The four-hour A&E waiting time target - used as a measure of hospital performance - could be abandoned in favour of a series of new standards under proposals that will be trialled later this year.

The plans from NHS England would see new waiting time targets set for the initial assessment of patients, "rapid" treatment of the most seriously ill including those with mental health conditions, and an average time for all patients replacing the four-hour standard.

The pilot schemes aim for mental health patients attending A&E in crisis to receive emergency treatment within an hour.

NHS England stresses the measures are still proposals and implementation will be subject to the outcome of the trials.

The trial will also set a new target for treating patients with the most critical conditions, including heart attack, stroke, sepsis and severe asthma attacks. These cases should also be expected to be treated within one hour.


The new average time measure will record the total time spent in A&E departments by all patients, and replace the four-hour target that has been in use for 15 years.

Image: Standards for non-urgent operations, currently supposed to be 18-weeks from referral to treatment, will also be reviewed

That four-hour target has not been met by the NHS in England since the summer of 2015.

NHS England will also trial a new standard for cancer care, with patients waiting no more than 28 days for a definitive diagnosis following referral by their GP.

Standards for non-urgent operations, currently supposed to be 18 weeks from referral to treatment, will also be reviewed.

The proposals follow a clinical review of NHS targets that have been routinely missed for several years as demand has risen.

The decision to ditch the four-hour target is likely to be the most controversial measure.

Some clinical and hospital leadership groups have expressed scepticism, and opposition parties are expected to question whether it is a politically expedient measure intended to deflect from the repeated failure to hit current standards.

Image: Mental health patients attending A&E in crisis to receive emergency treatment within an hour

Professor Stephen Powis, NHS England's national medical director and leader of the review, said: "The NHS is aiming to improve care for patients and save hundreds of thousands more lives over the coming years, with greater access to mental health support, better treatment for the major killer conditions and services which are more joined-up, personalised and closer to home.

"So, as we build an NHS that is fit for the future, now is the right time to look again at the old targets which have such a big influence on how care is delivered, to make sure that they take account of the latest treatments and techniques, and support, not hinder, staff to deliver the kind of responsive, high-quality services that people want to see."

Professor Carrie MacEwan, president of the Academy of Medical Royal Colleges, said: "We support any moves that improve the quality of care.

"If, as seems likely, the new standards on cancer, mental health, waiting times for both elective (referral to treatment times RTT) and in emergency care are demonstrably in the best interests of patients then we will support those.

"We look forward to working with NHS England and other stakeholders on a full evaluation of the pilot studies and any subsequent changes that are decided upon as a result."