Medical Negligence: NHS target for A&E treatment 'risks patient safety'
Doctors say a key NHS target - to treat people visiting accident and emergency units within four hours - is compromising care and patient safety.
The College of Emergency Medicine says the target, at English hospitals, puts staff under "incredible pressure".
The NHS target in England to deal with patients in A&E within four hours has been highly controversial. Critics say it forces clinical staff to put deadlines before quality of care.
Target-driven NHS
The chairman of the College of Emergency Medicine, Dr John Heyworth, says the target has helped to make emergency care a priority for the NHS. But he says staff are being forced to meet it at almost any cost.
The four-hour target is just one of a range of centrally imposed standards, most of them designed to speed up treatment. They have been used in other parts of the UK but have been much more heavily enforced in England.
A recent analysis by the Nuffield Trust concluded that targets played an important part in making the NHS in England more efficient than in other parts of the UK. The trust's director, Dr Jennifer Dixon, says they are a potent way of achieving quick results.
The Department of Health said that, in England at the beginning of 2003, almost a quarter of patients spent more than four hours in Accident and Emergency. It argued that since then there has been a "revolution in patient care", reducing that figure to less than 2%.
A spokeswoman said: "The funding for hospitals has risen dramatically and targets are minimum standards which taxpayers have a right to expect from NHS hospitals. All NHS providers are required by law to regard the NHS Constitution which includes a clear set of rights, pledges and responsibilities for staff - including no harassment or bullying, a pledge to be supported properly in a rewarding job, and the protection to speak up if services do not meet the standards we expect."
Despite his concerns over the four-hour standard, Dr John Heyworth from the College of Emergency Medicine said he had nothing against targets in principle. But he said he wanted a more sophisticated measure that accounts for quality of care, as well as speed.
Medical negligence lawyer Nicola Gaukroger from Reading based solicitors Boyes Turner said: "I think most people would agree that good quality care should always guide the decision making process in hospitals. It is therefore worrying to read of the pressure NHS staff feel is being placed on them by targets, which may not always be possible to meet. Certainly a measure that also accounts for quality of care, would be welcomed.
All too often we act for clients who have been rushed through A & E and are discharged without having received satisfactory examination and investigation. I suspect that patients who present with what are seen as relatively minor injuries, are particularly at risk of this. However, cuts often turn out be hiding tendon injuries, sprains are in fact fractures and abdominal pain is appendicitis or ectopic pregnancy, both of which can be life threatening.
It is therefore important that more time is taken so that when patients are discharged, they are confident they have received appropriate medical attention."
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