Emergency care: Getting better?

Performance in NHS accident and emergency departments is improving, a National Audit Office report has concluded.

The study, published on Wednesday, highlighted modernised working practices as one reason for the better performance.

And the environment and facilities in A&E departments have also improved, to the benefit of both patients and staff, said the spending watchdog.

But there was a warning that further improvements are required, especially for patients with more complex needs, such as older people or those with mental health needs.

The report was backed by figures indicating big reductions in waiting times in emergency departments.

Ministers have ordered that no patient should wait more than four hours in A&E, and while 23 per cent of patients exceeded this target in 2002/03 that had fallen to just five per cent by the second quarter of this year.

"The reduction in the amount of time that patients spend in A&E has largely come through improvements in working practices within hospitals and in particular the A&E departments," said the report.

"Further reductions in time spent in A&E will depend on better working between A&E, the rest of the hospital and other parts of the health and social care system; and the department is already providing a programme of guidance and support to trusts to help them address these issues."

The NAO said plans for local "emergency care networks" comprising cross-organisational and multi-disciplinary groups were a "promising development".

"Many such networks are in their infancy and lack the authority and influence over funding to bring about cooperation between the various providers of emergency care," it added.

NAO chief Sir John Bourn said the progress had been made against a background of a continuing high demand.

"There is scope, however, in those trusts which are behind the best for further reductions in the time patients spend in A&E," he said.

"The Department of Health should continue to pursue more effective joint working - on the one hand, between A&E departments and other parts of their hospitals, and on the other between all the providers of emergency care.

"Emergency care networks are a promising way of taking this forward."

Responding to the report, NHS chief executive Sir Nigel Crisp said there had been "significant progress" in emergency care.

"It is particularly pleasing that the NAO found a general consensus in the NHS that the four hour A&E target has substantially benefited both patients and staff," he added.

"We are fast approaching world standard on this thanks to the hard work of dedicated NHS staff.

"It is important that no patient, whether they have complex care needs or not, does not spend longer than necessary in A&E."