Sustaining and building on achievements
in treating patients without undue delay
Patients identified a reduction in waiting time in
A&E as the improvement they would most like to see, and the
Department has been pro-actively managing NHS trust performance
to ensure that, by December 2004, no one will spend longer than
four hours in A&E before being discharged or admitted to hospital,
unless clinically appropriate. It has used a combination of programmes
to help trusts identify and implement changes, such as the Emergency
Services Collaborative and the Improvement Partnership for Hospitals,
together with financial incentives to drive improvements. As a
result significant and sustained progress has been made towards
the target, and published performance data for July-September
2004 showed on average 95.9% of patients across all acute and
primary care trusts in England spent less than four hours in A&E.
However, a number of trusts still have some way to go since only
around 70 trusts had consistently achieved the weekly mark of
98%. From April 2005, the four-hour maximum total time in A&E
will no longer be a national target but will be part of the framework
of health and social care performance standards which will be
assessed by the Healthcare Commission.
Figure 1: Alternative patient journeys for emergency
care
Source: National Audit Office
Some patient groups are much less likely to be seen
within four hours. Avoidable peaks and troughs in the availability
of beds, waiting for specialist opinion and lack of access to
diagnostic services still cause delay. Undue focus on meeting
the target could mean less attention is paid to the timely completion
of treatment for patients, and a full range of formal measures
of quality of care or care pathways provided in A&E departments
has yet to be put in place. Obtaining sufficient suitably qualified
and experienced healthcare professionals remains a problem and
there is no accepted model for staffing A&E departments.
Improving the integration of emergency
care services
The modernisation of emergency care requires the
redesign of work systems around patients' needs. There are some
good examples of collaborative projects, but NHS trust chief executives
believe there is the potential to improve joint working. As a
means of securing the necessary integration of services, Emergency
Care Networks (cross-organisation and multi-disciplinary groups
to lead on local emergency care delivery) are a promising development.
Nevertheless, many networks are still in their infancy and lack
the authority and funding to bring about co-operation across the
various emergency care providers. Emergency Care and Emergency
Nurse Practitioner roles have been created to diagnose, treat
and discharge patients with minor illnesses and injuries, but
there is no national competency framework or standard curriculum.
1 C&AG's Report, Improving emergency care in
England (HC 1075, Session 2003-04) Back
