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Last Updated:  Thursday, 27 March, 2003, 17:43 GMT
Do A&E figures add up?
By Adam Brimelow
BBC Health Correspondent

The A&E spot-check is this week
Accident and Emergency units across England are coming under intense scrutiny this week -- to gauge progress on what's become the most urgent NHS target.

The government's set a four-hour deadline for treatment -- and it wants a 90% success rate by this week.

It insists that it is crucial to bring down waiting times in A&E units after years of spot checks which have revealed people waiting sometimes more than a day for treatment.

But critics say the big push on A&E is harming other services, and they have serious doubts about whether the government's figures will be an accurate reflection of the true state of casualty units.

Four hour sprint

At a major city A&E unit I visited this week, patients sat stoically, waiting their turn.

The computer crashed at reception - and while staff tried to improvise a solution the clock was ticking.

There are four hours for people to be admitted, transferred or discharged.

All week this week progress is being monitored to ensure A&E units meet the government milestone -- 90% success.

"There has been a state of panic out there to try and make the target reachable," according to Mr John Heyworth, President of the British Association for Accident and Emergency Medicine.

"We're seeing additional investment, money seems to be no object, or problem.

"Additional staff are being recruited wherever possible to make a difference"

Distortion

But he's worried that clinical priorities are being distorted.

"In hospitals across the country the elective work, that is to say patients being brought in for operations, is being curtailed to allow the beds to be available for the emergency patients to be admitted.

There has been a state of panic out there to try and make the target reachable
Mr John Heyworth, British Association of Accident and Emergency Medicine
"And that could be to some patients' detriment and it's extremely unfortunate, and we wouldn't wish that to happen."

This target counts towards hospitals star ratings - which can determine future funding.

Jonathan Fielden, a consultant who speaks for the doctors union the BMA, says hospital managers have been warned that failure won't be tolerated.

"I've had several individuals from different hospitals saying that ultimately jobs have been placed on the line on the issue of not meeting targets.

"We have already seen in hospitals with prior targets being missed, stars being missed, that people have been sacked, chief executives have been sacked."

Tough target

The Association of Community Health Councils for England and Wales has been monitoring A&E performance at hospitals month in month out for the last ten years.

Its chairman, Malcolm Alexander, says despite recent progress, he'll be staggered if they meet the government's target.

"The picture is one where there have been significant improvements in some hospitals as a result of extraordinary months of pressure.

"However there are very very serious hotspots where especially elderly people are waiting very long periods of time, sometimes in excess of 30 or 40 hours."

He doubts whether the results produced this week will be sustainable, because of all the extra money that's being spent."



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