Medics at the College of Emergency Medicine have said that the key NHS target to treat A&E outpatients within four hours is compromising care and patient safety.

BBC News reports that, although the government maintains that care and patient safety are the main priority for the NHS, the four-hour target for treating patients who visit A&E (accident and emergency) departments has always been controversial. Medical experts say that the final word on patient care should be left to doctors – although the four-hour target is useful in principle.

The College of Medicine says, however, that the target put medical staff in A&E under ‘incredible pressure’.

Chairman of the college, Dr John Heyworth, said that – although the target has helped make emergency care ‘a priority’ for the NHS – staff are being forced to meet it ‘at almost any cost’.

‘We've had nurses reduced to tears. We've had very senior consultants in emergency medicine threatened with a disciplinary process,’ said Dr Heyworth.

‘This is an outrageous misuse of the standard. It's not what the clinicians are in the emergency departments for,’ he added.

‘But it's representative of the immense pressure being put on chief executives – and all managers downwards from there – to comply with the target.’

The target for A&E was just one of a series of ‘centrally-imposed’ measures introduced by the Labour government to help speed up waiting times in the NHS.

Professor Julian Le Grand – who was former Prime Minister Tony Bair’s senior policy adviser between 2003 and 2005 – said that Mr Blair was ‘troubled’ by complaints from doctors regarding the targets. Prof Le Grand told the BBC:

‘I remember sitting in a meeting once where the Prime Minister said, “Do we have to just keep beating up on the consultants – in A&E for instance – endlessly to achieve this? Or is there some way we can think of building in incentives within the system so that we'll get these quality improvements on their own, without always having to crack the whip?”’

The term ‘centrally-imposed’ has fallen out of favour among politicians – although recent research by the Nuffield Trust revealed that targets had served to make the NHS in England more efficient than in other areas of the UK. It is thought the targets have had most effect in England, although they are used as a yardstick for waiting times in other parts of the country.

However, it is thought that Mr Blair’s concerns led to a move towards encouraging more ‘patient choice’ and competition between hospitals, rather than solely relying on targets to improve efficiency and quality of care.

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