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NHS: A&E Waiting Time Target

Volume 801: debated on Tuesday 21 January 2020


Asked by

To ask Her Majesty’s Government what plans they have, if any, to change the four hour accident and emergency waiting time target.

My Lords, the existing standard is still in place. NHS England and NHS Improvement are reviewing access standards in four key areas, including urgent and emergency care. The Government will respond to recommendations from the review once it is concluded.

My Lords, in December, for 68.6% of patients the four-hour target was met, against the actual target of 95%. That is the worst month ever. The Government’s response, behind the warm words of the Minister today, is that they want to get rid of the target, yet research published last week by Cornell and the IFS shows that the current target saves at least 15,000 lives a year. The Royal College of Emergency Medicine has said that there is no viable alternative to the current target. The college says that the Government should get on with getting this target back on track. Will the Government do that?

The noble Lord always asks astute questions. Winter is a challenging time. Over 2 million people attended A&E last month, and we have to pay tribute to the dedicated NHS staff for seeing over 70,000 people every day—the highest number in December ever. Although we have more NHS beds open this winter than last, our A&Es have had to treat more people. The A&E waiting standard is being looked at by clinicians, who are considering whether it is appropriate, given the changes that have occurred in clinical standards. The five key reasons considered for moving away from the standard include: the standard does not measure total waiting times; the standard does not differentiate between the severity of conditions; the current standard measures a single point in an often very complex patient pathway; and there is evidence that processes, rather than clinical judgment, are resulting in admission or discharge in the period immediately before a patient breaches the standard, which is a perverse incentive. The Government will not do anything without public consultation and clinical recommendation. We will wait to see that, and no decision will be made until that comes forward.

My Lords, let us not get distracted from the key issue here, which is that our A&Es are under enormous pressure. One reason is that people find it very difficult to see a GP, and that is why I think we can all welcome the announcement that we will see some more GPs. When might we see some progress on the ground?

My noble friend is absolutely right. We need to improve access to community care to make sure that people are diverted away from inappropriate visits to A&E. We have said that we will recruit over 6,000 doctors in GP practice, and we are working on that as we speak. We are also increasing the number of GP practices within A&E so that people can be diverted into appropriate care when they go to A&E inappropriately. The evidence is that already around 10% of those attending A&E are streamed into those GP practices, and we are currently trying to increase that provision.

My Lords, I declare my interest in relation to the Royal College of Emergency Medicine. Do the Government recognise the data from the weekly monitoring of 50 EDs that report to the Royal College of Emergency Medicine that shows that, in the first two weeks of January this year, an average of almost 6,500 people waited more than 12 hours in emergency departments, the figure having risen from just over 3,800 in October? These long waits represent risks to the health, and indeed to the very lives, of these patients. The president of the college, Dr Katherine Henderson, has urged:

“Rather than focus on ways around the target, we need to get back to the business of delivering on it.”

I emphasise that the review of clinical waiting times has been ongoing since 2018. The issues this winter are being addressed with urgent action in this winter. That includes: increasing the provision of same-day emergency care, so that patients can be seen as quickly as possible and are not admitted overnight, if that is inappropriate; reducing the number of patients who have unnecessarily lengthy stays, so that beds are available for those who need to be admitted; continuing to increase the number of urgent treatment centres, with a standardised level of care, so that those who do not need it can be diverted away from A&E—there are now over 140 urgent treatment centres, which can be booked from NHS 111 in most places; increasing the number of GPs in A&E, so that patients can be streamed to appropriate care; and enhancing NHS 111, so that patients can be booked into GPs locally or diverted to pharmacists.

My Lords, regarding the increase in the number of GPs, bearing in mind that the coalition Government cut the training of doctors by thousands upon thousands and that the Government have announced that they are going to increase the number of GPs by 6,000, will the Government produce a timeline of when they are going to meet that target of 6,000 extra doctors?

My Lords, I know that the timetables are going to come forward in the people plan, so I cannot give you that in detail today. What I can tell you is that we have announced that we are investing an extra £4.5 billion in primary and community care by 2024 to fund a good amount of this. The five-year GP contract was agreed between NHS England and the BMA last January, which makes the job much more attractive. In addition, salaried GPs will receive at least a 2% increase and there are incentives to attract them into rural areas, which are struggling the most with recruitment. We have also announced that we want to recruit staff into support services around GPs so that GPs are not focusing on administrative tasks, which has been a disincentive to recruitment over the last period.

My Lords, in addition to the importance of having more GPs to help relieve pressure on the service, there is still the continuing problem of social care, where many people are ending up in A&E or being returned to hospital after a brief stay back at home, or in a home. When will the Government publish their review on social care? We need to make sure that social care is absolutely understood and refunded properly in the future.

The noble Baroness, Lady Brinton, is right to hold the Government’s feet to the fire on this issue. I know the strength of feeling in the House on this matter. She will know that we have provided councils with an additional £1.5 billion to make sure there is short-term funding to address the challenges. Also, of course, the better care fund has provided some winter funding to address some of the challenges. But she is right that there needs to be sustainable funding for the long term. We look forward to the SR for that. Regarding the long-term solution, the Prime Minister has been clear that he wants to bring that forward within this year.