Removing hospital targets seen as first step towards more cuts

The "indicators" will come into force from next April – seeing the end of the four-hour waiting time target for patients in A&E.

The requirement for ambulances to attend serious but not life-threatening cases within 19 minutes has also been scrapped and replaced with a set of 11 new indicators.

Ambulance services will still be required to respond to 75 per cent of all category A – immediately life-threatening – calls within eight minutes, but will also have to perform against new measures, such as patients' recoveries after cardiac arrests or strokes.

The GMB union said the plan was a "shocking scaling back" of current ambulance services.

But Health Secretary Andrew Lansley said the Government wanted to provide a "balanced and comprehensive view" of how emergency care works and stop the "isolated" focus on faster care.

Mr Lansley said some parts the NHS feel pressured into meeting process-led targets for A&E and ambulances that "distort" priorities and lack clinical justification.

The set of eight indicators for A&E care will cover issues such as timeliness, patient satisfaction, outcomes and safety.

Five of the indicators have "performance management triggers" – meaning hospital managers will investigate if A&E units fail to maintain good performance.

However, central government will not monitor or sanction those units that fall behind.

While the four-hour A&E target has officially been scrapped, managers will be expected to investigate if more than 5 per cent of patients wait more than four hours.

Similar investigations would occur if more than 5 per cent of patients leave A&E before being seen, while people should ideally wait no more than 20 minutes for an initial assessment.

If more than 5 per cent of patients wait more than 15 minutes for such an assessment, managers should look into why, the Government aid yesterday.

There will also be a focus on prioritising patients that require rapid treatment instead of those who have been waiting the longest.

Another indicator says staff should treat people with some urgent conditions – such as deep vein thrombosis – in community settings, such as people's homes, rather than in hospital.

This would provide "better patient care" and lead to a reduction in emergency admissions to hospital which are "costly" and can expose patients to other infections.

A further indicator relates to patients being readmitted to hospital through A&E within a week of being discharged, which affects more than 30,000 people every year.

If more than 5 per cent of patients are readmitted this way, a performance management trigger should occur as it may reflect poor quality care, the Government said.

Patient experience of emergency care is another indicator while a further one says high-risk patients to be seen by a consultant to ensure safer care.

How units perform against the new indicators will be published on publicly-accessible websites.

Justin Bowden, national officer of the GMB union, said: "Andrew Lansley says he knows what matters most to patients but misses what matters most to the public when they dial 999 – that an ambulance arrives, and arrives quickly.

"Mr Lansley's statements about timeliness of care, without a target time for ambulance crews to arrive on the scene is a euphemism for get there when you can.

"If the Government was really serious about patient care they would have introduced these 11 clinical indicators and kept the 19 minutes response time.

"By removing the guarantee about time, the service the public currently receives will be watered down and as sure as night follows day, this announcement will be followed shortly by plans to cut ambulances and paramedics."