Four Hour Emergency Access Standard: Expert Working Group Recommendations Report

2. Background

5. The Scottish Government (SG) introduced the Local Delivery Plan Four Hour A&E standard in 2007 where 95% of all A&E patients should be admitted, discharged or transferred within four hours of arrival at an A&E department across NHS Scotland (including Minor Injury Units).

6. To manage demand at our hospitals, the system has adapted with new models of care being evolved quicker than our ability to put in place a system which can accurately record activity data. It is recognised that this could lead to inequity of patient care with those attending through a traditional A&E pathway monitored by a national target unlike those on an acute medical assessment pathway. The Covid pandemic accelerated the requirement for new ways in which to manage demand at the front door of our hospitals.

7. For example, through the Redesign of Urgent Care (RUC) Programme which launched in 2020, Flow Navigation Centres (FNCs) were established, providing a service for patients to receive a virtual consultation with a clinician and, if required, a planned appointment at A&E. The aim was to treat people closer to home and avoid attendances who would be better seen elsewhere.

8. Concerns were raised during 2022 about the consistency of reporting of A&E performance, in particular highlighting how some areas manage Acute Assessment Units. This issue was raised during an Office for Statistics Regulation (OSR) review of PHS A&E statistics in spring 2023 and was noted in the requirements to achieve fully accredited status. PHS improved the information it provides about comparability of its A&E statistics and committed to working with partners to improve comparability. In October 2023 the UK Statistics Authority confirmed that, following action by PHS, A&E Activity Statistics in Scotland comply with the standards of trustworthiness, quality and value and should be labelled accredited official statistics.^[1]