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Changes to A&E targets must not threaten patient safety, warns BMA

Matt Hancock calls for A&E waiting targets that ‘don’t work’ to be replaced with clinically appropriate targets

Louise Prime

Thursday, 16 January 2020

Scrapping the blanket four-hour waiting time target for A&E must not be allowed to compromise patient safety, nor to mask NHS underperformance or the effects of under-resourcing, the British Medical Association (BMA) has warned, after the health and social care secretary said it would be better for targets to be “clinically appropriate”. The NHS last week reported its worst results ever recorded against the target.

During a lengthy interview on BBC 5 Live Breakfast yesterday, Matt Hancock was asked (2:13:21) if the government would be judged for its failures against NHS targets. He responded: “We will be judged by the right targets. … Targets have to be clinically appropriate and the four-hour target in A&E – which is often taken as the top way of measuring what’s going on in hospitals – the problem with that target is that increasingly people can be treated on the day and are able to go home. That is much better for the patient, it’s also better for the NHS, and yet the way that’s counted in the target doesn’t work.

“It’s far better to have targets that are clinically appropriate, supported by clinicians. It’s best if that is led by the doctors.”

The BMA warned “in response to Matt Hancock’s admission that A&E waiting time targets are likely to be scrapped” that with emergency care at “breaking point”, any revisions to A&E targets must not be allowed to jeopardise patient safety. The BMA’s lead on emergency medicine said: “Whatever way you look at the state of emergency care, the picture is bad. Against the current four-hour target, the emergency care system has been woefully underperforming despite the extraordinary efforts of frontline staff with the most recent figures highlighting that emergency departments had their worst month on record in December. 

“It is crucial that any proposed changes to current targets are agreed with clinicians to ensure that patient safety is not compromised. This needs to be properly evaluated and should only take place if backed by evidence from the recent pilots to ensure improvements to patient care and maintenance of safety are the central objectives. 

 “Targets are an important indicator when services are struggling, and there is a very real concern that any change to targets will effectively mask underperformance and the effects of the decisions that politicians make about resourcing the NHS.  

 “Ultimately, replacing targets does not address the fundamental issues of capacity and resourcing within the NHS and the resulting pressure that has led to such poor performance in emergency departments in recent years. The emergency care system is at breaking point and this, above all else, must be addressed.”

Later in his interview, Matt Hancock was accused of ‘spinning’ promised NHS funding increases to make them sound better than they are in real terms. He countered: “No, this is the largest cash increase in history … we’re giving the NHS this increase in cash that is the biggest increase ever. … We’ve got make sure we get the best value for this money as well.” He added that he would love to take listeners’ questions in a return visit to the programme.

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