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Patients to be at the heart of A&E and ambulance care

Accident and emergency departments and ambulance trusts will in future assess their performance on what matters most to patients – quality, experience and patient outcomes, Health Secretary Andrew Lansley has announced.


The move comes amid concerns that parts of the NHS feel pressured into meeting process-led targets for A and E and ambulances that distort priorities and lack any clinical justification.


From April next year the current four hour waiting time standard for A&E will be replaced with a set of eight new clinical quality indicators that promote quality and patient safety.  Time will still be measured as part of the new clinical quality indicators as it is a significant risk factor for treating patients, but crucially time will no longer be the only factor. New indicators will include a ‘time to full initial assessment’ which will provide an incentive to assess patients quickly so that clinicians can prioritise the patients that require rapid treatment instead of simply who has been waiting the longest, and ‘unplanned re-attendance’ - encouraging the NHS to look at whether patients receive the best care first time round so that repeat visits to A and E are avoided.


The A&E indicators have been developed jointly by Professor Matthew Cooke, the National Clinical Director for Emergency Care, together with senior clinicians in the College of Emergency Medicine and the Royal College of Nursing.


At the same time Peter Bradley, National Ambulance Director, has been working with Professor Cooke to develop indicators for ambulance services.  The two sets of indicators have been designed to complement each other.


[quotw top=Health Secretary, Andrew Lansley, said] The new measures will focus on the quality of care and what matters most to patients - giving a better indication of patient care than the previous process-led targets ever could. [/quote]


He continued to comment “By putting patient safety and outcomes at the heart of the health service, A&E departments and ambulance trusts can demonstrate they provide safe and effective clinical care in a timely manner rather than meeting a specific target. This is not about hitting targets – importantly, it is about giving the NHS more freedom to deliver quality care. Patients should be able to expect a 24/7 accessible and safe emergency care service which is integrated across the NHS. By shifting the focus to a range of indicators we will ensure that patients receive the best possible care, in the right place, at the right time.


John Heyworth, President of the College of Emergency Medicine said “The College of Emergency Medicine welcomes this announcement. The introduction of measures to ensure timeliness of patient care in the Emergency Department and, crucially, time related incentives to maintain patient flow from the Emergency Department, will provide tangible improvements for our patients.
The combination of measures of quality and time will drive the continuing improvement towards the world class standard of Emergency Medicine which the public expect and deserve. This is an opportunity to transform emergency care to ensure the Emergency Department becomes the jewel in the crown of the NHS in which the public can place their trust and confidence at any time of the day or night.”