Frontline doctors have issued an unprecedented warning that patient safety is at risk at many A&E units across the NHS because hospitals are overwhelmed, as the health secretary ­provoked controversy by suggesting the four-hour treatment target should exclude people who waste time by presenting with minor ailments.

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The Royal College of Emergency Medicine said a substantial number of A&E departments were falling significantly short of the four hour standard – but Jeremy Hunt said that as many as 30% of those turning up were neither an urgent case nor a genuine emergency.

The college, which represents doctors in emergency care, warned: “In our expert opinion, when an emergency department falls below 75% against the four-hour standard, it shows a significant level of overcrowding and begins to put safety at risk. Present figures suggest a substantial number of departments are falling below this level.”



The college believes that one in four A&E units are at risk of offering poor care, citing delays in assessing patients and administering pain relief.

In an emergency statement to the Commons prompted by reports of intense pressure at A&E units around the NHS in England, Hunt said that the four-hour waiting time had to be revised to remove non-urgent cases.

“This government is committed to maintaining and delivering that vital four-hour commitment to patients,” Hunt said. “But since it was announced in 2000 there are nearly 9m more visits to our A&Es, up to 30% of whom NHS England estimate do not need to be there. And the tide is continuing to rise.

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“So, if we are to protect our four-hour standard, we need to be clear it is a promise to sort out all urgent health problems within four hours, but not all health problems, however minor.”

NHS Providers, which represents hospital bosses, welcomed the change as “potentially helpful” in relieving the record levels of strain A&Es are experiencing. But Jonathan Ashworth, the shadow health secretary, said: “Is he now really telling patients that rather than trying to hit the four-hour target, the government is now rewriting and downgrading it?”

The four-hour target, introduced by Labour in 2004, initially obliged hospitals in England to to see and either admit, transfer or discharge 98% of A&E patients within that period. The coalition relaxed that to 95% in 2010 – but the NHS’s latest figures show that some hospitals are only dealing with 50-60% of A&E arrivals within the supposed maximum four hours.

Hunt’s move came as growing numbers of hospitals were forced to declare an alert because they had run out of beds and did not know where to put the large numbers of patients who needed to be admitted.



The medical director of Kettering general hospital said the situation at his hospital was serious. Dr Andrew Chiltern texted colleagues at lunchtime on Monday to say: “On the verge of significant internal incident. Situation is dire. We need to achieve discharges. May need to take action of cancelling all two-week waits tomorrow and outpatient department activity if we can’t get control.”

Croydon university hospital in south London said it began looking after adult patients on a ward that is usually reserved for children who have had surgery. It has moved the people it normally cares for there into extra beds it has opened up on one of its children’s wards. It made the temporary switch last week in response to the huge difficulties hospitals are having finding enough beds for patients who are so sick that they need to be admitted for treatment.

Facebook Twitter Pinterest Jeremy Hunt said the current target is ‘a promise to sort out all urgent health problems within four hours’. Photograph: Dan Kitwood/Getty Images

The health secretary also told MPs that hospitals may have to cancel operations and outpatient appointments so that staff can concentrate on the sickest patients. GPs may also be drafted in to help hospitals cope with record demand for medical care.



NHS Providers also voiced its fears that the overload facing A&Es could endanger patients. It said: “Persistently large number of trolley and 12-hour waits is a proxy for significantly elevated risk to patient safety and potential for significant harm. The same applies to persistently large numbers of long ambulance waits [outside an A&E with a patient unable to be handed over to busy hospital staff].”



The warning has prompted concern because the three triggers it identifies for patient safety being compromised are all now found fairly regularly at some hospitals.



In November, 237 patients waited more than 12 hours to get a bed at the Royal Stoke university hospital, while some ambulance crews were stuck outside hospitals in Merseyside last week for up to eight hours, unable to hand over their patients to A&E staff. A number of trusts – including Lewisham in London, Mid Essex, Addenbrooke’s in Cambridge and East and North Hertfordshire – had to declare a red or black alert on Monday because they were so hard-pressed.



NHS Providers denied that the NHS was in meltdown and rejected the British Red Cross’s claim that the NHS is experiencing a “humanitarian crisis” as an exaggeration. It said that the “vast majority” of trusts were coping, but added that a “small number of trusts are failing to cope and have seen persistently large trolley and 12-hour waits” and some hospitals have seen the demand for A&E care soar by 20% in a year. While NHS personnel have been working flat-out recently to maintain services, “this level of staff goodwill is becoming unsustainable”.

The Liberal Democrat former health minister Norman Lamb warned that it could lead to some patients being left to wait ­indefinitely in A&E.

“This is a slippery slope towards the downgrading of standards of care across the NHS,” he said. “The government cannot just keep moving the goalposts as the health service struggles to cope with rising demand.”

Hunt, who spoke hours after Theresa May gave a keynote speech on mental health, said that Tuesday 27 December had been the busiest day in the NHS’s 69-year history. Pressures may intensify further later this week with the arrival of very cold weather, he warned.

“We need to have an honest discussion with the public about the purpose of A&E departments”, he added. However, NHS experts said that inadequate GP and social care services were partly to blame for the relentless rise in A&E attendances.