A new range of performance measures for emergency care will replace existing NHS targets, the Government has announced.
The “indicators” will come into force from next April – seeing the end of the four-hour waiting time target for patients in A&E. The requirement for ambulances to attend serious but not life-threatening cases within 19 minutes has also been scrapped and replaced with a set of 11 new indicators.
Ambulance services will still be required to respond to 75% of all category A (immediately life-threatening) calls within eight minutes, but will also have to perform against a new set of measures, such as how well patients do who have suffered a cardiac arrest or stroke.
The GMB union said the plan was a “shocking scaling back” of ambulance services currently provided to patients but Health Secretary Andrew Lansley said the Government wanted to provide a “balanced and comprehensive view” of how emergency care works and stop the “isolated” focus on faster care.
He added that some parts of the NHS feel pressured into meeting process-led targets for A&E and ambulances that “distort” priorities and lack clinical justification.
The set of eight indicators for A&E care will cover issues such as timeliness, patient satisfaction, outcomes and safety. Five of the indicators have “performance management triggers” – meaning hospital managers will investigate if an A&E unit is failing to maintain good performance – but central Government will not monitor or deliver sanctions to those units that fall behind.
While the four-hour A&E target has officially been scrapped, managers will be expected to investigate if more than 5% of patients wait more than four hours. A similar investigation would occur if more than 5% of patients leave A&E before being seen, while people should ideally wait no more than 20 minutes for an initial assessment.
Mr Lansley said: “By putting patient safety and outcomes at the heart of the health service, A&E departments and ambulance trusts can demonstrate they provide safe and effective clinical care in a timely manner rather than meeting a specific target. This is not about hitting targets – importantly, it is about giving the NHS more freedom to deliver quality care.”
Justin Bowden, national officer of the GMB union, said: “If the Government was really serious about patient care they would have introduced these 11 clinical indicators and kept the 19 minutes response time. By removing the guarantee about time, the service the public currently receives will be watered down and as sure as night follows day, this announcement will be followed shortly by plans to cut ambulances and paramedics.”
John Heyworth, president of the College of Emergency Medicine said: “The introduction of measures to ensure timeliness of patient care in the emergency department and, crucially, time related incentives to maintain patient flow from the emergency department, will provide tangible improvements for our patients. The combination of measures of quality and time will drive the continuing improvement towards the world class standard of emergency medicine which the public expect and deserve.”