Four hour targets for accident and emergency are to be scrapped

The government has said it will scrap the four hour waiting time target in accident and emergency departments switching its focus instead to “measuring what matters most to patients”—quality and outcomes of care.

The health secretary Andrew Lansley revealed the plan during questions in the House of Commons after he announced that a full public inquiry would take place into the failing of care at Mid Staffordshire NHS Foundation Trust (BMJ 2010;340:c3117 doi: 10.1136/bmj.c3117).

Mr Lansley said that over the coming weeks the government will set out further NHS reforms that deal with some of the issues at the heart of the problems at Mid-Staffordshire including scrapping targets without clinical justification and publishing detailed data about the performance of healthcare providers.

Mr Lansley said, “The events at Mid Staffordshire were a tragic story of targets being put before clinical judgment and patient care, focusing on the cost and volume of treatment not the quality. That is why I want to move away from targets and replace them with measuring what matter most to patients—their experience of the NHS, the quality of their care and the outcome of their treatment.”

When questioned about which targets would fall under his axe he said, “We are going to look, and we will look constructively, at how we can scrap the four hours target as it currently exists and work on the basis of what the clinical evidence makes clear directly contributes to delivering the best possible results for patients.”

He said that in Stafford hospital the four hour target was “being pursued not in order to give the best possible care to patients, but in spite of what would be the best possible care for patients.” Patients suffered as they were discharged prematurely or transferred to units where there was no provision to look after them.

Asked for more details on his plans Mr Lansley replied, “I was very clear in saying that I am going to abolish the four hour accident and emergency target. I will issue guidance to the NHS shortly . . . to ensure that we deliver better quality. That is not just about the time spent waiting in an emergency department; it is about the quality of the service provided and it is based on clinical evidence.”

Mark Porter, chairman of the BMA’s Consultants Committee, said that waiting time targets had improved the NHS, but that patients should always be treated on the basis of clinical need.

“Waiting time targets—by focusing attention on every patient—have improved the NHS in many respects. However, in some cases they have also created pressure on staff to make inappropriate decisions that could compromise care,” he said.

“Whatever replaces targets in future, there needs to be engagement with doctors and nurses, and local flexibility.”