Reforming emergency care; for patients.

mergency care is important to me for lots of reasons, but for one in particular: it's important to patients. We know that A&E services—and by implication all the components that make up the whole emergency care system—are among patients' top concerns. Within A&E I believe a critical concern for patients is how long they have to wait for clinical care, and I can't blame them. When you are in pain, frightened, or with a sick child each hour you wait feels like purgatory. And when patients get stressed the staff can suffer too. We have a target for waiting times in A&E—by the end of 2004, no one (unless it's clinically advisable) should spend more than four hours between arrival and admission, transfer or discharge. I think that is reasonable and achievable, even modest in some ways, but I don't expect it to happen by magic. The way we organise and cooperate across the whole emergency care system has to change. See and Treat wasn't the government's idea but, having taken clinical advice, we do think it's a good one. There is a growing body of evidence indicating that it can cut waiting times for patients with minor problems without adversely affecting times for others. The guidance on how to make See and Treat work was developed in conjunction with the BAEM and the RCN and endorsed by them, but it's not a strict blueprint that we expect to see implemented to the letter everywhere. It can only work properly if it's applied in a flexible and open minded way that reflects local conditions. What matters is that it makes a real difference to patients' experience of A&E. See and Treat works, but we know that it isn't the whole answer. Staff working in A&E are very busy people, and it isn't always easy for them to stop and think about how they do their jobs. That's where the emergency services collabora-tive and local emergency care networks can help—by giving staff from across the whole system the time and space to get together, iron out problems, and spread good ideas and practice. Next we will turn our attention to all the other factors that can keep patients waiting in A&E, especially those patients who may need to be admitted. Things like bed management, diagnostics or admissions and discharge procedures can present more complex and awkward problems but that doesn't mean …