BMA Response to NAO report on improving emergency care in England

Commenting on the National Audit Office report - Improving Emergency Care in England - Mr Don MacKechnie, Chairman of the BMA's Accident and Emergency (A&E) Committee said: "A&E departments have worked exceptionally hard to bring down waiting times for patients and the results of this are evident in the National Audit Office report on emergency care.

"In the last 18 months we have seen a significant reduction in the number of patients waiting over 4 hours, as the report shows, and this is notable for patients with minor injuries who have benefited from new initiatives such as 'see and treat'.

"However, the report also recognises that there are still unacceptably long waits for some groups of patients, such as the elderly or people with mental health problems, especially when a decision is taken to admit the patient into hospital.

"Trusts who have not already done so, need to establish Clinical Decisions Units (CDUs) adjacent to A&E and managed by A&E clinicians to allow appropriate care for the more complex clinical presentations. These CDUs will serve not only to reduce unnecessary hospital admissions but also to ease pressure on doctors to discharge patients prematurely.

"Most A&E departments have now made all possible internal changes in working practices and in boosting staffing levels to meet the 4-hour target. But there are still significant changes that many trusts must make to other areas of the hospital and in their relationships with other providers ? such as social services and mental health trusts - if they are to meet the Government's target for 98% of patients spending less than 4 hours in A&E by the end of 2004.

"The 4-hour target is not purely an A&E problem. Moving to the 98% target is within reach but it is an extremely difficult and steep slope to climb and it can't be reached by A&E alone. Improving waiting times for patients who need a hospital bed still requires trust wide changes in the approach to emergency care.

"There are still too many patients who have to wait too long for a bed to become available and appropriate bed management strategies remain deficient in a number of trusts. Trusts must also ensure that they have enough specialist doctors who can quickly attend to patients in A&E when their skills are needed.

"A&E departments will also have to work closely with their colleagues in primary care to ensure patients are directed to the most appropriate services during the daytime and out-of ?hours.

"The 4-hour standard is here to stay and we will need sustained resources to ensure it is met by A&E departments across the country."