Official A&E waiting-time figures are flawed, says surve

One of the largest surveys of NHS patients will today show a significant discrepancy between its findings and the Government's claim that 97 per cent of patients spend less than four hours in the emergency department.

The report, published today, found that only 77 per cent of patients said their visits to accident and emergency departments lasted four hours or less. The figure is a significant improvement on the 69 per cent achieved in the previous year's survey.

The Healthcare Commission interviewed around 55,400 patients about their experience in A&E, but the Government, which is making its record of NHS improvements into a key election topic, says its record is more impressive.

John Reid, the Health Secretary, announced last June that 94 per cent of patients are "seen, diagnosed and treated within four hours of arrival at accident and emergency."

His department says that this figure has risen to 97 per cent, and recently announced cash incentives of £100,000 "extra capital funding" for all hospitals who consistently meet this target.

Experts have cast doubt on the Department of Health's statistics. This month, the British Medical Association said that some hospitals were admitting patients to wards to get them out of the accident department before the four-hour deadline.

According to the rules of the key "four-hour" statistic, the clock starts ticking as soon a patient walks through the door and does not stop until they have either been discharged or admitted.

Don Mackenie, the chairman of the British Medical Association's A&E sub-committee, said: "We are concerned that there may be inappropriate use of admissions made through A&E to meet the four-hour target. This would obviously lead to reduced bed capacity and elective surgery being cancelled. The BMA is looking into this."

The Department of Health insists that the difference between the figures was due to the way they are compiled by the department and the alternative approach used by the Healthcare Commission. Rosie Winterton, the health minister, said: "Our data covers the experience of every attender at A&E, whereas the Healthcare Commission survey only covers adults, excluding children who make up 25 per cent of attenders."

The majority of people who replied to the Healthcare Commission's questionnaire were women, 93 per cent were white and people aged over 66 were more likely to respond than any other age group. Overall, it found that patients want better information from doctors and other medical staff about their treatment, and higher standards of cleanliness in hospitals.

For example, 17 per cent said they found the lavatories to be "not very clean or not at all clean." Only 45 per cent described A&E as "very clean". The department said that the NHS had begun "a major initiative" to improve cleanliness.

Has someone been 'fixing the books' or is this more of labours 'lets redefine the problem, so that it is actually not a problem' type politics?

According to the rules of the key "four-hour" statistic, the clock starts ticking as soon a patient walks through the door and does not stop until they have either been discharged or admitted.

The 'four-hour' clock also stops ticking when the patient is moved to either an 'observation unit' (i.e. a bay adjacent to A&E where patients can continue to wait, but not be affected by the target time); moved to an 'assessment unit' (i.e. another alternative, non-time-targetted place), or, most imaginatively, placed on a trolley whose proportions are such that it is not defined as a trolley for the purpose of waiting time targets.

Patients wait just as long as they ever did when they go to A&E - they just get moved around a bit more so that the Trusts can meet target times.

Yet again, Neue Arbeit have failed to understand or tackle the root of the problem. What's needed is for A&E to be just that - Accidents and Emergencies - only. Staff should be able to turn away the wasters who ought to go to their GP and the illegals who aren't entitled to treatment and so can't register with a GP - they can be nicked and treated by HMP's doctors. There also needs to be some work on the amount of alcohol related injuries which clog A&E departments.

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