The four-hour ER goal is a sham. Hospitals gamble on the numbers and the sickest are at risk, writes PROFESSOR ROB GALLOWAY

Normally, this column will look at a recent medical story making headlines and comment on whether you should trust it or not.

But this week I’m going to predict the news? with a prediction that I am so sure of, that if I were a gambler I would even bet on it.

It is this: in the coming days, once the data is collected, the government will come out and say that, thanks to its policies, the emergency room situation is improving.

Despite estimates released yesterday by the Royal College of Emergency Medicine that rising waiting times for A&E beds led to more than 250 unnecessary deaths per week in England alone last year, the government will point to a declining number of patients in March exceeded the four-hour target.

The four-hour goal means that we aim to see and discharge or admit patients within four hours of arriving at the emergency department.

But let me tell you now: it’s a sham. Because last month’s four-hour data has been manipulated, the result of two policies introduced by the government earlier this month.

Instead of focusing on the patient, these two policies feel like the last ditch of a desperate government. And what’s worse, all of this has been made possible by NHS England officials, whose job should be to do what’s right for patients, and not by our political leaders.

The first policy came into effect on March 1, when the government arm-twisted hospital chief operating officers and CEOs into signing a form (later leaked to the Health Service Journal) saying they would commit commit to achieving the target of four hours to 76 people. percent of patients in the emergency room (for comparison, when this goal was first set 20 years ago, it was 98 percent).

A further letter was then sent on March 12, stating that hospital trusts would be ‘eligible for additional capital funding of £2 million in 2024/25’ if they were among the top ten, or top ten improving, trusts when hit from the four-hour target until March 31, 2024. The next ten trusts to show the greatest improvement will receive £1 million.

This is called the Capital Incentive Scheme, but that’s just a fancy way of saying bribery. Essentially, your hospital trust gets an extra £2m to spend on a building if it is one of the best of the 124 acute trusts in England. That’s 20 trusts each getting £2 million to improve your care. Sounds great, right?

The problem is that this shows that the government’s priority is good headlines and not good patient care.

And the reality is that you or your loved ones who need emergency care may end up suffering because of this policy. Let me explain why.

There are two types of patients who come to the Emergency Department: the first are the relatively small patients who come in, with injured wrists, sore throats and the like. Waiting a long time will be annoying for them, but it won’t do them much damage.

Then there are the people who are usually brought in by ambulance and who require admission: for example, the elderly, vulnerable patients, people who have had a stroke or trauma patients. These patients are currently suffering the most in our emergency departments. Not just suffering, but literally dying as a result of delayed admission to ward beds.

This was proven by a landmark study led by Chris Moulton, former vice-president of the Royal College of Emergency Medicine, published in the Emergency Medicine Journal in 2022. The study found that for every 82 patients who spent more than six to eight hours While waiting in the emergency room for a hospital bed, one additional patient died.

That doesn’t sound significant until you realize what it actually means: every week, another 200 to 400 people die unnecessarily due to long waits for hospital beds.

The simple fact is that it is relatively easy to improve four-hour performance for the easier type of patients, where additional staff can help solve the problems. Much more difficult are the complex patients who require admission to a ward, but due to the lack of beds they sometimes cannot leave the emergency department for days.

And it’s clear that trusts across England have prioritized the easier types, to ‘play’ the numbers for the bribes? Sorry, I mean the capital incentive scheme.

Colleagues in emergency departments across the country have reported that staff numbers have been temporarily increased in the second half of March. Some healthcare professionals have also been offered services at higher rates than they would normally receive? These are usually clinicians who can make the biggest difference for the ‘easy win’ patients, such as emergency room doctors, who see the less ill patients (who can then be discharged home within four hours).

But as we enter April, emergency department staffing levels appear to be down across the country.

That’s because the politicians’ request through NHS England was that the improvements would only be implemented in March and not afterwards. Is it a coincidence that at the end of March the numbers are crunched to see how well emergency departments are performing so that the public can be informed about the state of the NHS?

I have been working in the Emergency Department since 2001 and have never experienced such conditions as now. In the 12 months from January 2023, more than 1.5 million patients waited more than 12 hours in A&E. that is 4,200 per day.

A government that cares about patients would make an effort to improve care for those who need it most? such as those who wait more than 12 hours

First aid before going to a hospital ward. Would a government concerned about headlines do exactly what it did this month? push to try to get slightly faster treatment for our less sick patients and improve the four-hour performance figures? with the incentive of a new building.

BUT the best way to improve emergency department care is not a new building in an already well-functioning hospital, but increasing community care. This would improve the rate at which patients can be discharged from hospital, freeing up beds in the ward. Then the sickest ER patients can get the hospital bed they so desperately need much faster.

I’m not the only one concerned about this policy. Adrian Boyle, president of the Royal College of Emergency Medicine, told me: ‘The Capital Incentive Scheme is a poor way to tackle the problems facing emergency patients. Money and effort must ensure that there are enough beds so that patients are not cared for in the corridors.’

What this whole sad saga shows is that political decisions are absolutely key to the way we treat our patients in the workplace? how you and your loved ones are cared for.

Unfortunately, political interference impacts patient care. It is time to depoliticize the NHS and rather than allowing it to simply serve its political masters it must become a truly ‘patient first’ organization with agreement and planning between the parties so that a change of government has no impact on the changes the NHS so desperately needs. . Our patients deserve nothing less.

@drrobgalloway