To ask the Secretary of State for Health what guidelines he has issued on the target for no patient to be waiting for more than four hours in accident and emergency, with special reference to patients with a clinical need to remain for over four hours. 
§ Ms Rosie Winterton
The NHS Plan established the target that by December 2004 accident and emergency (A&E) patients should wait no more than four hours between arrival and discharge, admission to hospital, or transfer to another facility.
There are exceptional circumstances in which an A&E department remains the safest clinical environment for a patient even though four hours have elapsed. The Department of Health has been engaged in constructive 836W discussions with the British Association for A&E Medicine, the Faculty of A&E Medicine and the Royal College of Nursing about how these cases should be defined and monitored.
The product of these discussions is a paper that was published for wider consultation on 11 September. The paper is available on the Department's website, at www.doh. gov.uk/emergencycare/clinical-exceptions. htm. The consultation period runs until 31 October 2003. After consultation we will publish the final version of the paper and develop a process for excluding these patients from the monitoring of NHS trusts' performance against the A&E target.