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Four-hour A&E target should not apply to non-urgent cases, says Jeremy Hunt

A key target to deal with patients within four hours at A&E should not apply to non-urgent cases, Jeremy Hunt has suggested.

The Health Secretary told the Commons there was a need to "protect" the target for the most serious cases, with people who turn up to A&E inappropriately sent elsewhere for care.

His comments appeared to suggest he planned to water down the target, which applies to all patients going through A&E. Hospitals have not hit the target nationally since summer 2015.

But the Department of Health insisted this was not the intention and there were no plans to alter the target.

Mr Hunt told MPs in the Commons that up to a third of patients do not need to be seen in A&E as he sought to defend claims by the Red Cross that the NHS is in the middle of a "humanitarian crisis".

He said: "It is clear that we need to have an honest discussion with the public about the purpose of A&E departments. There is nowhere outside the UK that commits to all patients that we will sort out any health need within four hours.

"This Government is committed to maintaining and delivering that vital four-hour commitment to patients. But since it was announced in 2000 there are nearly nine million more visits to our A&Es, up to 30% of whom NHS England estimate do not need to be there. And the tide is continuing to rise.

"So, if we are to protect our four-hour standard, we need to be clear it is a promise to sort out all urgent health problems within four hours, but not all health problems, however minor.

"As Prof Keith Willett, NHS England's medical director for acute care has said, no country in the world has a standard for all health problems, however small, and if we are to protect services for the most vulnerable, nor can we.

"So NHS England and NHS Improvement will continue to explore ways to ensure that at least some of the patients who do not need to be in our A&Es can be given good alternative options, building on progress under way with the streaming policy in the NHS England A&E plan.

"This way we will be able to improve the patient experience for those with more minor conditions who are currently not seen within four hours, as well as protect the four-hour promise for those who actually need it."

Mr Hunt also said NHS hospitals will be able to cancel outpatient appointments as a cold snap hits the UK.

He said hospitals were on the whole coping better than this time last year but that, with further cold weather on the way, some "distressed" trusts would be able to take action to relieve pressure.

This may include ensuring people in care homes and residential homes really need taking to hospital, freeing up GPs for urgent work and trying to open more care beds so elderly people who are medically fit can be discharged from hospital

Earlier, Mr Hunt was accused of being out of touch with the scale of the problems facing A&E departments across the country.

Mark Holland, president of the Society for Acute Medicine, said : "After waiting for some time to hear what the Health Secretary's response is to the strain emergency and acute services in the NHS are under, I find myself in disbelief at the comments being made today.

"Healthcare professionals and medical bodies across the country are reporting difficulties from the front line en masse, yet we are faced with dismissal.

"Mr Hunt is completely out of touch if this is what he believes to be an accurate reflection of the current situation."

In the Commons, shadow health secretary Jonathan Ashworth said : "I know La La Land did well at the Golden Globes last night - I didn't realise the Secretary of State was living there. Perhaps that's where he has been all weekend.

"Can he now confirm that the NHS is facing a winter crisis and the blame for this lies at the door of Number 10 Downing Street?

"Does the Secretary of State agree it was a monumental error to ignore the pleas for extra support for social care in the Autumn Statement a few weeks ago?"

Liberal Democrat health spokesman Norman Lamb said of the mention of the four-hour target only being for urgent issues: "This is a slippery slope towards the downgrading of standards of care across the NHS.

"If the Health Secretary thinks it is acceptable for patients to be left waiting indefinitely in A&Es, or that this is a solution to the severe pressures facing the NHS, then he is sorely mistaken.

"The real 'honest discussion' that is needed is over how to fund the NHS and social care in the long term."

Chris Moulton, vice president of the Royal College of Emergency Medicine, told the Press Association that four hours was a long time to wait, even if a condition was non-urgent.

And he added: "How can we decide who can wait until we have actually seen the patients?"

He went on: "People have been asked to stay away from A&E for years but attendances continue to rise relentlessly."

He also said the Government had been promising "for years" to divert people away from A&E who did not need urgent care there.


From Belfast Telegraph