If you continue without changing your settings, we’ll assume you’re happy to receive all cookies from the BMA website. Find out more about cookies
When you visit any web site, it may store or retrieve information on your browser, mostly in the form of cookies. This information might be about you, your preferences or your device and is mostly used to make the site work as you expect it to. The information does not usually directly identify you, but it can give you a more personalised web experience.
Because we respect your right to privacy, you can choose not to allow some types of cookies. Click on the different category headings to find out more and change our default settings. However, blocking some types of cookies may impact your experience of the site and the services we are able to offer.
These cookies are necessary for the website to function and cannot be switched off in our systems. They are usually only set in response to actions made by you which amount to a request for services, such as setting your privacy preferences, logging in or filling in forms.
You can set your browser to block or alert you about these cookies, but some parts of the site will not then work. These cookies do not store any personally identifiable information.
These cookies are required
These cookies allow us to know which pages are the most and least popular and see how visitors move around the site. All information we collect is anonymous unless you actively provide personal information to us.
If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance.
These cookies allow a website to remember choices you make (such as your user name, language or the region you're in) and tailor the website to provide enhanced features and content for you.
For example, they can be used to remember certain log-in details, changes you've made to text size, font and other parts of pages that you can customise. They may also be used to provide services you've asked for such as watching a video or commenting on a blog. These cookies may be used to ensure that all our services and communications are relevant to you. The information these cookies collect cannot track your browsing activity on other websites.
Without these cookies, a website cannot remember choices you've previously made or personalise your browsing experience meaning you would have to reset these for every visit. In addition, some functionality may not be available if this category is switched off.
Our websites sometimes integrate with other companies’ sites. For example, we integrate with social networking sites such as Twitter and Facebook, to make it easier for you to share what you have read. These sites place their own cookies on your browser as a result of us including their icons and ‘like’ or ‘share’ buttons on our sites.
Last week, several newspapers and broadcasters reported that the secretary of state for health and social care, Matt Hancock, had hinted at scrapping the four-hour target for emergency care.
While there is work being carried out by the Royal College of Emergency Medicine and NHS England, looking at alternatives to the four-hour target, the timing of Matt Hancock’s comments coincided with publication of the worst ever national performance against the target since it was introduced in 2004.
Although it is easy to criticise a target which does not measure quality of care or outcomes, it’s clear that it has focused attention, and resources, on the emergency care system when it was in desperate need of it. The timing of the validity of the target being questioned by Mr Hancock seems to be an attempt to divert attention from the fact that performance is worse than ever.
Whatever way you look at the state of emergency care, the picture is bad.
Against the current four-hour target, the emergency care system has been woefully underperforming – despite the extraordinary efforts of frontline staff – with the most recent figures highlighting that emergency departments had their worst month on record in December.
It is crucial that any proposed changes to current targets are agreed with clinicians to ensure patient safety is not compromised. This then needs to be properly evaluated and should only take place if backed by evidence from the recent pilots to ensure improvements to patient care and maintenance of safety are the central objectives.
We understand that the Royal College of Emergency Medicine continues to work with NHS England in developing, piloting and, most importantly, evaluating possible replacements for the four-hour target. However, at this time, no suitable replacement for it has been found.
Targets are an important indicator when services are struggling, and there is a very real concern that any change to targets will effectively mask underperformance and the effects of the decisions that politicians make about resourcing the NHS.
Ultimately, replacing targets does not address the fundamental issues of capacity and resourcing within the NHS and the resulting pressure that has led to such poor performance in emergency departments in recent years.
The emergency care system is at breaking point. This, above all else, must be addressed.
Simon Walsh is BMA emergency medicine lead