Key changes to be made in the NHS Standard Contract for 2022/23 just published by NHS England (NHSE) include an amendment to the 12-hour standard for maximum waits in A&E so that wait times in future must be measured from the point of arrival, rather than from the decision to admit, discharge or transfer, as is the current standard. This inevitably means that reported breaches of the target are “set to rocket”, said the Health Service Journal (HSJ) in response.
The change follows a Royal College of Emergency Medicine (RCEM) report at the end of last year that showed that even under the old target, only 6% of A&E departments stated that their longest stays were less than 12 hours, while 39% recorded maximum waits of 12-24 hours, 36% waits of 24-48 hours, 14% 48-72 hours and 6% more than 72 hours.
At the time, Dr Katherine Henderson, president of the RCEM, commented: "Across the UK there is a shortfall of 2000 to 2500 whole time equivalent emergency medicine consultants and, crucially, there are also widespread shortages of emergency medicine nurses and both junior and supporting staff. At the same time capacity is severely depleted across the UK... We are facing a crisis in urgent and emergency care and a crisis of patient safety."
A separate report published in the Emergency Medicine Journal in January found that A&E waits of more than 5 hours were linked with increased all-cause mortality, while performance against the theoretical 4-hour waiting time target, introduced in England in 2004, had steadily declined.
The RCEM welcomed the new amendment. Dr Henderson said: "We have long been calling for this change, and we are delighted to see this significant step towards greater transparency. The full publication of this data will be an immensely positive step that could be the catalyst for transformation of the urgent and emergency care pathway that should help to improve the quality of care for patients.
"We know that long stays in emergency departments harm patients and long stays (usually due to lack of an available bed) have consequences for other patients; ambulances cannot transfer patients into the department, and then cannot [go] back into the community, thereby putting further lives at risk."
The change will greatly increase the number of reportable 'trolley waits', the HSJ noted, noting that the RCEM has said an arrival start time better reflects the true scale of long waits.
"We expect NHS England to publish this data in full on a monthly basis; we see no reason why this should not be feasible from the start of the new financial year," Dr Henderson said.
NHSE said that the amended definition was changed in response to stakeholder feedback from a consultation that ended in January, in which responses were received from 187 organisations or individuals in relation to 37 specific changes proposed in the draft contract for the financial year 2022/23.
As well as the change to A&E wait standards, the contract amends the standard on long waits for elective treatment from a maximum 52-week wait to a maximum 104-week wait. This requirement will apply from July 2022, and is part of the 3-year delivery plan for tackling the COVID-19 backlog of elective care.
The change was necessitated by the reality of the NHS’s starting position, given the impact of the pandemic, NHSE said, and “should be viewed as minimum standards from which t o build improvement". Expectations of the NHS will be reviewed for 2023/24 and beyond, "with the aim of reverting to more demanding standards... at the earliest realistic opportunity".
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Cite this: Dr Sheena Meredith MB BS. Reported A&E Wait Breaches 'Set to Rocket' as Target Tightened - Medscape - Mar 04, 2022.
Dr Sheena Meredith Disclosure: Dr Sheena Meredith has disclosed no relevant financial relationships
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