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Clinical standards review data shows ‘initial steps in the right direction’

31 October 2019

Responding to today’s publication of a progress report from NHS England on the Clinically-led Review of NHS Access Standards, President of the Royal College of Emergency Medicine, Dr Katherine Henderson said:

“The publication of some data from the pilot sites is very welcome, but it’s too early to draw strong conclusions given the short duration of the testing period.

“We are though, pleased to see a commitment to tackle the longest waits and reduce ‘corridor care’.

“Particularly welcome is acknowledgement of the need to understand the effect that the proposed standards have on crowding within the Emergency Department (ED). A core requirement of any proposed metric is that crowding is reduced, so we really need to understand the impact of the ‘small increase in the mean time in department for non-admitted patients’.

“Given that the test period was during the summer, questions also remain as to whether the data being reported is not subject to seasonal trends. For instance, conversion rates. We are not yet convinced that this work has reduced the number of people who need admitting to hospital. This analysis can be compromised by changes in casemix and volume. Further analysis and testing into winter will be needed to properly understand this.

“We also know there is a lot of variation and it would be good to know where the new measures have had the most impact.

“Still, what is presented in the report are initial steps in the right direction and NHSE has noted our concerns. We are engaged in the process and are glad that there is recognition that a single measure alone is not sensitive enough to understand the effectiveness of care in urgent and emergency care systems.

“We still conclude that the four-hour standard should only be replaced by measures that maintain the benefits it has delivered, whilst improving on its failings. It will be a huge change to do this and while change can be good, any change must encourage patient flow, address long waits and also help reduce bureaucracy.

“We would also reiterate that patients with the greatest need have always been and will continue to be prioritised for treatment by staff. We’re glad to see this is endorsed by patients through the HealthWatch survey.

“The College supports the approach of testing and critically evaluating whether the standards can be improved; this will mean that some proposed standards may have to be discarded if necessary.”

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