Cat B targets replaced as DH announces changes to performance measures

Accident and emergency departments and ambulance trusts will in future assess their performance on what matters most to patients – quality, experience and patient outcomes, Health Secretary Andrew Lansley announced today.

The move comes amid concerns that parts of the NHS feel pressured into meeting process-led targets for A and E and ambulances that distort priorities and lack any clinical justification.

From April next year the current four hour waiting time standard for A and E will be replaced with a set of eight new clinical quality indicators that promote quality and patient safety. Time will still be measured as part of the new clinical quality indicators as it is a significant risk factor for treating patients, but crucially time will no longer be the only factor. For example the new indicators will include:

  • ‘time to full initial assessment’ – providing an incentive to assess patients quickly so that clinicians can prioritise the patients that require rapid treatment instead of simply who has been waiting the longest; and
  • ‘unplanned re-attendance’ – encouraging the NHS to look at whether patients receive the best care first time round so that repeat visits to A and E are avoided.

The A and E indicators have been developed jointly by Professor Matthew Cooke, the National Clinical Director for Emergency Care, together with senior clinicians in the College of Emergency Medicine and the Royal College of Nursing.

At the same time Peter Bradley, National Ambulance Director, has been working with Professor Cooke to develop indicators for ambulance services. The two sets of indicators have been designed to complement each other.

To view a lay guide to the new A&E quality indicators click here.

To view a lay guide to the new ambulance service clinical quality guidelines click here.

The Category B, 19-minute response time target for ambulances (serious but not immediately life-threatening) will be replaced with a set of 11 new clinical quality indicators. This will improve the quality and safety of care by focussing on those groups of patients with the greatest clinical need rather than according to the categorisation of call alone.

Ambulance services will still be required to respond to 75% of all category A (immediately life-threatening) patients within 8 minutes and, where needed, to provide transport to these calls within 19 minutes.

The clinical quality indicators have been designed to look at the whole patient care pathway and to encourage discussion in the local NHS about how care can be improved. The aim is to promote a culture of continuous improvement involving clinicians, managers and commissioners.

Health Secretary, Andrew Lansley, said:

“The new measures will focus on the quality of care and what matters most to patients – giving a better indication of patient care than the previous process-led targets ever could.

“By putting patient safety and outcomes at the heart of the health service, A and E departments and ambulance trusts can demonstrate they provide safe and effective clinical care in a timely manner rather than meeting a specific target. This is not about hitting targets – importantly, it is about giving the NHS more freedom to deliver quality care.

“Patients should be able to expect a 24/7 accessible and safe emergency care service which is integrated across the NHS. By shifting the focus to a range of indicators we will ensure that patients receive the best possible care, in the right place, at the right time.

“I want to thank Professor Cooke and Peter Bradley for leading this work along with the Royal College of Nursing and the College of Emergency Medicine for their valuable contribution. This collaboration means that in future emergency care will combine clinical outcomes with patient experience, safety and timeliness of care.”

John Heyworth, President of the College of Emergency Medicine said:

“The College of Emergency Medicine welcomes this announcement. The introduction of measures to ensure timeliness of patient care in the Emergency Department and, crucially, time related incentives to maintain patient flow from the Emergency Department, will provide tangible improvements for our patients.

“The combination of measures of quality and time will drive the continuing improvement towards the world class standard of Emergency Medicine which the public expect and deserve. This is an opportunity to transform emergency care to ensure the Emergency Department becomes the jewel in the crown of the NHS in which the public can place their trust and confidence at any time of the day or night.”

Professor Matthew Cooke, National Clinical Director for Emergency and Urgent Care said:

“The new clinical quality indicators for A and E and ambulance services offer a fantastic opportunity to ensure that we always deliver the best care and that timeliness is considered along with the quality of care and patient experience.

“We now have measures that, for example, will look at the proportion of high-risk presentations in A and E that are reviewed by senior staff or how quickly potentially life-threatening conditions are first assessed so that the emergency care system can be viewed as a whole to give patients the best possible clinical care.

“The new set of indicators will encourage discussion and debate in the NHS locally about the quality of emergency care. This will support continuous improvement, rather than simply meeting a target and this is the right focus when offering quality care for patients.”

More information:

1. Full details of the A and E clinical quality indicators can be found in the implementation guidance issued by the Department at

2. A similar publication for the ambulance clinical quality indicators will follow in the New Year.

3. You can view the department’s Quarterly Monitoring of A and E data for monitoring the four hour standard at
Data on performance against the ambulance service response time targets is available at

4. List of A and E indicators:

1. Percentage of patients with certain ambulatory care conditions admitted
2. Unplanned re-attendance rate
3. Total time spent in the A and E department
4. Left without being seen rate
5. Service experience
6. Time to initial assessment
7. Time to treatment
8. Consultant sign-off

5. List of ambulance indicators:

1. Outcome from acute ST-elevation myocardial infarction (STEMI)
2. Outcome from cardiac arrest – return of spontaneous circulation
3. Outcome from cardiac arrest – survival to discharge
4. Outcome following stroke for ambulance patients
5. Proportion of calls closed with telephone advice or managed without transport to A and E (where clinically appropriate)
6. Re-contact rate following discharge of care (i.e. closure with telephone advice or following treatment at the scene)
7. Call abandonment rate
8. Time to answer calls
9. Service Experience
10. Category A 8 minute response time
11. Time to treatment by an ambulance-dispatched health professional