The four-hour target doesn't tell us the whole story
Treating 95% of A&E patients within four hours is not the most important success indicator for those accessing emergency NHS care.
While the current target does help illustrate performance across the NHS, and can help identify problems, the lack of detail means it tells us far less about the quality of care people receive and their overall experiences.
It therefore makes it very difficult for people to understand how their local hospital compares to others around the country, or what sort of service they should expect if they do have to seek help in an emergency.
6,500 people say what's important when visiting A&E
To inform the NHS Long Term Plan, and the review of clinical standards, we have been looking at what factors people think are most important when visiting A&E and how these could be used to support a more meaningful measure of performance.
We analysed feedback from over 6,500 patients, gathered from 25 sites across England, over the last three years to understand what matters most to people. We found people are most concerned about quality of care, staff attitudes and communication, when it comes to A&E.
Waiting times are still a common theme running through the feedback, but people rarely state if they waited under four hours or not. They are more likely to express either having been seen in an appropriate amount of time or having waited a long time, much of which is influenced by a whole range of other factors.
What makes a good A&E?
In January 2019, we worked with YouGov to ask 2,000 adults from across the country to rank 10 factors that would make a good A&E service.
While all of the options offered were considered important, guaranteed waiting times such as the current four-hour target were considered far less important.
1. Ensuring that the treatment patients receive is of the highest quality.
- Assessing patients quickly on arrival and reassuring them they will be seen in a medically appropriate timeframe.
- Seeing patients in priority order – most urgent cases first – even if this means some people may have to wait longer.
- Highlighting that systems are in place to monitor people while they wait in case their condition gets worse.
- Ensuring there are staff on hand to provide support while people wait, such as offering pain relief or providing drinks.
- Giving people an estimated waiting time on arrival and keeping them informed if things change, such as a major incident.
- Making information about current waiting times easily available to people before they turn up at A&E and providing information about alternative services.
- Treating or admitting all patients within a guaranteed timeframe (currently four hours) regardless of what attention is required.
- Reassuring patients that if they end up waiting longer than expected it won’t result in a parking fine in the hospital car park.
- Clearly communicating that a safe number of staff are working on the ward, particularly during busy periods.
These findings are being published today to coincide with the announcement from NHS England about plans to test a new set of performance measures in A&E.
This process of testing is essential to ensure that the proposed measures have a positive impact on clinical outcomes, patient safety and people’s experiences of care.
Ultimately, the aim must be to create a trusted measure that helps track hospital performance that is of use to both professionals and the public.
Commenting on Healthwatch’s findings and on NHS England’s plans, Healthwatch England National Director, Imelda Redmond, said:
“What shapes people’s experiences of A&E is often not how long they wait, but the quality of care they receive and how that care is delivered.
“People’s experience of care can therefore be significantly improved by staff carrying out quick initial assessments to reassure patients, prioritising those in greatest need and concentrating on communication to keep people updated on progress. This is of course what doctors and nurses working in A&E want to do all the time, but current targets sometimes draw attention away from this.
“When the four-hour target was introduced in 2004 it helped to significantly reduce the lengthy waits faced by many patients. But 15 years on the NHS faces different challenges, and from what people tell us, the time is right to look again at this core measure.
“Over the next few months Healthwatch will be supporting NHS England as they test new measures of waiting times in A&E to ensure they have a positive impact on people’s experiences of care, as well as on clinical outcomes and patient safety.
“Ultimately we want to see targets support hard working A&E departments so they can concentrate on delivering the best possible care for their patients.”