, so it is important not to delay contacting us.