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RCEM statement on four-hour target speculation

16 January 2019

The Royal College of Emergency Medicine (RCEM) notes the recent media speculation with regards to the proposed dismantling of the four-hour Emergency Care Standard (ECS) based upon the comments made by Mr Simon Stevens and others.

Dr Taj Hassan, RCEM President, said: “The College has not been consulted at any stage on this issue since 2017. As the expert academic body on the standards of safety and clinical care delivered in Emergency Departments (EDs) this is surprising and of serious concern.

“The four-hour ECS has been a resilient, sophisticated and very successful overall marker of a hospital’s emergency care system performance for the last 15 years. Sadly, the past five or six years has seen a steady deterioration in system performance due to under investment in acute hospital bed capacity, cuts in social care funding and understaffing in EDs. This has resulted in a significant increase in the number of crowded EDs which scientific evidence clearly shows is linked to increased mortality and morbidity for patients. It also results in secondary attritional harm to staff having to work in such environments which further compromises patient care.”

The College has consistently advocated that the best way to improve safety and clinical care in our EDs is to address the systemic issues of under investment and plan well for the future. We have also supported the addition of other quality indicators that complement the four-hour standard and will help to measure safety and quality of clinical care.

Indeed, the RCEM has worked collaboratively with the Get It Right First Time (GIRFT) team via its co-Leads Dr Chris Moulton, Vice President of RCEM and Dr Cliff Mann, NHSE, past President of RCEM, to develop a range of complementary system performance indicators to help Trusts focus on improving flow within the hospital.

Dr Chris Moulton said: “In no way were these metrics designed to replace the four-hour target but to work alongside it; providing better granularity and a greater depth of detail. The lack of system flow due to under investment in the acute hospital and community bedbase has been the ‘elephant in the room’ to address for the last 5-6 years. The GIRFT supplementary metrics are reliant on the target remaining as it is and cannot and must not be used as a way around tackling these issues properly.”

Dr Hassan said: “The College has always sought to work collaboratively and provide its expert advice for the various complex cohorts of patients that are admitted to EDs. Indeed, we have led on and delivered good work that is ongoing in the area of workforce planning for the future in our Emergency Departments. However much of that work will be wasted effort if we now choose to ‘move the goal posts’ without any evidence review, expert discussion or clear collaborative planning.

“We will continue to provide expert advice on workforce planning, system design and the right matrix of quality indicators with the four-hour ECS at the very heart in order to maintain system performance as part of the implementation of the Long Term Plan. Only by taking this approach and working well together can we improve the quality of care for our patients for the next decade.”

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