Critics claim proposal is driven by ministers’ desire to avoid negative publicity about patients facing longer delays

Plans to scrap the four-hour A&E target have sparked a furious backlash from doctors and nurses, with some claiming it is driven by ministers desire to avoid negative publicity about patients facing increasingly long delays.
A&E consultants led a chorus of medical opposition to the move. They pointedly urged NHS leaders and ministers to concentrate on delivering the long-established maximum waiting time for emergency care rather than finding ways around it.
Under the target, 95% of people arriving at A&E in England are meant to be treated and then discharged, admitted or transferred within four hours. But performance against the target plunged to a new record low of just 68.6% last month in hospital-based A&E units as a result of staffing problems, the decade-long squeeze on the NHS budget and the dramatic growth in the number of patients seeking care.
The Royal College of Emergency Medicine (RCEM), which represents A&E doctors, was responding to Wednesdays apparent confirmation by the health secretary, Matt Hancock, that the target introduced by Labour in 2004 is set to be axed because it is no longer deemed to be clinically appropriate.
So far weve seen nothing to indicate that a viable replacement for the four-hour target exists and believe that testing [of alternatives to the target] should soon draw to a close, said Dr Katherine Henderson, the president of the RCEM.
Rather than focus on ways around the target, we need to get back to the business of delivering on it.
Hancock told BBC Radio 5 Live: We will be judged by the right targets. Targets have to be clinically appropriate.
The four-hour target in A&E which is often taken as the top way of measuring whats going on in hospitals the problem with that target is that increasingly people are treated on the day and are able to go home. Its much better for the patient and also better for the NHS and yet the way thats counted in the target doesnt work.
At prime ministers questions Boris Johnson told MPs that delays for NHS care were unacceptable and vowed that we will get those waiting lists down as he repeated his pledge to recruit 6,000 extra GPs and provide 50m more appointments with surgery staff.
Rachel Power, the chief executive of the Patients Association, warned that any dilution of the four-hour wait would be premature and unjustified. We would be greatly concerned about what it would mean for patients, and whether it might be happening simply to disguise a collapse in NHS performance due to unnecessary long-term underfunding, avoidable workforce shortages and predictable growth in patient need.
The Emergency Care Association, to which 8,000 A&E nurses belong, said ministers should exercise extreme caution in decisions about the target because it could cause significant detriment to patient safety within our emergency departments if the four-hour target was abolished. There are fears that patients thought to have only minor ailments could come to harm by having to wait a lot longer than four hours because they also have a more serious condition.
Many doctors suspect that NHS Englands possible replacement of the 95% target is linked to ministers desire to limit the embarrassment the services inability to meet it brings every time the monthly performance figures are published. The target is enshrined in the NHS constitution and covers the 25 million patients a year who seek help at a hospital A&E, a minor injuries unit or urgent care centre.
Changing any target for political expedience alone is plain wrong, said Dr Nick Scriven, the immediate past president of the Society for Acute Medicine, which represents specialists in hospital care of the very sick.
If the target were to be removed without [a] clinically-driven data-proven exercise to identify a better one, then it would look like the government removing something purely because it is not now being met by a service under immense strain and would be the wrong thing to to do, he said.
One consultant anaesthetist said: They dont want to hear bad news. It feels like its talk to the hand cos the face aint listening.
Dr Simon Walsh, the British Medical Associations emergency medicine lead, said: 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 politicians make about resourcing the NHS.
The Royal College of Physicians, which speaks for hospital doctors in England, stressed that the target had played a crucial part in driving improvements in waiting times for patients.
Many A&E doctors believe that the four-hour wait encourages some people to seek care inappropriately at A&E instead of waiting for a GP appointment but also concede that it has ensured that no one goes without care for too long.
Scriven chided Hancock for appearing to pre-empt and sideline the conclusions of NHS Englands review group led by its medical director, Prof Stephen Powis. It may recommend replacing both the four-hour target and the requirement that patients should receive non-urgent hospital treatment, mainly surgery, inside 18 weeks. Hancock has placed them in an invidious position for what appears nothing more than political posturing, said Scriven.
Jonathan Ashworth, the shadow health secretary, said the review of targets must be transparent and based on watertight clinical evidence, otherwise patients will think Matt Hancock is trying to move the goalposts to avoid scrutiny.
Fourteen NHS trusts in England are trialling a new way of measuring A&E waits as part of NHS Englands review of NHS access standards.
When it first came in the target required hospitals to treat 98% of A&E arrivals within four hours. The Conservative-Liberal Democrat coalition government reduced that to 95% in 2010. The target was last met in July 2015. and performance has dropped 10% in the last year alone.
Simon Stevens, NHS Englands chief executive, made clear last year that the least sick patients, such as those with a sprained finger, may well have to wait longer than four hours as a result of a likely shake-up.