Luton & Dunstable hospital made the 95% A&E target a whole-hospital job and hit 98.6%

A BBC News report from December 2017 asks how Luton & Dunstable University Hospital consistently beats the trend while national A&E targets are missed. Its figures showed 98.6% of patients treated, assessed or discharged within four hours, comfortably ahead of the 95% target. The hospital took on the challenge of reaching and keeping the target from 2012, and it did not happen overnight.

Leadership was key. Pauline Philip, chief executive since 2010, told all staff the target was a whole-hospital priority and would come in on a Sunday evening to clear blockages. She phoned council chief executives to remove social care barriers. Patients who could be treated by GPs go to an urgent care centre by the front door, and senior doctors decide whether some arrivals can be sent elsewhere, such as a pharmacist.

Consultants closely monitor patients admitted from A&E so beds free up quickly. A senior member of staff assesses all elderly patients from admission and can authorise Better Care Fund spending to speed safe discharge home, and local commissioning and council staff review each day's A&E patients sent home to see whether community care could have kept them out.

98.6% of A&E patients were treated, assessed or discharged within four hours in late 2017, against a 95% target missed across the NHS.

The target was framed as a hospital-wide goal, not an emergency department problem.

Beds were treated as the bottleneck, with experienced doctors pulling admitted patients through.

Delayed discharges to social care were attacked directly through council partnerships and spending authority.

Daily reviews of patients sent home looked for community care that would prevent future A&E visits.

A queue at the front door is usually a flow problem behind it: assign owners across the whole system, from beds to social care.

Philip was made a Dame in 2017 and seconded to NHS England to lead national urgent and emergency care. The BBC notes some in the NHS question whether an obsessive focus on the 95% mark distorts care. The hospital said it takes nothing for granted and shares what it learned with other hospital managers.