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

Health bosses have called the targets ‘outdated’.



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Health bosses have called the targets ‘outdated’ and claim the move could prevent tens of thousands of unnecessary hospital admissions each year by improving upon the current four-hour ‘cliff edge’ target.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


Safe staffing and equality have been an issue since the start

Parliament passed the Nurses Registration Act in 1919.



State registered nurse

A new exhibition charts the history of nursing from the Nurses Registration Act to modern-day.

In the centenary year of nurse registration, a new exhibition charts the history of the journey from the Nurses Registration Act in 1919 through to the modern-day.

Called ‘Wake up Slackers! The great nursing registration controversy’ the exhibition looks at the heated arguments around the official registration of nurses through the first registration of men, overseas nurses and one of the first nurses to be struck off.


The Royal College of Nursing (RCN) was just three years old when registration first happened and securing this had been part of its founding ambitions.

The exhibition shows how many of the discussions and controversies of the past, including safe staffing, continue today and influence many of the discussions around modern nursing.

The Nurses Registration Act.

The exhibit contains artefacts from the RCN archive including invites to member meetings to discuss the College’s proposals for state registration, House of Commons Parliamentary debates during the year the Nurses Registration Act was passed in 1919, as well as drafts of legislation.

Opening during Black History Month, the exhibition also showcases the story of Eva Lowe, one of the first known black nurses on the register. Research shows how, despite being well qualified she was rejected many times before finding employment. It shows how she received vague and unsatisfactory excuses for her rejection, some based on false concern for her welfare.

As well as letters and documents from the RCN’s own archive, the exhibition will also feature items loaned from other collections such as that of the regulator the Nursing and Midwifery Council.

Are nurses born or made?

Frances Reed, Events and Exhibitions Co-ordinator at the Royal College of Nursing said: “It is incredible today to think that 100 years ago there were arguments about whether or not nurses should be registered.

“Today it seems unthinkable for somebody with such responsibility for the welfare of patients not to be registered and yet there were strident clashes over it, despite other health professions securing regulation well before nursing.

“The story of the first black nurse on the register, Eva Lowe is important to highlight too. There is little known about black nurses whose names are on the very early 1920s registers.  It is essential we recognise that their contribution to health care existed well before Windrush.

“It’s also particularly striking to see how hard Eva Lowe had to fight to become the first black nurse on the register, and how 100 years later racial inequalities still exist in the health and care system.

The exhibition runs at RCN HQ in Cavendish Square, London 17 October – 20 March 2020

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One in six nursing associates drop out before qualifying, finds report

Despite this trainees showed “high levels of enthusiasm and commitment to the programme”.



Group of nurses in meeting

Only 65% of trainee nursing associates said they planned to work as a nursing associate once qualified.

An independent evaluation of the nursing associate role commissioned by Health Education England (HEE) has found that while there are “high levels of enthusiasm and commitment to the programme”, one in six nursing associates are dropping out before completing the course.

Attrition rates for trainee nursing associates fell slightly below that of student nurses, with 18% leaving before completing the course.


While ill health and personal issues were some of the most common reasons for leaving the programme, nearly a quarter (23%) withdrew because they failed to meet the academic requirements of the programme – with numeracy skills cited as a key issue.

One trainee said they found the “attitudes towards the role and the negative feedback about Nursing Associates” challenging.

Only 65% of trainees said they intend to continue working as a nursing associate once qualified as the programme is often seen as a stepping stone to becoming a registered nursing.

Highlighting challenges.

Mark Radford, Chief Nursing Officer, Health Education England said the report “highlights some challenges that we must address to ensure that students such as ensuring the quality and oversight of placements, attrition and numeracy support.”

“We also recognise that further work and research is required to ensure that the profession is supported and utilised in the workforce of health and social care as part of the MDT. I am pleased to be able to report that we are in the process of identifying candidates to be considered as NA ambassadors across England.

Commenting on the report, Andrea Sutcliffe, Chief Executive and Registrar for the Nursing and Midwifery Council (NMC), said; “Having had the pleasure of meeting many nursing associates across the country, I am continually inspired by their enthusiasm and dedication for providing care and they should be very proud of the difference they make for the people they support.”

“I look forward to seeing how nursing associates continue to develop and be supported in their work, long into the future.”

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