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3 Oct 2014
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Leaky A&E biochemical protection suits
Nicola Stanbridge

Accident and emergency consultants have told us of their week of panic. 90% of emergency patients should now be admitted, transferred or sent home in under four hours.

But to meet that target, tested in the last week of March, the Today programme found evidence that hospitals were forced to postpone operations and move staff from other departments.

Hospitals could lose their star rating and future funding if they fail the target. Rumour had it some were cancelling operations.

St Mary's in London was one hospital we approached about this and over several days they decided to reveal that operations were being postponed . In a statement they said: "10 non-urgent patients have had operations rearranged for a later date - april or may, over and above the average cancellation rate. We've decided to consolidate efforts on improving emergency care this week, including extra resources, ring fencing some private beds for NHS use & offering care in the external private sector."

Many others, like St Thomas' in London, opted to make greater use of private beds to improve waiting times.

Sir George Alberti, the Government's Emergency Access Tsar, wouldn't say if he found these measures acceptable or not, telling us emergency work had been the poor relation in the past and the government was now trying to get a balance with elective surgery, part of a long term plan to improve everything for patients .

The Royal London Hospital also told us they had temporarily turned a children's ward into an adult observation unit to help reduce A&E waiting times, although at the end of June it will revert back to being a children's ward. Sir George hoped it wouldn't revert to its previous status, saying the aim was to get sustainable improvements in place .

The manager of nursing services at York District Hospital considered rescheduling elective surgery, but instead put what they call their 'A team' in place for a week, their best bed managers speeding up the discharging process for patients & more senior A&E nurses.

For the quarter ending in December, less than one-fifth of acute trusts hit their 4 hour target. Unsurprisingly most A&E units wouldn't let us in to see them at work in the last week of March because they were so stretched. But Kings' College in south London had been hitting the target and let us in.

One patient we met, Dean, said on visits to Kings' A&E in the last three months he hadn't waited more than 2 hours compared to up to 9 hours previously. "They seem to have cracked it." Achieved through no small amount of extra work.

Justin Forder's an orthopaedic registrar at Kings who was treating a patient while we were there. He said he had other commitments which meant it wasn't always possible to get to A&E within a specific time. "Then you're pressured to make a quick decision sometimes with 15 minutes to go before the 4 hour target's up. In reality you often need more x rays or investigations." He said his priority is what's best for the patient.

Meanwhile bottlenecks elsewhere in the system are still a cause for concern. Sister Carol Olding told us: "It gets to a pressure time when someone's been seen, there's been a decision to admit but there's no bed available, it means breaking the 4 hour target even though A&E has done everything right."

The Department of Health is at pains to say the targets won't create league tables, but it's feared failing A&E units - ones in most need of extra resources - could lose in the star rating system and consequently lose out on future funding.

Sir George Alberti admitted on the Today Programme that such targets would affect star ratings. "That's a political decision, nothing to do with me."

Hospitals could lose their star rating and future funding if they fail the target

Listen - We find evidence that hospitals have postponed operations to meet government targets - Nicola Stanbridge's report.

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