NHS England signals the end of four-hour A&E targets

Health bosses have called the targets ‘outdated’.

Sarah Jane
11 March 2019
Emergency Department

Last month only two hospital trusts hit the target to see and treat 95% of patients within four hours.

The four-hour A&E waiting time target could be abandoned in favour of new performance standards that will be trialled later this year.


Health bosses have called the targets ‘outdated’ and claim the move could prevent tens of thousands of unnecessary hospital admissions each year by improving upon the current four-hour ‘cliff edge’ target.

The Care Quality Commission claims the four-hour target has “been valuable in focusing efforts on improving emergency care” but says if services are to improve “we must find better measures to ensure patient safety.”

‘The sickest patients will be prioritised’.

Instead of aiming to see and treat all patients in four hours, the sickest patients will be prioritised with patients attending with heart attacks, acute asthma, sepsis, stroke and mental health patients in crisis receiving treatment within an hour.

The changes will be piloted this year and if successful could be introduced in 2020.


The Chief Executive of health thinktank the Nuffield Trust claims that while the targets are due a much-needed review, “a lack of staff and capacity” also needs to be addressed.

He said: “I agree that the A&E target is overdue a check-up: it has started rewarding the wrong behaviours, like moving patients just to stop the clock.

“The new target to treat patients with a mental health crisis within an hour at A&E sends exactly the right message about the urgency called for in those situations.”

Adding; “the root causes of poor performance lie in a lack of staff and capacity, which we have barely started solving.”


‘It’s about the quality of care’.

National Director of HealthWatch, Imelda Redmond, claims that what shapes the patient experience isn’t waiting time but the quality of care received.

She said; “When the four-hour target was introduced in 2004 it helped to significantly reduce the lengthy waits faced by many patients. But 15 years on the NHS faces different challenges, and from what people tell us it is clear that the time is right to look again at this core measure.

“Over the next few months Healthwatch will be supporting NHS England as they test new measures of waiting times in A&E to ensure they have a positive impact people’s experiences of care, as well as on clinical outcomes and patient safety.

“Ultimately we want to see targets free up hard working A&E departments so they can concentrate on delivering the best possible care for their patients.”

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