accident and emergency – Page 2 – The NEN

Staff ‘deeply worried’ about Urgent and Emergency Care crisis

Scotland records worst A&E performance once again

Responding to the latest Emergency Department performance figures for Scotland for September 2022 Dr John-Paul Loughrey, Vice President of the Royal College of Emergency Medicine Scotland, said: “The situation as we enter winter is dire. Month-on-month, more and more patients face longer and longer waits – that we know are associated with patient harm and even death.

“Emergency Medicine staff and our paramedic colleagues are doing all they can to ensure the urgent and emergency care system continues to function and patients continue to receive care. We want to thank health care workers for their hard-work and diligence at this incredibly challenging time.

“We know that patients are deeply worried about the crisis. Emergency Medicine staff are worried too, distressed that they are unable to move patients through the hospital or take in patients from ambulances to the Emergency Departments.

“The difficulty in discharging patients from hospital when they are medically fit to be discharged is causing exit block in hospitals. The lack of social care is preventing these patients from being discharged.

“This is leading to a lack of flow throughout the hospital and leading to long waits in Emergency Departments, long waits in ambulances outside Emergency Departments, and long waits for an ambulance in the community.

“The Scottish Government must get a grip of this crisis and urgently boost the social care workforce, only then will we be able to discharge patients, free up beds and reduce these long waits throughout the system.”

The latest performance figures for September 2022 for Emergency Departments across Scotland show:

There were 113,522 attendances at major Emergency Departments
65.6% of patients were seen within four-hours
- This is the lowest four-hour performance since records began and is 8.2 percentage points lower than September 2021.
13,506 patients waited more than eight-hours before being seen, admitted, discharged, or transferred
- This is the highest number of eight-hour waits since records began
- It means that more than one in 10 patients were waiting eight-hours or more in a major Emergency Department.
- Double the number of patients have waited eight hours or more in 2022 so far (January – September) than in all of 2021.
5,296 patients waited more than 12-hours before being seen, admitted, discharged, or transferred
- This is the highest number of 12-hour waits since records began
- This is an increase of 172% compared to September 2021.

Fears for NHS as winter looms

Responding to the latest Emergency Department performance figures published by NHS England for August 2022, President of the Royal College of Emergency Medicine, Dr Katherine Henderson said: “The data is stark. We are worried about the coming winter.

“These are the second worst data on record. Too many patients are waiting too long. We know long waits contribute to patient harm. In August over 29,000 patients waited over 12 hours after a decision to admit was made, with some patients waiting up to three days for a bed.

“We think the consequence of this is shown in the ONS data as 500 excess deaths a week. We must not accept these long stays as normal. We need to see leadership and meaningful action that gets to grips with this crisis.

“We urge the new Prime Minister, Liz Truss, and incoming Health and Social Care Secretary, Therese Coffey (above), to make tackling the crisis in Emergency Care a priority.

The scale of patient harm occurring is shocking. The Emergency Care system is failing to its core functions; it is vital that we mitigate the impact of this crisis ahead of winter and do all we can to keep patients safe and reduce these dangerous waiting times.

“The Prime Minister and Health Secretary must urgently bolster the social care workforce. Thousands of beds are occupied by patients who are medically fit to be discharged, but the lack of social care service means that getting patients home is a slow and complex process.

“This means that hospitals have difficulty in discharging patients in a timely way, leading to exit block, poor flow throughout the hospital and subsequent problems in Emergency Departments and ambulance waits. The need for investment in social care couldn’t be clearer.

“Staff are exhausted, overwhelmed and in the midst of the worst crisis the NHS has ever faced. Widespread shortfalls of staff across all grades and departments mean health care workers are spread increasingly thinly and more prone to burnout – there are currently around 130,000 vacancies in the NHS almost 10% of its workforce.

“The Prime Minister must deliver the fully funded long-term NHS workforce plan that the government pledged to deliver in 2019. Emergency Care is in crisis and there is a shortfall of 2,000-2,500 Emergency Medicine consultants and widespread shortages of vital nursing staff, trainees, SAS doctors and junior and supporting staff are contributing to the challenges.”

The latest Emergency Department performance figures published by NHS England for August 2022for show:

There were 1,304,378 attendances at major Emergency Departments
- There were 1,988,779 total attendances at all Emergency Care facilities
28,756 patients were delayed for 12 hours or more from decision to admit to admission
- This is the second highest number of 12-hour waits on record, just 561 short of the previous record in July 2022
- There have now been 178,770 12-hour waits (from decision to admit to admission) so far this year
Four-hour performance at major Emergency Departments was 58.0%, this is the second worst four-hour performance on record, the lowest was recorded the previous month, July 2022
- More than 2 in 5 patients were delayed by four-hours or more
Type 1 admissions stood at 350,618 (a daily average of 11,310)
130,528patients spent more than four hours in an Emergency Department from decision to admit to admission (also referred to as ‘trolley waits’)
Bed occupancy stood at 92.8% (far higher than the recommended 85%)

Hopsital Episodic Statisticsfor July 2022 published by NHS Digital show:

The longest wait in an Emergency Department from time of arrival until treatment was 4,320 minutes or 72 hours
The number of patients leaving the department before being seen stood at 6.0%
The rate of unplanned reattendance was 9.0%

July sees worst performance figures ever recorded in Scotland

‘this should ring alarm bells to all political and health leaders’ RCEM says

Responding to the latest Emergency Department performance figures for Scotland, Dr John-Paul Loughrey, Vice Chair of the Royal College of Emergency Medicine Scotland, said: “The latest Emergency Department performance figures for July should ring alarm bells to all political and health leaders.

“These are the worst performance figures since records began, with over 4,000 patients waiting 12-hours or more in major Emergency Departments in Scotland – equal to nearly one in every 25 patients.

“The depth and scale of this crisis is deeply concerning. Patients are already coming to harm, a consequence of long and dangerous waiting times. These data must be a call to action, especially as winter is fast approaching.

“The government must urgently expand capacity where safely possible; we know there is a shortfall of 1,000 beds in the health system in Scotland. The Scottish government and local authorities must also bolster the social care workforce. Good social care underpins an effective health service.

“Ensuring the timely discharge of patients, which relies on good social care, is crucial for freeing up beds, admitting patients and encouraging flow throughout the hospital.

“Lastly, we must see a long-term workforce plan for the NHS in Scotland. Staff have been pushed to the brink; burnout and distress are leading to health workers considering leaving the workforce.

“We must do all we can to retain staff as well as look to recruiting new staff into the health service. Without the workforce, more and more patients will face longer and longer waits and come to further harm.

“Our priority is patient safety and delivering effective care, that is only possible with a workforce that is not overwhelmed, not burnt out and not undervalued.”

The latest performance figures for July 2022 for Emergency Departments across Scotland show:

There were 110,494 attendances at major Emergency Departments
66.5% of patients were seen within four-hours
- This is the lowest four-hour performance since records began
- This meant that 37,067 patients waited more than four-hours to be seen, admitted, discharged, or transferred.
11,419 patients waited more than eight-hours before being seen, admitted, discharged, or transferred
- This is the highest number of eight-hour waits since records began
- There have been almost 20,000 more eight hour waits between January 2022 and July 2022 than in all of 2021.
- It means that one in 10 patients were waiting eight-hours or more in a major Emergency Department
4,271 patients waited more than 12-hours before being seen, admitted, discharged, or transferred
- This is the highest number of 12-hour waits since records began
- It means that nearly 1 in 25 patients waited 12-hours or more in a major Emergency Department
- In the first seven months of 2022 there have been double the number 12-hour waits when compared to the whole of 2021
- It is a 14% increase on the previous month, June 2022 and a 461% increase on the same month last year, July 2021

Tip of the Iceberg: New report exposes real number of A&E waits

Over 1,000 patients faced a 12-hour wait in A&E every day in 2021

A new report by The Royal College of Emergency Medicine ‘Tip of the Iceberg: 12-Hour Stays in the Emergency Department’ reveals that on average 1,047 patients waited 12-hours or more from their time of arrival every day in a major Emergency Department in 2021 in England, equalling a total of 381,991 patients experiencing these 12-hour waits in 2021.

There is a total of 124 NHS Trusts in England. The College received responses from 74 NHS Trusts that were contacted. The figures above are only representative of 60% of NHS Trusts in England. The true total figure of 12-hour waits from time of arrival in major Emergency Departments in England in 2021 will be even higher.

These figures show the deep crisis facing the NHS and the Urgent and Emergency Care system. The alarming number of 12-hour waits are an indicator of the serious and dangerous levels of crowding occurring in Emergency Departments.

Crowding is unsafe, inhumane, and undignified for patients, our previous report Crowding and its Consequencesfound that patients can come to associated harm and even death.

The NHS in England currently measures 12-hour waits from decision to admit (DTA). The Decision to Admit is the decision to admit a patient to a hospital bed made by a clinician. Measuring from decision to admit is a gross underrepresentation of the reality of patient waits, as many patients will have already waited for a long period in a busy Emergency Department before this decision is made.

12-hour DTA waits have been increasing substantially, so much so that in the first four months of 2022 alone (January – April 2022) there were a total of 79,610 12-hour DTA waits; nearly as many as the cumulative total of the 11 years since data collection began (82,746 12-hour DTA waits between August 2010 – December 2021). It is evident that while the pandemic has contributed to the current situation somewhat, long waiting times have clearly been rising for over a decade.

Our recent report Beds in the NHS found that 25,000 staffed beds have been lost since 2010/11 and this has contributed to the steady increase in long waiting times in Emergency Departments since 2010/11 as detailed in Tip of the Iceberg.

Commenting on the FOI findings, Dr Adrian Boyle, Vice President of The Royal College of Emergency Medicine, said: “These figures are staggering and show the critical state of the Urgent and Emergency Care system.

“They also make clear that measuring 12-hour waits from decision to admit masks the reality facing patients and staff. Clearly, it is misleading to measure 12-hour waits in this way, and it is detrimental to staff efforts to improve A&E waiting times.

“NHS England have previously promised to make 12-hour data measured from time of arrival in the Emergency Department public and publish it alongside monthly NHS performance figures. We are still waiting for them to fulfil their promise.

“We recently wrote to Amanda Pritchard, Chief Executive of NHS England, about this, questioning why the data has not yet been published and when it will be. We have not received a response. Until it is published the NHS cannot hope to drive meaningful change and improvement in Emergency Care. Publishing this data will bring about greater accountability, and help all stakeholders understand the extent of crowding, long stays, and corridor care.

“NHS England must publish 12-hour data from time of arrival as a matter of urgency, this is the first step towards meaningfully tackling this crisis. At present, we fear that the full scale of this crisis is either being ignored or inadvertently misunderstood by the government.

“To truly tackle the problem, you must understand the scale of the task at hand. This data should facilitate better understanding of the challenges facing Urgent and Emergency Care and the wider health system and allow us to take the steps towards tackling it.

“In the short-term, the government must set out a meaningful plan for social care that includes recruitment and investment in the social care workforce and paying a wage that values and reflects significance of their role.

“In the medium-term, the government must finally commit to publishing a fully funded long-term workforce plan that recruits new staff into the health service and includes measures to retain existing staff who are burned out and questioning their careers. Then will it be possible to open the 13,000 staffed beds required to drive meaningful improvement within the health service.

“The health service is failing, and failure to act will take it deeper into crisis and inevitably lead to another ‘worst winter on record’ and further patient harm. The government can talk about phantom new hospitals all it likes, but political unwillingness to tackle the deepest health crisis in NHS history costs; the cost is both deteriorating patient health and patient lives, and an undervalued workforce struggling to deliver.”

Tip-of-the-Iceberg-12-Hour-Stays-in-the-Emergency-Department Download

Emergency Care ‘remains in extreme crisis’

More than one third of patients facing long waits in Scotland, as Emergency Care remains in severe crisis.

Responding to the latest weekly Emergency Department performance figures in Scotland Dr John Thomson, Vice President of The Royal College of Emergency Medicine Scotland, said: “We are continuing to see severely poor performance in the Emergency Care system. Staff are becoming more and more burnt out; the appalling crisis in Emergency Care is seriously distressing.

“The public are extremely worried about these long waiting times, and rightly so, because patients are coming to harm. Staff continue doing all they can to deliver care and keep patients safe, but it is incredibly challenging.

“It is a desperate situation, a result of widespread shortages of staff and beds throughout the system and a crisis in social care. Despite exiting winter and entering spring, the situation remains dire; we have never faced a crisis worse than this. The intense workload is breaking staff, and the distressing circumstances are breaking their morale.

“Patients continue to face seriously long waits, and we continue to state that this crisis is worse than ever, and that patients are coming to harm. The government cannot let this deteriorate further, staff and patients urgently need meaningful action now to tackle the desperate situation in Emergency Care and address the widespread staff shortages, the bed shortages, and the social care crisis.”

The latest weekly Emergency Department performance figures for Scotland show:

There were 22,774 attendances at Emergency Departments

Four-hour performance was 66.2%, the lowest ever on record-

7,705 patients waited more than four-hours in an Emergency Department

More than 3 in ten patients were waiting for more than four hours in an Emergency Department

2,373 patients waited more than eight-hours in an Emergency Department

Nearly one in six patients were waiting for more than eight-hours in an Emergency Department

944 patients waited more than 12-hours in an Emergency Department

One in twenty-five patients were waiting more than 12-hours in an Emergency Department

Royal College: Urgent and Emergency Care ‘in dire crisis’

RCEM urges action to address failing A & E system

The latest monthly Emergency Department (Major EDs) performance figures for Scotland for February 2022 show:

There were 95,692 attendances
Four-hour performance was 71.7%, 1.9% lower than the previous month, January 2022, and the second lowest on record
27,087 patients were delayed by four hours or more, this is means more than one in four patients were delayed by four hours or more
6,248 patients were delayed by eight hours or more
2,230 patients were delayed by 12 hours or more, this represents the highest proportion of attendances experiencing 12 hour waits since records began

Dr John Thomson, Vice President of the Royal College of Emergency Medicine Scotland, said: “The crisis in Urgent and Emergency Care is dire. The health system in Scotland is ceasing to function as it should. Patients are at risk of severe harm and staff are facing stress, distress, burnout and moral injury on a daily basis.

“This is unsustainable and dangerous. The first step to tackling this crisis is opening 1,000 beds that are desperately needed across the system and recruiting senior decision makers in Emergency Medicine. In addition, the crisis in social care, which is resulting in the most vulnerable patients residing in hospital for extremely long periods of time before being discharged means that the system is unable to cope.

“This patient safety crisis must be a priority for the Scottish Government, and they must take meaningful action now before more patients come to severe harm.”

One in four ambulances delayed 30 minutes or more as Emergency Care falls deeper into crisis

The latest Winter Sitrep data for the week ending 27 March show:

There were 79,588 ambulance arrivals, 2.7% less than the previous week.
More than one quarter of ambulances experienced delays of 30 minutes or more, equal to 21,051 ambulances – an increase of 7.4% on the previous week
This is the highest proportion of ambulance delays on record
More than one in nine ambulances were delayed by more than 60 minutes, a 10.2% increase on the previous week, setting a new record high for this reporting period.
The average number of delays for this winter has continued to creep up, increasing from 0.3% up to 21.3%. The previous highest weekly average number of delays was 14.3% in 2019-20.

The Royal College of Emergency Medicine and The College of Paramedics have collaborated on this Ambulance Handover Options Appraisal guidance that details the ways in which Paramedics and Emergency Medicine staff can reduce ambulance handover delays.

Dr Ian Higginson, Vice President of The Royal College of Emergency Medicine, said: “The data show Emergency Department crowding, long “hidden” within the walls of EDs, has become more visible as handover delays have dramatically increased, leading to ambulances waiting outside EDs with their patients still inside.

“It is vital that ambulances return to active service whenever possible and safe to do so. Delaying ambulance handovers should be a last resort. Holding patients in ambulances leads to unnecessary delays to their care, leaving seriously ill or injured patients in the community requiring an ambulance to wait longer.

“Ambulance handover delays are almost entirely caused by dangerous crowding in Emergency Departments. The root cause of these problems is “exit block” where there are delays for patients to be admitted to inpatient beds from the ED. Patients suffer harm or die unnecessarily when they cannot get an ambulance in time, when they are held in ambulances on arrival in ED, or when they are treated in crowded EDs.

“Emergency Departments must have sufficient capacity to meet demand, and constant flow from the Emergency Department into inpatient beds, otherwise they will not be able to keep patients and staff safe. This means that risk must be properly shared within organisations, and through systems.

“When this does not happen leadership teams tend to look for mitigation. Unfortunately, this mitigation is usually focused at the front door of the hospital, rather than being directed at the root cause of the problem. The Royal College and The College of Paramedics have produced this joint guidance to support good decision making when managing ambulance handover delays in an effort to tackle ambulance handover delays and dangerous Emergency Department crowding.”

Tracy Nicholls, Chief Executive of The College of Paramedics, said: “We hear from our members how consistently challenging this situation is and, whilst we can see that paramedics, ambulance clinicians and hospital ambulance liaison officers are doing everything they can, the system is now at breaking point.

“Those who need an ambulance are continuing to wait an unacceptable length of time and those paramedics and ambulance clinicians who are running to their next job can clearly see how long their next patient has been waiting and know they are going to be met with frustration, anxiety or fear.

“It seems incongruous that additional measures are being taken at the front door when the whole system flow of patients still needs to be addressed, but we suspect that there are now few options left without further risk to both those who are using the ambulance services and those who are working within them.

“Ambulance operations centres are still fielding calls at record numbers because callers want to know when an ambulance will arrive and are often calling back time and time again.

“It is difficult to hear that an ambulance might be delayed but imagine how a caller feels when their 999 call isn’t answered straight away. The moral injury is not just with the paramedics, but also with all of those involved directly with patients and their care.

“The College supports RCEM’s call for both the reduction in ambulance handover delays and in ED overcrowding. It is only by working together as a system that we will see this much-needed change and this guidance document outlines the risks associated with the current challenges.”

Emergency Departments continue to face severe pressures as RCEM calls for meaningful action

The latest A&E activity and waiting times for major Emergency Departments in Scotland for January 2022 show:

73.7% of attendances were seen and resulted in subsequent admission, transfer or discharge within four hours
There were 96,338 attendances, a 1.4% decrease when compared to the previous month, December 2021
More than one in four patients were delayed by four hours or more
6,682 patients were delayed by eight hours or more, a 23% increase when compared to the previous month, December 2021
This is equal to 6.2% of all attendances
2,155 patients were delayed by 12 hours or more, a 30% increase when compared to the previous month, December 2021
This is equal to 2.1% of all attendances

Dr John Thomson, Vice President of the Royal College of Emergency Medicine Scotland, said: “The health service in Scotland continues to face severe system pressures.

“Emergency Departments remain dangerously crowded with many patients facing extremely long waiting times as ambulances still face delays in offloading patients. These long waits are leading directly to harm for our patients.

“Despite the challenges of widespread bed shortages and staff shortages, Emergency Medicine staff continue to do all they can to keep patients safe. It is the hard work and dedication of EM staff who are preventing urgent and emergency care from tipping over the edge and falling deeper into crisis.

“Frontline workers continue to be pushed to their limit and are experiencing significant moral injury as a result of inadequate bed capacity and patient flow. It is clear that without significant, immediate change, both patients presenting to our Emergency Departments, and the staff working in them, face ongoing harm.

“Emergency Medicine staff will continue to be pushed to their limit unless an adequate urgent and emergency recovery plan is set out by the Scottish Government – this would prevent any threat of derailing elective care recovery.

“In the longer term, the Royal College continues to call for a fully funded long-term workforce plan and for 1,000 additional beds to be opened in the system. The current status quo is not sustainable for patients or staff, it is time to see meaningful action.”

Long waiting times continue to put patient safety at serious risk

The latest A&E activity and waiting times for major Emergency Departments in Scotland for December 2021 show:

73.7% of attendances were seen and resulted in subsequent admission, transfer or discharge within four hours
There were 97,644 attendances, a 6% decrease when compared to the previous month, November 2021
More than one in four patients were delayed by four hours or more
5,342 patients were delayed by eight hours or more, equal to 5.5% of all attendances
1,605 patients were delayed by 12 hours or more

Responding to these figures, Dr John Thomson, Vice President of the Royal College of Emergency Medicine Scotland, said: “With fewer attendances performance has plateaued but be in no doubt that the health service and its staff in Scotland remain under unprecedented pressure and increasing burnout.

“One in four patients face delays over four hours, while both eight- and 12-hour waits are still at record high levels not seen before 2021. What is deeply concerning is the pattern and the potential for these long waiting times to become the status quo in perpetuity.

“Both our own report Crowding and its Consequences (below) and a recent article in the Emergency Medicine Journal ‘Association between delays to patient admission from the emergency department and all-cause 30- day mortality’ detail the real harm, and in some cases death, that long waiting times can cause patients.

“The impact of this continued poor performance is distress and moral injury to staff and serious discomfort and risk to the safety of patients. This must be an urgent signal and call to action for system change. We have long called on the government to open 1,000 more beds in the system in Scotland, and to commit to publishing a long-term workforce plan. While there remains an urgent need to address the social care crisis to help patients be discharged from hospital in a timely way.

“Quite simply things cannot continue as they are, more patients will come to harm and staff will face increasing distress at the quality of care they are or, more significantly, aren’t able to provide. The government must recognise the severity of the situation and the risk that continued poor performance, long waiting times, patient harm, and sinking quality of care will continue to spiral.”

RCEM_Why_Emergency_Department_Crowding_Matters Download