Even more A&E

Again from BBC News:

Martin Shalley, A&E consultant at Birmingham's Heartlands Hospital, says staff face daily battle to meet the target for patients to be seen, treated and discharged within the four hour limit.

Mr Shalley talks a lot of sense.

"We have nurse practitioners to help to see the walk-in patients. Nurses also see some patients with minor illness."

Absolutely sensible, there's no need for doctors to have to see every patient, an experienced nurse is completely able to assess and treat a patient.

However, Mr Shalley said that there were some occasions where patients needed to stay in A&E for longer, and there was just no way the four hour target could be met in those cases.

"Sometimes you just have to bite the bullet. If a patient does need to stay in A&E for longer than four hours, they do. It's fine.

"It may be that there are no beds in the intensive care unit. Or they need a lot tests, or a patient may need to be resuscitated. It can all take time."

That's true as well, particularly here in the middle of the night, if a patient needs certain blood tests then the sample needs to be taken 25 miles to Taunton, the travel time cuts into the 4 hour wait. (It's one of the reasons why we miss our targets) That's why we're looking at redeveloping our diagnostic test procedures in order to be able to do blood tests more efficiently.

Mr Shalley said: "We do all believe in targets. They have improved emergency care.

"But 98% is just a little bit too high a target."

If 98% is too high for a hospital (and Mr Shalley's own hospital makes the targets so it can't be unreasonable) then the hospital has to look at the reasons why, it may not be in A&E, it may be a bottleneck elsewhere in the system.