A&E: Does missing the target matter?

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The news that the NHS in England has missed its waiting time target with performance dropping to its worst level for a decade is dominating the headlines. But does it really matter?

After all, it was just 2.4% short of the 95% threshold during the October to December quarter. That means over nine in 10 patients were seen in four hours.

The figure is better than that being achieved in Wales and Northern Ireland - and much of the rest of the world for that matter. Unsurprisingly, it is a point ministers have been quick to make.

That is certainly a valid way of looking at it. But if you focus solely on the numbers, it is easy to miss what is happening on the ground.

The 2.4% figure equates to over 133,000 patients. That is a lot left waiting around - and that in turn causes delays elsewhere.

Reports have been emerging of ambulance crews facing waits to handover patients to A&E, while beds are full on the wards of hospitals.

'Really concerning'

These problems are now becoming widespread across the health service - as Scarborough Hospital deputy chief executive Mike Proctor explained in an interview with the BBC on Tuesday morning.

He described the situation he found when he started work on Monday at 7.30am. "The first working Monday in January is always a difficult day, It's one of the busiest days for emergency admissions.

"But what concerned me most was the starting point that we were at. All our ward areas were full of patients already, all our escalation areas were full of patients. In addition to that there were 18 patients on beds in our emergency department because there were no beds on wards for them to go to. Now, that is really concerning.

"Once you start to turn your emergency department into a ward, then it's not far down the road before you get an emergency department that can't function as an emergency department."

In the end, the hospital declared a major incident, calling in extra staff and cancelling routine operations. It was actually ready to take the ultimate step and close its doors by stopping ambulances from arriving.

Mr Proctor opted against this measure - known as black alert - because he knew it would just have passed the problem on to hard-pressed hospitals in the region.

What he described is not unique. There is a growing number of hospitals that are making such a declaration. You can be sure there are many others who have effectively done so but not gone public with it - there is nothing to say they have to.

A&E performance across the UK
Nation Target Latest performance
England 95% of patients in four hours 92.6% October to December
Northern Ireland 95% of patients in four hours 80.5% in November
Scotland 98% of patients in four hours 93.5% of patients in September
Wales 95% of patients in four hours 83.8% of patients in November

Since the BBC launched its NHS winter project at the start of December, which tracks how major units are performing each week, we have been inundated with stories of how difficult this winter is proving.

One A&E nurse contacted us recently to say he had just had his "worst shift" in his 25-year career. He described how his department was "crumbling under the pressure" with the numbers of patients regularly exceeding safe levels since September.

He said the hospital had been continually on black alert as patients queued in corridors. "Patients are suffering as a result and it makes my heart bleed that I have delayed assessing someone for hours, have denied them prompt pain relief and they are left in the corridor."

While these are the sort of stories that can emerge every winter, the frequency with which they are being reported and the language being used at the moment shows the problems are on another level altogether.

What is more, when you look at where the problems are concentrated, they are overwhelming found in the major hospitals.

The overall national figure includes the performance of smaller units, such as walk-in centres and minor injury clinics. Once you strip them out only about one in 10 A&E units are meeting the target. In some places a third of patients are waiting over four hours.

This is happening despite a record amount of money being ploughed into A&E units this winter. It is these figures that are sending a shudder across the NHS and government.

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