Medics picking ‘easy’ A&E cases to hit targets

Doctors push through less urgent patients at expense of the elderly to earn bonuses, claim insiders

DOCTORS are under pressure to prioritise less urgent cases in A&E so the NHS can get bonuses for hitting targets, leading medics have claimed.

The Royal College of Emergency Medicine (RCEM) said elderly vulnerable patients were being forced to wait even longer for care, as a result of a health service drive to claim performance is improving.

Hospitals are being offered bonuses of up to £1million to achieve A&E targets by the end of this month.

Senior doctors said that hospitals were now under pressure to push through the “quick wins” – the low priority cases who could be dealt with quickly, while elderly patients were being forced to wait even longer.

Dr Adrian Boyle, president of the RCEM, said the immediate financial rewards were “short-sighted and unhelpful” and too often leading to the wrong decisions being made.

He told The Telegraph: “The pressure is so extreme that it is distorting clinical priorities, and the harm is on patients, and in particular the elderly patients.”

In January last year, the NHS recovery plan set a target of 76 per cent of patients attending A&E to be admitted, transferred or discharged within four hours by March 2024.

The delivery plan was drawn up amid some of the worst waiting times on record. The 76 per cent aim is far lower than the official target of 95 per cent, which has not been hit since 2015.

Figures for February show just 69 per cent of cases were treated within four hours across England.

Now medics and NHS senior managers say they are being put under pressure to rush some of the lowest risk patients through.

The practice has echoes of the Mid Staffs scandal, where nurses and medics repeatedly warned of the distortion of clinical priorities to hit the four-hour target, with the most vulnerable patients left to suffer.

Dr Adrian Boyle said: “Everyone focuses on the quick wins and the easier patients and we know that far too many people, once they have waited beyond four hours, they get stuck. So we know that last year there were more than 1.5 million people who stayed more than 12 hours in A&E.”

“I’m worried that we have forgotten what we learned in the Mid Staffs inquiry,” he added.

One junior doctor from Newcastle said she had been driven to despair by the delays in treating the most vulnerable elderly patients in a bid to hit targets. She said medics were regularly facing “awful scenarios” because of a drive by NHS England which was distorting priorities.

During an LBC phone-in with Wes Streeting, Labour’s health spokesman, she said: “You end up in a bizarre situation where you have well patients taking beds when there is someone elderly and sitting on a chair for over 24 hours waiting for that bed, but because your patient is at 3 hours 59 minutes they are being moved.”

Mr Streeting said it was a disgrace that elderly people were “waiting entire days in pain and agony at A&E.”

He said: “Rishi Sunak is desperate to twist the figures and make it look like the NHS is recovering. If only he was just as desperate to turn the NHS around for real.”

Earlier this month NHS England announced new financial bonuses for trusts which do well against the fourhour target. The ten trusts with the best four-hour performance during March will each receive £2million

An NHS England spokesman said: “The four-hour A&E target exists for a reason, and it is absolutely right that everything possible is being done to improve performance because that will ultimately ensure that patients get the urgent care they need in a timely way.”

‘You have well patients taking up beds while someone elderly waits for 24 hours’ ‘Rishi Sunak is desperate to twist the figures and make it look like the NHS is recovering’