In 2007-08, 72 per cent. of trusts achieved the four hour standard of 98 per cent. of patients being seen, diagnosed and treated within four hours of their arrival at accident and emergency (A and E). As shown in the latest Healthcare Commission emergency department patient survey (2008), the percentage of respondents rating their overall care as excellent, very good or good was high at 88 per cent. It is important that patients have access to high quality timely care in A and E. However, we recognise that there are still areas for improvement and would encourage all trusts to examine their results and use these as a means to continue to improve patients' experience of A and E services.
Investment and reform is working. Our drive to eliminate long waits in A and E has made local health services work in new and better ways resulting in faster access to treatment for patients.
There are occasions when, for clinical reasons, patients may need to remain in A and E for longer than four hours—but it is for clinicians to make that judgment. That is why the minimum operating figure of 98 per cent. was introduced in 2003, following discussions with clinicians, to allow for the minority of patients that clinically require more than four hours in A and E.
It is a local matter for national health service trusts to ensure that they meet the A and E four hour operational standard while not compromising patient care and clinical priorities. In cases of underperforming trusts it is for the primary care trusts and strategic health authorities (SHAs) to ensure that there are plans in place for improvement so all patients can expect the same high quality service. Where there is sustained underperformance, the Department seeks assurances via the SHA that NHS trusts have robust plans in place for improvement in A and E performance, in providing high quality, timely care to patients.