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

Why are hospitals under so much pressure?

The NHS across the UK is already struggling to meet its A&E targets, and winter - the busiest time of year - has only just begun. Nick Triggle looks at why hospitals are under the cosh.

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  • rate this

    Comment number 36.

    For big chunks of the time there is nothing more to do than sit and wait for something (usually a big bit of very expensive machinery) to become available or for lab tests to be run. A&E doesn't have its own bank of CT or MRI machines, or its own labs department, but instead shares them with the increasingly busy rest of the hospital.

  • rate this

    Comment number 35.


    A disproportionate number of the well over 5 million immigrants don't work in the NHS. Some do, therefore immigration is brilliant. As a side note terrorism adds vibrancy to a country that was otherwise lacking culture, even through we took civilization to 2 thirds of the world.

  • rate this

    Comment number 34.

    "I try to get a GP appointment. -4 days urgent/emergency or ring back tomorrow (always ring back tomorrow) and when you get an appointment its 5 - 10 day."

    Nearly every GP has non-urgent same day appointments you just have to be up and ring at 8am to get them. If they are too late ringing then they will all be gone hence the need to try again tomorrow.

  • rate this

    Comment number 33.

    The answer is simple, stop this ludicrous system where you have to ring on the day for appointments -our surgery opens at 8:30am so does the phone line. You cant get through before 9am because everyone is calling for an appointment-result by the the time you get through all the appointments are gone for the day at 9am. Solution go to A & E and someone will see you. What else can you do?

  • rate this

    Comment number 32.

    So it's all the problems are nothing to do with the 5 million let into Britain by Labours open door policy then?

  • rate this

    Comment number 31.

    What a silly question. 4 hrs enough & then some.When will they realise if GP s worked properly all day, every day & weekend then A & E would be under much less pressure. I try to get a GP appointment. -4 days (not 4 hrs) urgent/emergency or ring back tomorrow (always ring back tomorrow) and when you get an appointment its 5 - 10 day. You have to decide yourself whats an emergency I am not a doctor

  • rate this

    Comment number 30.

    This was telegraphed ages ago. It's been the mission of the last few governments, both Conservative/Coalition and Labour alike, to handicap the NHS incrementally to the point where they say there's 'no choice' but to privatise it.

  • rate this

    Comment number 29.

    Perhaps if we want a better NHS paying more taxes is the answer - not reorganisation and demanding "efficiency savings" - such actions just cause perverse incentives and sub-optimisation like the "4 hour target".

  • rate this

    Comment number 28.

    A friend was recently taken to hospital at 8:30pm by ambulance, with heart trouble. They took blood for testing and said she needed a heart scan, she waited and waited, told she was next in line, an hour and a half later she was still waiting. At 1am she went home without having the scan and booked herself in with the GP for the next day. By 1am you just want to go home and sleep

  • rate this

    Comment number 27.

    I was told once that if I burnt myself and the burn was bigger than a 2 pence piece I should go to A&E. It's small wonder it's clogged up, small cuts, bumps and burns should be dealt with at home and at the GP's office. Just not be fore 9am as some of us find it hard just to see our GP without taking half day!

  • rate this

    Comment number 26.

    If it is an emergency then 4 hours is far, far too long to wait, if it isn’t an emergency the patent should be sent to see their G.P.

  • rate this

    Comment number 25.

    Most people attending don't know their "Accidents" from their "Emergencies".

  • rate this

    Comment number 24.

    The problem with the NHS is stupid politicians sucking up to their corporate pals, safe in the knowledge that, if they lose their seat at an election, a lucrative CEO position awaits them at a privatised health company.

    James Naughtie was right !

  • rate this

    Comment number 23.

    Stupid people clogg the system up with ridiculous complaints.

    Common sense is no longer common. Stupidity seems to be encouraged by the authorities with Health & Safety guidance - in my loo at work there is a diagram and flow chart showing you how to wash your hands!!!

    When I was a lad such stupidity would be laughed at and ridiculed. Now we seem to think we are being clever it seems.

  • rate this

    Comment number 22.

    Its simple. Impose a £6 billion pound top down re-organisation of the NHS at a time when resources are tight. Make sure the re-organisation is the biggest shake up since the NHS was formed so that everyone is confused about their roles. Make sure it is opposed by doctors and nurses, then impose it on them so that they feel demoralised. Sit back and let everything go pear shaped.

  • rate this

    Comment number 21.

    The problem is not the NHS but with a population including people so stupid that they think they have a right to walk into a hospital with a snagged nail and demand medical treatment. Send them home with a leaflet advising them on how to grow up and behave like a responsible citizen. Given that people call 999 because their cat sicked up a furball, there is little hope for them.

  • rate this

    Comment number 20.

    15. Isitonlyme
    "Another story about failures in the NHS to back up a case for privatisation?"

    I doubt it. The A&E problems strike me as due to lots of little bits of the NHS (GPs, Ambulances, A&E, Wards, Community Care) "sub-optimising" to suit their own sub units.

    Privatising will only make this situation worse. Look at the "optimising" of National Rail and the Train Companies! (Lawyers rule)

  • rate this

    Comment number 19.

    People coming when they shouldn't

    GPs referring up when they don't know what else to do

    Other specialities refusing to see their own acute referrals until they've been seen by A+E

    Poor out of hours care organisation/delivery

    The extremely intoxicated

    An increasingly elderly population prone to catastrophic reactions to otherwise minor/moderate medical issues.

    And the list goes on......

  • rate this

    Comment number 18.

    Dear Jeremy Hunt,

    The NHS is not yours to privatise. It was paid for by taxpayers, so hands off.

    regards, The Entire Population Of The UK

  • rate this

    Comment number 17.

    Most people presenting themselves at A+E have no need to be there. They should be weeded out at triage and sent home with a bill for fifty pounds. If you have had a serious Accident, or are a genuine Emergency, then you are destined for A+E, probably in an ambulance. The clue is in the name. There was a case recently of some idiot attending A+E with scarlet fever, which is neither an A nor an E.


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