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Last Updated: Monday, 14 March, 2005, 06:01 GMT
A & E targets "put patients at risk"
ambulance parked at Accident and Emergency unit
Are waiting time targets a good thing? Your views were split
Patients are being put at risk by the government's strict targets to get them treated speedily in hospital Accident and Emergency Departments, according to doctors.

The targets should mean that nearly all patients are seen, treated and discharged within four hours - ending the long and worrying waits which used to be commonplace in casualty units.

But the British Medical Association, which has conducted its own survey, says there's widespread concern that patients are being discharged too soon and staff are being bullied by managers to hit the targets.

  • This morning, Breakfast asked: are patients being rushed through casualty?

  • We reported live from one of the largest Accident and Emergency departments in England - at the Royal Victoria Hospital in Blackpool.

  • We heard from Donald MacKechnie of the British Medical Association, which carried out the survey.

    He told our reporter Vicky Young that the need to get patients seen within four hours can distort treatment.
    McKechnie: "common sense goes out of the window"

    "It's when patients are approaching this magic four hours that common sense will go out of the window," he said.

    But, when he spoke to Breakfast live, he conceded that, by and large, things had improved in Accident and Emergency:

    "There's not a single consultant who wants to go back to the way we were two years ago," he told us

    "But a significant proportion would be happier with a target of between 90 and 95%."

    Doctors are concerned that patients are being discharged wrongly from A and E in order to keep within the four hour target.

    That might mean patients being sent home without proper treatment - or being sent on to the wrong wards for further treatment.

    There are also reports of staff being bullied, to make sure the targets are met.

  • We talked to Professor Sir George Alberti - a government advisor and the National Director of Emergency Access.

    "Distorting clinical priorities is a small problem," he told us. "Care is infinitely better than two or three years ago.

    "Patients are getting through very quickly and satisfaction has improved."

  • We got the NHS managers' view from Roy Male, who's Chief Executive of the Blackpool, Fylde and Wyre hospital trust, which runs the Royal Victoria Hospital.

    He told us that staff morale has improved - and that some staff who'd given up their jobs because of stress were now considering returning to their old jobs.

  • We asked what you think

    Government targets designed to improve patients' experience in casualty units now mean that nearly all patients should be seen, treated and discharged within four hours.

    These have led to dramatic improvements in waiting times - but the BMA says there's widespread concern among doctors that patients are being rushed through the system.

    It conducted a survey of 163 of the 200 casualty units in England. And it says that in half of those hospitals, doctors believed patients had been moved on inappropriately, to hit the targets.

    What you told Breakfast
    I am a doctor at a busy District General. Time and time again I see patients being poorly managed or sent to inappropriate wards purely to prevent 'breaching' the 4 hour rule. Shorter waits do not necessarily mean better patient care
    Tom Heaps, Leeds

    Nearly 40% admitted that patients had been discharged without being properly assessed or stabilised.

    And 27% believed that patient care had been compromised.

    Doctors complain, for instance, that patients are sent off to the wrong hospital wards, simply to get them off the books of Accident and Emergency departments.

    The Prime Minister conceded yesterday that the target of dealing with 98% of patients within four hours may be too rigid.

    But health ministers say the targets have brought about huge improvements in hospital A & E waiting times within the past few months

    Casualty waiting times
    "When patients approach this magic four hours, common sense goes out of the window," one doctor tells Breakfast

    BBC Breakfast


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