The targets for A&E get tougher next year

Top of their hit list was the four-hour target in A&E.

Doctor after doctor stood up to denounce the fact that the government wants 90% of patients to be assessed, treated, discharged or admitted within four hours.

Dr Emma Bywaters, a junior doctor at Newcastle General Hospital, led the attack. She said the target is damaging patient care and is potentially very dangerous.

Her views were echoed by other colleagues, many of whom used anecdotal evidence to back up their criticism of the target.

Anecdotal evidence

No doctor gave a personal account of how damaging the A&E target can be.

The fact is that few doctors are willing to put their heads above the parapet to give a personal account of how targets are affecting patient care.

One doctor who appeared to be hinting of having personally experienced problems as a result of the A&E target refused to speak to this journalist.

I have been told by my trust chief executive that I cannot say anything Anonymous junior doctor

"I have been told by my trust chief executive that I cannot say anything," he said moving swiftly and determinedly away.

Others were prepared to share their anecdotal evidence. Two members of the BMA's junior doctors committee hinted at incidents where patient care was compromised because of the four-hour target.

"I have heard of patients with minor illnesses being prioritised over patients who are more seriously ill," said Dr Simon Calvert.

"I know of patients who have been shuffled around the system so that the target is met," said Dr Simon Eccles.

"They are having to wait longer for treatment."

Many of the doctors were particularly critical of government plans to extend the A&E target further - to include all patients from next year.

"It is ludicrous and it is potentially very dangerous," said Emma Bywaters.

"For some patients, four hours just isn't long enough.

"Take, for example, someone who has been in a road traffic accident. First we have to examine them to see if there are any life threatening injuries and to carry out the appropriate scans.

"Even if all this runs smoothly and there are no delays it can take longer than four hours by the time they have X-rays, a CT scan and are seen by our specialist colleagues."

Strict target

But under the government's target, these patients would have to be either admitted to hospital or discharged if they have been in the hospital for longer than four hours.

"This is why managers and doctors at some hospitals have fiddled and fudged the issue by setting up beds in corridors so that these patients can be monitored and treated properly," said Dr Bywaters.

"We are honest people. We do not like that but we are forced to do it. For managers, their jobs can sometimes be on the line if the hospital does not meet the target."

Dr Bywaters says she has heard stories of patients who perhaps only needed to be monitored by doctors for an hour or two being admitted onto busy hospital wards in an effort to meet the target.

"I have heard of cases where patients have also been admitted to inappropriate wards.

"The medical team that is supposed to treat them have not been told where the patient was sent or what, indeed, is wrong with them.

"And because the patient has been formally admitted to hospital, they cannot be discharged until they are seen by a consultant.

"This can be hours later or may even be the following day. In the meantime, they are taking up a bed that could be used for another patient in greater need," she says.

"The government has got the wrong end of the stick with this target. It is ludicrous and is certainly not beneficial to patients."

Dr Bywaters is one of those doctors that supports the idea of using targets to measure performance in the NHS.

But she insists that targets must be of benefit to patients.

"There are some merits to targets but we do have problems with targets when they are not based on clinical evidence and when they interfere with our clinical judgement," she says.

"I think moving towards the 100% target for patients in A&E next year is not only ludicrous but it is also dangerous."