Does the four-hour A&E target matter?

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.

Nick Triggle Article written by Nick Triggle Nick Triggle Health correspondent

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  • rate this

    Comment number 16.

    "A&E actually deal with the drunks FIRST to get them out of the building.
    They are instructed to do so by the powers that be."

    Are you sure about that? I once had to take a very drunk friend to A&E after they stuck their hand through a glass window - I assure you we were made very aware that they disapproved of his state and were made to wait.

  • rate this

    Comment number 15.

    Another story about failures in the NHS to back up a case for privatisation?

    Does the Govt (& previous Govts) not see that constant interference is making it increasingly difficult for the whole NHS to perform.

    Yes, reform is needed - but sensible reform

    Despite what the Govt / media portray the majority of the UK value the NHS so HANDS OFF!

  • rate this

    Comment number 14.

    A&E actually deal with the drunks FIRST to get them out of the building.
    They are instructed to do so by the powers that be.

    Until this practice ends the genuine patients will always wait for several hours.

    And the leftie, PC crank, do-gooding, nutters here can minus my comment as much as they like.

  • rate this

    Comment number 13.

    And it's not just the NHS. Why doesn't the government just admit they are trying to justify privatising all public services?

  • rate this

    Comment number 12.

    4 Hour target helps patients, but it also give the NHS an excuse to keep patients in A&E longer than needed. I go in via A&E regularly and kept in overnight for bloodtests. But as soon as I'm told I'm staying in I know I will be waiting until close to 4 hours is up before going to a ward. Whats needed is bed allocation to be quicker, thus freeing up room in A&E

  • rate this

    Comment number 11.

    The A & E crisis is simply because so many people go to A & E when there is no emergency and no accident. If they cannot get an appointment with a doctor immediately they just trot along to A & E. The staff at A & E should assess the need and then send the non- A & E cases straight back to arrange a doctors appointment. A & E is for ACCIDENTS and EMERGENCIES Got it !!!!!!!

  • rate this

    Comment number 10.

    If the drunks and homeless didn't take up half the beds in A&E, then there would be no problem. Give them a separate ward.

  • rate this

    Comment number 9.

    I recently went with a relative by ambulance to a large A&E dept. While we waited for results I noticed that, although every bay had a patient, the doctors were often sat staring idly into space. It certainly wasn't the hive of activity depicted on Casualty. And there was a sizeable queue. Space is relatively cheap compared to staff, so surely they just need more beds in A&E to keep the drs busy.

  • rate this

    Comment number 8.

    "Does the four-hour A&E target matter?"

    Yes, to real people, but only if there is a profit in to Tories.

  • rate this

    Comment number 7.

    We need to ask ourselves why so many people are going to A&E. Perhaps more training for first aiders at work should stop people fainting instantly being carted off to A&E or else where for that matter. I understand things can be serious, but 8 time out of 10, it's lack of food or a hang over on a crowded train!

  • rate this

    Comment number 6.

    With this government in charge, is it any surprise?

  • rate this

    Comment number 5.

    Of course the target matters. Jeremy Hunt is deliberately allowing the NHS to fail, so he can sell it off cheaply to his corporate pals.

  • rate this

    Comment number 4.

    It's not a very good metric without any indication of how seriously ill the people waiting >4 hours are, and whether they actually needed A&E or could have been dealt with more appropriately by a GP, a walk-in centre or a district nurse.

  • rate this

    Comment number 3.

    As a recently retired nurse the problem is that staff cuts around the country have closed a lot of A&E departments to centralise everything....but staff and bed cuts in those units too rather than increases have caused the problem. If they didn't close the units you wouldn't have the problem you've got now

  • rate this

    Comment number 2.

    My wife & I had to wait eight hours for an "emergency" at Basildon Hospital in Essex. My wife was about to give birth to our daughter and she developed a condition which was potentially damaging for the unborn baby.

    Later, when we complained at the wait, the hospital accused us of making it up, as they'd doctored the records to show we waited "only" three hours.

    Awful experience, very stressful.

  • rate this

    Comment number 1.

    I don't think its that helpful to look at the 4 hour indicator on a national basis. What is important is to understand where the local and regional pressure points are and to work through regional and local solutions to dealing with the twin issues of the growing numbers of people presenting at A&E and the most efficient ways of dealing with them.


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