Hospitals warned over A&E failure

The minister has ordered a monthly performance review

Hospital managers have been warned over their "poor" performance by Health Minister Edwina Hart after all Welsh NHS trusts missed key targets.

She said it was "clearly unacceptable" that every accident and emergency (A&E) department missed its waiting time targets last month.

More than 11% of patients spent more than four hours waiting at A&E.

The Welsh NHS Confederation said trusts faced an "extremely difficult backdrop" of finite resources and rising demand.

Ms Hart said national targets should have been met four years ago and gave NHS trusts a deadline of the end of March.

She described their performance in the meantime as "poor" and has written to the chairs of every trust in Wales.

The letter said Ms Hart was "extremely disappointed" with last month's waiting time figures, and demanded a review on why the targets were consistently being missed.

This is clearly unacceptable with performance being poor for most organisations over the past three years Health Minister Edwina Hart

She will now personally review their performance every month, and warned of further action unless things improve.

Conservatives accused the assembly government of dithering and ignoring the advice of the professionals, and said things would only get worse unless additional resources were made available.

Ms Hart's letter referred to the fact that no trusts met their four and eight-hour targets in January.

These are set from the time of a patient's arrival until admission, transfer or discharge.

The target states that 95% of new patients must spend less than four hours in major A&E departments and no patient will wait longer than eight hours.

"This is clearly unacceptable with performance being poor for most organisations over the past three years," she said.

WAITING TIMES Gwent Healthcare 90.3% Cardiff and Vale 85.8% North Glamorgan 80.2% Pontypridd & Rhondda 92.8% Swansea 85.6% Bro Morgannwg 94.2% Powys - N/A Carmarthenshire 88.8% Ceredigion & Mid 77.5% Pembrokeshire & Derwen 86.1% Conwy & Denbighshire 90.3% North East Wales 93.7% North West Wales 92.8% All Wales 88.8% Percentage of patients who spent less than four hours waiting at major A&E units, Jan 2008. The target is 95%. Source: Statistics For Wales

"I have written to trust chairs asking them to review the performance of their organisations to determine what the remaining barriers are to the achievement of these targets."

Earlier this month, Ms Hart announced plans aimed at relieving the strain on A&E wards. "Urgent" care centres will be given a trial, diverting patients away from A&E units if their lives are not in danger.

Ms Hart said the strategy "rebalances" a system "designed to cope with the past".

Waits of up to four hours for treatment can still occur at some Welsh hospitals and up to eight hours as ambulances queue up outside waiting to hand over patients.

She has also asked for figures to be collected on patients who use A&E when they could instead see their GP.

One consultant at the A&E department at the Royal Glamorgan Hospital at Llantrisant, estimated up to 40% of the 200 patients treated there daily should be seeing their GP instead.

The Welsh NHS Confederation, which represents trusts, said they were trying to reach very challenging targets "against an extremely difficult backdrop of finite resources and increasing demand for emergency services".

Jonathan Davies, policy and political manager, said: "Trusts would agree that it is unacceptable for patients to wait four hours for treatment but this problem cannot be solved by trusts alone."

He said there were wider issues, such as inappropriate use of emergency services and binge drinking.

"Time will tell if long-term plans for urgent care centres are the solution, but in the meantime, trusts need support from politicians and the wider health community to address these problems in the short term," he said.