A&E targets put patients at risk claims top doctor

Patient care and safety is being compromised by one of the key NHS targets of treating people in accident and emergency units within four hours of arriving, it was claimed today.

John Heyworth, president of the College of Emergency Medicine, called for the number of accident and emergency consultants in England to more than double to help medical staff to make up for "25 years of under-investment" in the specialty.

He said A&E doctors were under pressure to make decisions which may be hurried because of the four-hour target and there were examples of patients being moved out of casualty departments to "anywhere" in a hospital where there is a bed, so the "clock stops ticking".

"In principle, the four-hour target is a good thing, but for patients and clinicians at the moment, it is not working as intended," he said.

"There are not enough staff in emergency departments, not enough experienced consultants and not enough beds in hospitals.

"With the ever-increasing workload in our departments, there is a mismatch between demand and our ability to deal with it.

"This means that on a daily basis clinicians are under immense pressure to comply with the targets."

On average four to five consultants are assigned to accident and emergency units which receive between 60,000 and 80,000 patients a year - a "woefully inadequate" ratio, he said.

Mr Heyworth, who is an A&E consultant at Southampton General Hospital, said the number of A&E consultants working in England should rise from around 850 to 2,200 "as soon as possible".

The four-hour target in A&E departments set by the Department of Health specifies that patients should spend less than four hours in A&E from arrival to admission, transfer or discharge.

Figures released by the Department of Health have shown that at the beginning of 2003 almost a quarter of patients spent more than four hours in A&E.

Department of Health statistics for 2008/09 have shown 98.1% of patients in England spent less than four hours in A&E from arrival to admission, transfer or discharge.

A spokesman said: "The funding for hospitals has risen dramatically and targets are minimum standards which taxpayers have a right to expect from NHS hospitals.

"Patient safety and good quality care should always take priority over administrative targets where a doctor believes that is necessary.

"Ministers have repeatedly said that to managers and doctors.

"All NHS providers are required by law to regard the NHS constitution.

"The NHS constitution includes a clear set of rights, pledges and responsibilities for staff - including no harassment or bullying, a pledge to be supported properly in a rewarding job, and the protection to speak up if services do not meet the standards we expect."