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Tuesday, March 15, 2005

Government's A&E target puts patient care at risk, says BMA survey

Despite the colossal efforts of accident and emergency (A&E) staff to improve waiting times for patients, the pressure to meet the Government’s 4-hour waiting target can put patient care at risk, according to new figures published today (14/3/05) by the British Medical Association (BMA).
The BMA’s survey of A&E waiting times, which was distributed to A&E consultants in the first week of January 2005, found that staff had worked extremely hard towards meeting the Government’s target that by 31 December 2004, 97% of patients were seen, treated and discharged within four hours. The survey also found that some trusts had received extra money from the Government, in return for delivering on waiting times, allowing them to buy new equipment and bring further benefits for patients.
However, the survey also revealed a number of areas of concern, including risks to patient care and bullying of staff, as hospital managers attempted to meet the 4-hour target.
Eight out of 10 A&E departments* in England who replied to the BMA’s survey said that clinical concerns had arisen because of pressure placed on them to see patients within four hours. Complaints included:
* Just over half (52%) said that patients were moved to inappropriate areas or wards
* Two out of five (40%) said patients had been discharged before they were adequately assessed or stabilised
* Just over one in four (27%) reported that care of the seriously ill or injured was compromised because of the pressure to the meet the 4-hour target.
Commenting on the BMA’s A&E survey, Mr Donald MacKechnie, chairman of the BMA’s A&E committee, said: “A&E doctors, nurses and support staff have all been working exceptionally hard to meet the Government’s 4-hour waiting time target despite an overwhelming increase in attendances. Our survey shows that waiting times for patients visiting A&E have significantly fallen since 2003 and this is a fantastic achievement.
“But I am appalled to hear that some A&E staff are being put under intolerable pressure, even bullied, by their trusts as they attempt to treat and discharge patients within four hours. It is absolutely right that patients visiting A&E are seen and treated as quickly as possible but not if staff are being forced to make inappropriate decisions and patient care is any way compromised.”
Just under a half of A&E departments failed to meet the Government’s 97% end of year target because there were not enough beds on the wards, delays in accessing specialist opinion or diagnostic services and inadequate numbers of A&E staff. Mr MacKechnie said: “Adopting a hospital-wide approach can help trusts to solve many of the delays in A&E. The job of A&E is made even harder when there is insufficient availability of in-patient beds for emergency admissions or there are delays in patients receiving the diagnostic tests they need as part of their treatment.”
Mr MacKechnie questions whether the Government’s final target of 98% - the figure that trusts must meet by 31st March 2005 - is realistic or sustainable. He said: “Cutting A&E waits has become a key policy for the NHS and it has been good news for many departments who were often seen as the ‘Cinderella’ service. It has attracted more resources and patients are benefiting from being seen more quickly and efficiently. But these improvements need to be sustainable. Staff cannot continue working at this pace.
“A&E consultants are telling us that the 98% target is a bridge too far and that 95% would be much more realistic given the level of resources. Consideration should also be given to having different expectations to reflect the severity of patients’ injury or illness.”


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