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The Future of the Four-Hour Emergency Care Standard

1 March 2019

The Royal College of Emergency Medicine is committed, first and foremost, to patient safety and the delivery of quality care for our patients on a consistent basis in Emergency Departments – the most intense environment in the NHS. 

We speak for over 8,000 doctors, consultants and other practitioners working in Emergency Departments across the UK and internationally.

We have always advocated for a strong collaborative approach in measuring and improving the quality of care our staff deliver in the very tough environment of the Emergency Department.

We believe that there are indeed opportunities to improve the way that we measure the quality of care delivered set within a wider set of system flow metrics (of which the four-hour Emergency Care Standard is a vital component).

Whilst it is entirely the responsibility of policymakers at NHS England and NHS Improvement to decide upon quality standards in England and the consequences of such implementation, the role of this College is to provide the expert advice representing those working in emergency care who live and breathe the delivery of such care every minute of every day and night.

President, Taj Hassan said: “The four-hour Emergency Care Standard (ECS) is a remarkable totemic standard that is now deeply ingrained in the very fabric of NHS culture and process. It has very many advantages and some limitations. Our job is to find ways to work together to address the limitations and ensure our patients get the very best care possible at a time when emergency care systems are struggling very badly – the worst since 2003/04 when the four-hour ECS began – in the mildest winter, with low flu & norovirus rates.

“Attempting to make such change at such pace and without due regard to expert evidence is doomed to result in significant unintended consequences. The key issues to be addressed are the systemic ones to increase funding in acute beds, community care and staffing to help make our departments less crowded and improve safety. Moving the goalposts of measurement to make things seemingly look better is certainly not the way forward.

“Any attempt to impose a set of standards upon NHS Emergency Department staff that are not clinically appropriate, thoroughly tested or do not have the support of doctors, consultants, nurses and all other employees working in this environment will have a significant risk of critically destabilising a substantial number of systems that are struggling to maintain safety. It will add to staff attrition, demoralise others and produce even more significant added harm for patients in Emergency Departments.”

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