"There is a 3:38 in Bay 5"

Having spent a few days in A+E, it is already immediately obvious what the most important thing is. Wouldn't you think that in 2008 the central focus of care in the A+E department would be the patient? It isn't the nurses' fault, nor the doctors', both of whom work very hard to ensure patients receive the best care possible, but there is something more important on their minds. What can be more important than the patients I hear you cry with horror? I'm sure most of you have guessed by now: the 4 hour target.

The 4 hour target effectively means that all patients presenting to A&E, regardless of what is wrong with them, must be seen, assessed, treated and shipped out (either sent home or forwarded on to another department) within 4 hours. This might seem like a good plan, and well, it is wonderful that nobody has to wait for more than 4 hours before they see a doctor, but unfortunately every patient is different. You can't shoehorn all patients with their vast range of problems into the same 4 hour bracket. Things just don't work like that in real life.

Sometimes it is easy to see, assess and treat patients within 4 hours. But in a fair number of cases, and particularly on a Friday or Saturday night, this is simply not possible. Or rather, it isn't possible to assess patients properly and provide the best possible care. It really shouldn't matter how long it takes, it should matter that it’s done right!

Patients are no longer known by their names, or even by their conditions any more. At best they might be known by their location – “bed 5” - but more often than not patients are referred to by a very special number. This number tells you how long they've been in the department. Displayed prominently on an electronic whiteboard is a list of all the patients currently in A&E and waiting to be seen, and the second a patient ticks past a 3 hour wait, their name lights up like a Christmas tree in bright red. If their stay approaches 3 hours 30, then the managers start to appear from their hidden lair (where I imagine they must watch intently the time spent in A&E by each individual patient). Of course they don't actually care in the slightest about Mr Jones who is having a heart attack right there in the department. The fact is, they are there to remind you that he has got to go. Wherever it may be. As long as its not A&E, and as long as it's not their problem any more. If you even mutter the word 'breach' (the description of those who miss the 4 hour target) in the vicinity of the A&E department you'll either be shot, or smothered in managers eager to find out what you know and what they can do to stop it.

In my few days in A+E I've already seen patient care put at risk due to this target. To me this is ridiculous, in fact, it's beyond ridiculous, it's dangerous. I imagine this target was thought up by someone in an office somewhere who'd not been near an A&E department since getting a little too drunk one night during their Philosophy degree. That is the problem with these things, they're dreamt up by people who haven't the faintest idea about how they will work in real life. Targets, targets, targets is all anyone seems to care about these days, forget the patients in hospital, they don't matter. I'm sure it makes wonderful headlines and prodigious soundbites for the government. Which voter wouldn't want to see "A&E Waiting Times Down!" plastered across the media? And there we have it, as much as the government, it's the fault of masses who demand reassuring statistics and some of the media, who leave only a few huddled words below a headline that hits the reader between the eyes. We need our journalists, and the voters, to look beyond headlines and ask, “waiting times might be down, but at what cost?”