A senior doctor representing emergency department medics in Scotland has said he would back a potential review of the four-hour A&E target.

It comes as hospitals across Scotland record some of the worst A&E performance data on record.

Dr John Thomson, the Vice President (Scotland) for the Royal College of Emergency Medicine, told healthandcare.scot it appeared the target was being “ignored” by NHS boards.

The A&E consultant, who works in Aberdeen Royal Infirmary, said his Royal College was looking very closely at the situation in England, where the four hour target is being replaced.

Just 76% of patients were seen, and then admitted, transferred or discharged within four hours in the second week of August, with the figure dropping below 60% in some major hospitals.

A spokeswoman said the Scottish government was providing NHS boards with £12m to improve A&E performance but did not comment on the four-hour target.

The aim of seeing, admitting or discharging more than 95% of patients within four hours has been in place in Scotland in various forms since 2007 but waiting times had been falling for years before the pandemic.

Emergency departments south of the border are set to follow 10 metrics measuring different points of the patient journey, including 15-minute targets for ambulance handovers and initial assessments, after NHS England backed the changes.

Dr Thomson said: “It was always a very different position in Scotland, [the four hour target] more accurately reflects the pressures.

“However, we’ve seen a sustained period where hospitals have not met the standard nationally – some areas haven’t met it for a number of years – and therefore it appears to be being ignored at a board level, in terms of change to meet that standard.

“We are just taking a watching brief of what metrics are introduced in England.

“From a Royal College of Emergency Medicine Scotland perspective, we’re very open to the discussion around changing the four hour standard, but only if we’re changing it to something that improves patient care.

“There’s no point changing it for change’s sake, we need to make sure we’re changing it to something that we can measure that’s important to patients.”

The comments mark a shift in position by the Royal College, which has in the past backed keeping the four-hour target.

A 2017 review by former chief medical officer Sir Harry Burns said the current system of targets was “fragmented” and do not follow the “journey of care”.

Dr Thomson said delays at A&E were often down to a lack of beds in the rest of hospitals, meaning patients cannot be transferred – and said this was often misunderstood, including by healthcare professionals.

“The fact that the performance is so poor is not a reflection on my nursing and medical colleagues within emergency departments,” he said.

“It’s a reflection of the fact the system does not have the capacity to cope with the patients presenting to the front door.”

The Scottish government spokeswoman said Scotland has had the “best performing core A&E departments in the whole of UK for more than six years”, adding:

“We recognise the additional pressure our NHS staff are facing as they work tirelessly and consistently to respond to the pandemic whilst continuing to provide vital treatment and optimal patient care. We are in daily contact with every board and are monitoring the situation closely.

“To minimise pressures, we recently announced £12m in additional funding to health boards across Scotland to support non-covid emergency care. This immediate action will help put measures in place to reduce waiting times for urgent or emergency treatment, with a focus on boosting staffing levels and available beds.”

 

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