Opinion: Time to dump the 4 hour A & E target

To be frank, as a doctor, I have been underwhelmed by our Liberal Democrat offering on health issues over the years; certainly we are not as strong on health as we should be.

The almost daily drip feed from the right wing press on NHS shortcomings and failures is demoralising to staff and frightening to patients and designed to be so. It serves no-one except those who want to undermine the public’s confidence in the NHS. The service treats three quarters of a million patients every day of the year, and for most people there is no alternative.

So I am  relieved that at last we have something distinctive to offer with Norman Lamb’s ideas on mental health; parity of access and delivery, more  research and funding. This is important, and we need to ‘own’ it as Liberal Democrat policy.

Mental health is a bit like cancer in that it touches every family at some point, but no one wants to talk about it or admit they might get it. One in four of us will suffer directly and all of us know someone in our family or circle of friends who has had, or is suffering depression, or psychosis. Quite a lot of us will know someone who has attempted suicide, or even succeeded.

The need to tackle suicide specifically is long overdue and important, but don’t let’s fall into the trap of having a zero suicide target. This is unachievable and will be yet another failure to beat the health service with.  Instead, I hope we can settle for steady downward pressure, year on year, on the numbers of attempted and completed suicides and celebrate each year what has been achieved.

However, we clearly need to offer more on health so here is my idea for a no cost policy which will grab headlines AND be very welcome to all hard pressed NHS staff.

Dump the 4 hour A&E target.

This ill-conceived target helps no-one, neither patients nor staff, and is universally hated by staff because it distorts the work flow on the basis of need. As the clock ticks towards the 4th hour patients are juggled around and given priority their condition does not deserve in a desperate attempt to avoid the inevitable ‘breach’ and newspaper headline.

In a big, busy A&E (and with the current reconfiguration there will be no other kind of A&E) only the simplest casualties can make it through the system in this timeframe. Yes, you may be able to get a cut finger stitched, have your tetanus booster and be out of the door in four hours, even if you have to wait a while to be seen because there are other patients in the queue before you, the reality of any public system, but sadly most A&E patients have more complex needs.

This 4 hour target is not about everyone being seen within 4 hours. That’s relatively easy. It requires assessment, diagnosis, treatment and discharge within that time frame. First you’ll be seen and  investigated with whatever tests are needed, such as X-rays, scans or blood tests. To have these done, you will need to go to other parts of the hospital and sit in other queues. You might even have to see a specialist. You then have your test results analysed, receive the  appropriate diagnosis and  treatment (or none) and are discharged. Achieving all of that in 4 hours is a huge and unnecessary challenge. This target sets up A&E to fail, and guess what, it’s failing. Let’s dump it and get on with treating patients according to their needs, and if it takes 6 or 8 or even 12 hours, so be it. The important thing is that each patient gets the time and attention they need. That’s an equitable service.

* Catherine Royce is a retired medical doctor, Lib Dem activist, member of the Lib Dem Women Exec and ALDES member