Scrapping four-hour A&E target ‘could be detrimental’ to patients – hospital boss

Nick Hulme, chief executive of Ipswich and Colchester hospitals, has had his say on plans to scrap t

Nick Hulme, chief executive of Ipswich and Colchester hospitals, has had his say on plans to scrap the four-hour A&E target Picture: ARCHANT - Credit: Archant

Controversial plans to abandon the four hour waiting time target at A&E could be detrimental to patients, the boss of Ipswich and Colchester hospitals is warning.

Chief executive Nick Hulme said he does not support a proposal by NHS England to potentially drop its flagship guarantee that patients will be seen in a four hour window.

He feels four hours is a long time to wait anyway, and warned of potential “chaos” if the move is rolled out – with the potential of treatment delays and crowded departments.

“I know it’s a bit controversial, but I don’t support this plan. I welcome the consultation (into whether it should go ahead),” he said. “I personally think scrapping the four hour target could be detrimental for patients.

“For me, it is the only measure we have got – it’s a measure of how the whole system works together.

“Four hours is a long time to wait anyway. I used to work at an A&E department before they brought the standard in and it was chaos. “People were waiting for hours and hours.”

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What is the NHS consulting on?

NHS bosses are running pilots this year to see if scrapping the four hour A&E target would benefit patients.

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A new measure of time is being tested at certain hospitals, aimed at ending hidden long waits and providing a more accurate view of hospital performance.

If they are successful, they want to roll changes out in 2020.

Pilots across England will see trusts record how long every patient spends in A&E, not just whether their discharge or admission time breaches the target.

It is not clear yet when and where these pilots will take place.

To meet current targets, 95% all patients must be seen within four hours.

However, NHS chiefs believe these new proposals – developed by some of the country’s leading clinicians – will help to improve care.

“This could prevent tens of thousands of unnecessary hospital admissions each year by improving upon the current four hour ‘cliff edge’ target,” a spokesman said.

“Around a fifth of all emergency admissions from A&E happen in the final 10 minutes before the deadline, suggesting that hospitals are being driven to focus on the target, rather than what is the best approach for each patient.”

How are things going at Ipswich and Colchester’s A&E departments?

Mr Hulme oversaw last summer’s merger of Ipswich and Colchester hospitals into the new East Suffolk and North Essex NHS Foundation Trust.

In February, the merged trust failed to hit national targets again – 90.2% of patients were seen within the four-hour time frame.

The situation was similar at West Suffolk Hospital, which saw 88% of patients in this time.

Mr Hulme said there has been a rapid turnaround at Colchester, which has gone from one of the worst-performing A&Es to the best in the country.

However, he admitted Ipswich was struggling – partly because of problems with physical capacity, which is why they are looking to expand at the Heath Road site.

Patient flow is also an issue, he said, and the hospital has a higher percentage of sicker patients.

Changes are currently being rolled out in the department to solve some of these challenges.

Nevertheless, he stands by his view on the four hour target – adding that it is an opportunity to see where all the pressure points are, and how to relieve them.

West Suffolk Hospital bosses ‘would welcome being part of local review’

Those in charge at the Bury St Edmunds based trust feel it is important for the NHS to consider wider measures to improve the A&E experience for patients.

“The four hour A&E target has transformed emergency medicine, and has been particularly helpful in supporting patient flow, however, it was introduced a number of years ago and it’s important for the NHS to consider wider metrics that will help NHS trusts improve patient care,” a spokesman said.

“We would welcome being part of a local review if our outstanding trust is considered an appropriate site to participate in a ‘pilot area’, to help shape new standards that benefit both patients and our staff.

“Meeting the four hour A&E standard is important to us, and we know it’s important to our community too.

“Despite us seeing and caring for more people, we are generally performing much better than last winter thanks to better preparation and planning, and to the incredible efforts of our staff.

“They continue to pull out all the stops to provide high quality care to people, every day, and we remain above the national performance average as a result at 88% for February 2019.”

MORE: How your A&E experience will change as under-pressure hospitals miss waiting time targets

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