Senior medic says NHS leaders have “heaped pressure” on hospitals by failing to overhaul four-hour A&E target

Following today’s announcements regarding standards in the NHS, a senior medic has said NHS leaders have “heaped pressure” on hospitals during recent chaotic winters by failing to overhaul the four-hour A&E target.

Dr Nick Scriven, president of the Society for Acute Medicine, said the organisation had been calling for change since 2016.

“Back in 2016, SAM made loud and clear calls for the NHS to stop aiming only to meet the four-hour standard when it was clear a whole system approach was required,” he said.

“Ironically, the target of treating and discharging or admitting 95% of patients in emergency departments within four hours has not been met at all since then.

“It is no coincidence that, over this period, we have seen hospitals under unprecedented stress and demand – all while being unable to obtain a clearly defined picture due to a lack of appropriate and timely performance data.”

He added: “The review of the target is an opportunity to focus on a range of patient outcomes and quality standards to measure pressures and take effective action earlier – a lack of wide-ranging information heaps further pressure on already-stretched hospitals.

“We do agree that, while standards are arbitrary and quite blunt, they are useful if they are interpreted sensibly but other factors should be considered when assessing pressures and our ability to treat patients as we would like.

“These include the number of opal 4 alerts and capacity-related major incidents, daytime bed occupancy figures, numbers of patients moved to non-specialist wards and timeliness of senior clinical reviews.

“Regarding its testing and implementation it is vital to test across a broad range of hospitals across the performance spectrum and have whatever is decided on firmly embedded before any sign of autumn/winter pressures resume.”

Dr Susan Crossland, vice-president of SAM, said: “The health secretary said recently he was open to considering alternatives and our suggestion has been laying in wait since 2016.

“We will continue to make genuine attempts to improve the health service for patients and staff and hope that the health secretary’s actions back up his words and he engages in meaningful discussions regarding this emotive but essential topic.”

Acute medicine deals with the immediate and early treatment of adult patients with a variety of medical conditions who present to hospital as emergencies.

The specialty receives the majority of patients admitted from A&E and helps maintain the flow of patients through emergency departments to avoid exit block, the term used when patients cannot be moved into a hospital bed.

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