Four hour target for EDs: The UK experience

When Tony Blair’s New Labour Party was elected to government in May 1997, they inherited a National Health Service (NHS) with diverse problems. Media outlets, in particular newspapers, were publishing stories about patients waiting for long times in EDs, overworked and under-resourced staff, full hospitals, significant delays in hospital discharge and poor access to diagnostic and other relevant services. The picture was of a fragmented, poorly led and dysfunctional service. Last century, the data recorded by the NHS about ED activity were limited to the basics – attendances, admission rates and demographics. A question in the House of Lords in 2008 about ED waiting times (recorded in Hansard, the parliamentary record) was given the short reply ‘the figures for 1997 were not collated’. Despite poor data, there was anecdotal evidence in the 1990s to show that it was quite common for patients to wait on trolleys for 12 h or more before admission. Tony Blair decided that the NHS would never work without major reforms of the system and the workforce; he also believed that the public-wanted choice, an idea permeating much of his thinking about public services until he left office. His mantric rhetoric about choice, coupled with the idea that an unreformed workforce were undermining the NHS, evolved into the belief that only targets would get it moving. So what did New Labour do?