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Alternatives to "999" emergency service sought

The first set of proposals is from a review group headed by the chief medical officer, Sir Kenneth Calman, and deals with emergency care services in the community. The review was prompted by concern that existing systems of emergency care may be too focused on traditional access points, such as "999" calls, family doctors, and accident and emergency departments of hospitals. The alternatives proposed would reduce strain on these facilities.

 Key points of the directive

 * 48 Hour working week for most employees
 * Minimum daily rest period of 11 consecutive hours in every 24
 * Rest break when the working day is longer than six hours
 * Minimum rest period of one day a week
 * Three weeks of annual paid leave (four from 1999)
 * Night work not to exceed an average of eight hours
 * Free health assessments for night workers
 * Exemptions include: transport sector (air, rail, sea, roads), doctors in training
 * Special arrangements are allowed for: senior managers and executives, the self
   employed, family workers, people working in hospitals, prisons, docks, airports,
   security, the media, emergency services, agriculture, utilities, and tourism

The review group supports such initiatives as education campaigns to increase public awareness of how to deal with emergencies and where to seek professional help; telephone helplines to guide people to local services; and emergency care planned and managed to be accessible 24 hours a day. Further research is recommended into the viability of alternative models.

The group believes that examples of innovative practice around the country have the potential for an improved national system of emergency care responsive to local need. Making the best use of the resources in primary and social care is central to developing a good community emergency care service, it is stated.

Secondly, the health secretary, Stephen Dorrell, has proposed a new standard in the patient's charter for accident and emergency departments. The current standard provides for patients "to be seen immediately and have their need for treatment assessed." This target is met by 93% of departments. The proposed revision is for patients to be assessed by a doctor or trained nurse. Those needing immediate treatment will be assessed at once, others within 15 minutes of arrival. Patients will then be given a priority category that will determine the urgency of treatment.

Further discussion between the department and the professions has begun on proposals for a standardised triage system that could form the basis for a national "time to treatment" standard.

Mr Dorrell said the aim is to have a standard for accident and emergency departments that is more tailored to individual needs. The present standard ensures that everyone sees a doctor or nurse quickly. In future, patients should also know that the length of time they have to wait for treatment is related to their clinical need. Work on assessment priorities is being led by the British Association for Accident and Emergency Medicine and the Royal College of Nursing. -- JOHN WARDEN, parliamentary correspondence, BMJ

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