The NHS drive to cut waiting time for emergency care to a maximum wait of four hours is getting close to achievement. In 2003 almost a quarter of patients spent more than four hours in Accident and Emergency Departments. Now, it is less than one in 20 patients and it is predicted that at the start of 2005 it will be one in 50.The improvement has been achieved partly by employing more doctors and nurses in emergency care work, but also by re-thinking processes and the mix of skills and by better integration with other parts of the health service and social services.

In the traditional model of the Accident and Emergency Department doctors formed a bottle neck. By expanding the role of nurses, paramedics and allied health professionals the bottle neck has been removed. Staff motivation has improved with greater clinical freedom to use expertise more fully.

Some patients, such as an older person who has fallen, who formerly would have received treatment in hospital, are now treated at home by paramedics with follow up support by social services.

By international standards, NHS emergency care performance is ahead of the field. Long waits are an enduring problem for healthcare systems around the world. A survey revealed that 84% of Australian patients waited over eight hours for a bed following the decision to admit them. In 2002, 6 per cent of Canadian patients waited over 24 hours for their admission. In the USA a study in 2002 found that 28 percent of their patients spent over four hours in the emergency department, and there was no sign of this improving.