RCEM Backs New A&E Metrics 

Nicky Broyd

May 27, 2021

The Royal College of Emergency Medicine (RCEM) is supporting changes to A&E metrics in England, including the end of the current 4-hour waiting time target.

The changes follow a consultation with stakeholders and the public, and hospitals will now be expected to see and assess patients within 15 minutes.

Other indicators apply to NHS 111 performance, and ambulance response times.

Listening

The 4-hour target has not been met across all types of A&E departments since 2015.

Professor Stephen Powis, NHS England's national medical director said: "Since the previous standards were introduced in 2004, there have been many innovations in urgent treatment and care, so it is right we listen to patients, the public and other experts to ensure NHS services deliver what matters most to patients as well as what is most important clinically."

He added: "The pandemic has only made this work even more vital – patients need to get the right care, in the right place, at the right time and in a COVID safe way while they do so."

Corridor Care

RCEM President Dr Katherine Henderson commented: "It is vital that there is a clear programme of implementation ahead of winter. We are particularly keen to prevent ambulance offload delays and long waits in emergency departments (EDs) for a bed. The metrics in the planning guidance should be defined and implemented.

"Doing this ahead of winter is vital to help us highlight and tackle 'corridor care'. Overcrowded EDs with patients being treated in corridors risks the spread of infection and could derail any hope of elective recovery. Measuring and reporting 12-hour from time of arrival may help prevent this.

"There is no justifiable reason for a patient to spend half a day in an ED. This data is already collected, but only reported annually. This must be reported alongside the monthly performance statistics.

"We also welcome the wider recognition that there is a potential need for a 6- or 8-hour metric. Long stays are wholly unacceptable and detrimental to patient care. But one metric is not more important than any of the others.

"The holistic approach of the measures will help better identify pressure points in the system, and it is good to see that some integrated care systems are already thinking about how this will help at a local level. These measures should be a vital component of thinking around local transformation in line with the Government’s white paper."

CQC's New Focus

In a separate announcement, the Care Quality Commission (CQC) announced a new inspection strategy based on four themes:

  • Regulation driven by people’s needs and experiences, focusing on what is important to them as they access, use, and move between services

  • A more dynamic and flexible 'smart' approach to provide up-to-date and high quality information and ratings, and a more proportionate regulatory response

  • Safety through learning, with a culture that enables people to speak up

  • Encouraging health and care services to access support to help improve the quality of care where it’s needed most 

CQC Chair, Peter Wyman, said: "Health and social care services are about people. Where people are not experiencing high quality care in a way that works for them and their individual needs, we must work together to change it. This is what our new strategy is about.

"The world of health and social care has changed dramatically since CQC was established over a decade ago as an independent regulator – not least in response to the COVID-19 pandemic. Our new strategy responds to these changes, setting out a plan to deliver regulation that better meets the needs of everyone using health and care services, driving improvement where it is needed and supporting those who work in and lead services to deliver the best possible care."

BMA Council Chair, Dr Chaand Nagpaul, commented: "While this strategy is moving in the right direction, to really improve patient safety CQC must reconsider its crude rating system of inspection - which does not occur in any other UK nation. Instead of instilling fear or blame in staff who are doing their best in a system under pressure, CQC should identify specific areas of improvement and facilitate support for positive change, as occurs in regulatory approaches in many other countries. CQC must equally recognise that the NHS is vastly understaffed and under-resourced, and inevitably, this has an impact on the care that staff are able to offer patients."

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