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SAM warns changing targets for political expediency “plain wrong”

Following comments made today by health secretary Matt Hancock regarding potentially removing the four-hour emergency access target, SAM president Dr Susan Crossland and immediate past president Dr Nick Scriven raised their concerns.

Dr Crossland said: “Potentially scrapping the target because it is no longer being met shows the disregard this current government has for improving patient care.

“While the four-hour standard is a single point measure, a bit like a sledgehammer to crack a nut, it does and has helped focus the timely care of acutely unwell patients.

“There have been multiple clinical groups working towards the development of new standards, but this is complex work that is still in its infancy.

“We fully support improvement in managing unplanned care and understand that measurement and benchmarking is a vital part of quality improvement.

“We need to be clear that in scrapping the four-hour emergency standard, Mr Hancock must enable us to somehow measure and improve the care we give to patients month-on-month and year-on-year.

“Resources, staffing and infrastructure within the NHS are key to getting this improvement.”

Dr Scriven said: “Changing any target for political expediency alone is plain wrong. In this case, the ‘four-hour target’ has been in place for a long time and has helped the flow of patients from the emergency department over many years despite initial scepticism from the Royal College of Emergency Medicine.

“It has been relatively easy to collect this data and measures exactly the same thing wherever it is done. It has proven that focusing on a specific target can help the patients through the acute end of hospitals in a timeframe appropriate for their illnesses.

“There has been a group – including representatives from the RCEM, the Royal College of Physicians and SAM, working with NHS England over the last few months on the project to replace various access standards including four-hour access with measures that might work better for patients.

“This is not yet, as I understand, in a place to recommend any specific new targets with any firm evidence base behind them.
Interestingly, the test sites for the new measures are not reporting against the current target which, in my opinion, hinders interpretation of the data.

“With the month-on-month deterioration in performance against the old target surpassed by an even bigger failing in December, there are many questions that need answering and simply scrapping the target would be, I think, the wrong thing to do without the clinical backing from experts working in the area.

“If the target were to be removed without this type of clinically-driven data-proven exercise to identify a better one, then it would look like the government removing something purely because it is not now being met by a service under immense strain and would be the wrong thing to do.

“It seems as though Mr Hancock’s statement has preempted and sidelined any possible pending decision from the clinical working groups and has now placed them in an invidious position for what appears nothing more than political posturing.”

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