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Doctors Say Shifting Four-Hour A&E Wait Target Is "Hitting Snooze On Problems"

"The only way to resolve the NHS crisis is to fund the beds and staff to address the appalling logjam in our A&Es," one doctor told BuzzFeed News.

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Doctors have expressed frustration over Jeremy Hunt's redefining of the four-hour A&E wait time targets in response to the massive strain on NHS hospitals' emergency departments.

Speaking in parliament on Tuesday, the health secretary said the target of getting 95% of patients seen within four hours – a policy introduced by Labour – should apply only to "urgent health problems".

He said: “This government is committed to maintaining and delivering that vital four-hour commitment to patients. But since it was announced in 2000, nearly 9 million more people are using our A&Es, up to 30% of whom NHS England estimate do not need to be there, and the tide is continuing to rise.

"So if we are going to protect the four-hour standard, we need to be clear it is a promise to sort out all urgent health problems within four hours, but not all health problems, however minor."

His statement provoked outrage among doctors, who have said the pressures in A&E are the result of a multitude of challenges.

"Patients will still be waiting as long, Hunt has just decided he doesn't want to measure unfavourable statistics anymore," Dr Amar Mashru, an emergency medicine specialist told us. He believed that instead, it meant the crisis became "harder to quantify if you remove the measures by which they are measured".

Hunt's decision to shift the targets came ahead of new NHS Improvement data that showed there were more than 18,000 people waiting on trolleys in A&E departments in hospitals in England last week alone.

Up to 485 of those patients had to wait for over 12 hours – three times the number for the whole of January last year, according to the BBC.

"Does he not understand this is real life?" Dr Rachel Clarke, a junior doctor in Oxford, told BuzzFeed News. "Patients are really dying in corridors in our A&Es, with many more languishing in those corridors for hours upon hours before even being seen by a doctor."

Clarke accused Hunt of failing to address the current crisis facing A&E and instead "trying to make it disappear by fiddling the figures".

In recent years, under-resourced NHS hospitals have struggled to meet the four-hour target.

"I am genuinely fearful that removing the four-hour target from ‘non-urgent’ cases will mean patients being shoved to the back of the A&E queues where they will sit, ignored, for far too long," Clarke added.

"Quite apart from the inhumanity this poses, it is potentially dangerous. Sometimes in A&E, an apparently minor case turns out to be much more serious, but you have no way of knowing this until you have properly assessed the patient.

"Those cases may not be assessed until too late if there is no incentive to ensure they are seen promptly."

Another NHS Trust's damage limitation plan kicks in. This is unsustainable for staff or patients. #NHScrisis

Dr Philip Lee, an elderly care and acute physician, said he worried about redefining a target that acts as a useful barometer for how well a hospital is managing.

"If you remove that, you end up losing that warning signal that things are going wrong," he said, noting that problems including a lack of critical care beds, or resuscitation areas working at full capacity, would continue to exist.

"It's basically hitting 'snooze' on your problems," he added.

Doctors are currently charged with admitting, treating, or discharging 90% of patients who attend A&E within four hours, but a combination of increased demand and reduced resources means hospitals are seeing only 50–60% of patients in this time.

Many doctors have pointed out that this is not simply as a result of too many non-urgent patients attending A&E departments.

"For all parts of the pathway for getting people into hospital, through A&E, getting them on to a ward and then off a ward, are being affected by these chronic cuts to services," Dr Rishi Dhir, a surgeon at London's Homerton Hospital, told BuzzFeed News.

"We have problems getting emergency patients out of hospital because we don’t have the social services in place, or physiotherapists or that kind of thing," he added.

To illustrate that issues spanned wider than A&E waiting rooms, Dhir described an incident the previous evening where he had rushed to the aid of a woman he saw come off her bike as he made his way home from work.

"I saw a girl lying in the road who had been knocked off her bike by a car. The car had stopped and she was covered in a few coats. It was freezing cold and a wet road, and rain was bucketing down," he said.

Ambulance staff told Dhir they wouldn't be able to reach the scene for 50 minutes. "They said they were really busy, and they are; they’re completely swamped."

Dhir later found out that the injured woman, who happened to be a doctor, had a spinal fracture, meaning it was essential that she was moved in a particular way by trained paramedics so as not to give her a spinal cord injury, which could lead to paralysis.

"She’s lucky she was a doctor because she was telling people not to move her too," Dhir said. "But if it had not been a doctor, or if she’d been unconscious, someone might well have moved her and caused even greater injury."

Jeremy Hunt now says commitment to see A&E patients within 4 hrs only applies to urgent cases. If you're missing the target, move the target

Dhir shared the story on Facebook to point out that "the problems aren’t just in A&E, they’re everywhere". He wrote: "This isn't a message looking for sympathy or praise but just to highlight the gravity of the situation in all parts of the NHS caused by chronic underfunding."

He later said he believed six years of underfunding the NHS was now coming to a head.

"There are cancer drugs that we can’t give any more. Resources have just been made sparser and we’re seeing it on a daily basis now," he said.

But, Dhir added, his frustration was less political and simply a reflection of issues he encountered on a daily basis. "If you look at most doctors they’re quite conservative in their thinking. I voted for the Tories in the last election," he said.

"I think it’s a house of cards and it’s starting to fall down. The public is starting to wake up. You can walk into any hospital and you can see people on trolleys and in corridors."

Lee agreed that a lack of resources across the NHS was at the core of the problem, and that the government needed to urgently provide extra funding, as well as halting money-saving plans to cut beds, to avoid further crises as winter continues and flu season gets under way.

"Fund extra beds in social care, buying capacity in care homes and increasing funding in community first," he said. "We can cope and manage, if the system works as it should, and we can get stranded patients out."

The Department of Health said there were "absolutely no plans to change the four-hour standard", and that Hunt's clarification was "to protect the four-hour target for people who do need it".

Laura Silver is a reporter for BuzzFeed News and is based in London.

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