Does the four-hour A&E target matter?

  • 4 June 2013
  • From the section Health
  • comments
Ambulance
Ambulances can sometimes be forced to queue outside A&E

The A&E target certainly made a big difference when it was first introduced. Waits of 12 hours were not unheard of before the four-hour target came into force in England a decade ago.

But like all targets, it is a blunt tool too.

Patients undoubtedly enjoy much shorter waits than they did - even during these last few months.

When the target was brought in nearly twice as many patients were waiting longer than four hours than the numbers during the peak this winter.

However, there are ways to play the system.

Two of the most common are getting ambulances to queue before hospital staff will take their patients on (to stop the clock starting), and transferring patients from A&E to wards set up alongside them - often known as medical assessment units or clinical decision units (so the clock stops).

While the statistics will say only a very few patients wait for over four hours, the reality - as many testify - is somewhat different, whether the target is hit or missed.

Uncomfortable waits

But what really matters here is whether waiting longer harms patients.

There are always exceptions, but most people would accept that the NHS is good at prioritising the most ill patients.

Therefore those waiting longest will tend to be the patients who are most able to cope with delays.

However, that does not mean that for those individuals there may be some very uncomfortable waits.

That is particularly true for the busiest hospitals.

The units that are most likely to miss the targets and the ones that can least afford too. They tend to be the biggest and busiest hospitals where the sickest patients are taken.

These major units are known as type 1. When you break down those figures to weekly data you can see that overall the target was not hit at all from September to May.

That is a remarkable situation in the modern NHS, as Patients Association chief executive Katherine Murphy acknowledges.

She believes the situation is "reaching crisis point".

But a delve deeper into the figures makes even more worrying reading.

When the figures are broken down by individual hospital there have been weeks where approaching half of patients have waited longer than four hours in some places.

In those situations even with doctors prioritising the sickest patients it gets extremely difficult to make sure the delays do not adversely affect some.