The Royal College of Emergency Medicine (RCEM) has responded angrily to recent media speculation that NHS England is about to dismantle the four-hour Emergency Care Standard (ECS).

NHS England boss Simon Stevens dropped heavy hints on this during the launch of the Long Term Plan. But it’s clear that whatever discussions have taken place have not included the front line consultants running emergency departments.

According to a statement from Dr Taj Hassan, RCEM President:

“The College has not been consulted at any stage on this issue since 2017. As the expert academic body on the standards of safety and clinical care delivered in Emergency Departments (EDs) this is surprising and of serious concern.”

It argues that the 4-hour target “has been a resilient, sophisticated and very successful overall marker of a hospital’s emergency care system performance for the last 15 years”.

However the past five or six years has seen a steady deterioration in system performance due to under investment in acute hospital bed capacity, cuts in social care funding and understaffing in EDs.

This has resulted in a significant increase in the number of crowded EDs “which scientific evidence clearly shows is linked to increased mortality and morbidity for patients.” The increased pressure in under-resourced departments also piles added stress on to staff “which further compromises patient care.”

Dr Hassan points out that the RCEM’s concern that much of the good work that has been done “will be wasted effort if we now choose to ‘move the goal posts’ without any evidence review, expert discussion or clear collaborative planning.”

The anger in the College is underlined by a sharply-worded open letter to Simon Stevens from its lay group chair Derek Prentice, which expresses the fear that he is “hell bent on undermining the benefits that the four-hour A&E standard has delivered to patients over many years, a decision you claim that so called ‘top doctors’ want.”

The letter goes on:

“It begs the question who are these ‘top doctors’ you quote? They are not from the leaders of the body representing over 8,000 people working in our A&Es, the Royal College of Emergency Medicine, who believe the target is vital for timely, high quality patient care.

“…The public has a right to know who these individuals are who want the target removed, not least given that in the NHS Plan with many laudable objectives, this attack on the patient interest stands out alone as the only cut in services proposed.

“So Mr Stevens, who are these doctors with such contempt for the patient interest?”

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