Tag: crisis

RCEM: Emergency care ‘in dire crisis’

Devolved governments call for more cash for NHS pay

The UK Government has been urged to increase the amount of funding available for NHS pay.

Ahead of the Autumn statement, Scottish Health Secretary Humza Yousaf and Welsh Health Minister Eluned Morgan have written to UK Health Secretary Steve Barclay to ask for additional funding to help avert strike action this winter in the NHS.

The letter reads:

“We wanted to write to you in advance of the Chancellor’s Autumn Statement on 17th November to once again make the case for additional funding for our hardworking NHS staff.

“In recent weeks the Deputy First Minister of Scotland and the Welsh Government Minister for Finance and Local Government have written to His Majesty’s Treasury to make clear the need for additional funding for public services.

“The Royal College of Nursing have announced a sweeping legal mandate for industrial action across the UK. In Scotland, they have joined several other unions representing NHS staff in gaining a legal mandate for industrial action with ballots expected to confirm a mandate in the rest of the UK.

“The risk to the NHS of industrial action this winter is profound, and we all need to do all we can to avert industrial action in any form. The NHS across the UK continues to feel the effects of the pandemic as it recovers and remobilises, and any action is likely to have catastrophic effects in all parts of the UK.    

“We are experiencing a cost of living crisis and the anger of NHS staff is entirely understandable. Sky rocketing inflation combined with high interest rates, a direct result of the havoc caused by the UK Government’s mini-budget, means that we are simply unable to come close to matching the expectations of NHS staff across the country. While the support provided by the UK Government on areas such as support for energy bills is welcome, it has not gone nearly far enough.

“Media reports suggest that the Chancellor is considering reimposing austerity on the people of the UK again, for which there is no mandate, through extensive spending cuts. That would be a disaster for our public services, including the NHS, at a time when they need more investment, not less.

“We would therefore implore you to work with us to make the case to the Chancellor in advance of his Autumn Statement for increased funding for the NHS and the devolved governments as a whole, primarily to pay our hard working NHS staff a fair pay rise in the face of the cost of living crisis this winter, and avoid what could be catastrophic industrial action in the NHS.”

Responding to the latest Emergency Department performance figures published by NHS England for October 2022, Dr Adrian Boyle, President of the Royal College of Emergency Medicine, said: “The crisis in Emergency Care is dire. October saw nearly 44,000 patients face a 12-hour DTA wait – we know 12-hour waits measured from decision-to-admit are just the tip of the iceberg and hides the reality.

“We know far more patients wait for 12-hours measured from their time of arrival. NHS England and the Department of Health and Social Care will still not commit to publishing this data, despite it being collected by all Trusts. We believe this is a barrier to tackling the root of the crisis.

“We know excessively long waits and dangerous crowding are associated with patient harm and increased risk of mortality. Scientific studies have shown that there is one death for every 67 patients waiting between eight and 12-hours from their time of arrival in the Emergency Department.

“The ONS continue to report worryingly high excess mortality figures and we believe that dangerous crowding, long delays, and the crisis in urgent and emergency care are contributing to a significant proportion of these excess deaths.

“We are increasingly concerned about the winter and the health system’s ability to cope. We are already at 94.3% bed occupancy for all general and acute beds and each month patients face the longest waits on record. The system is failing in its core function – the quick and effective delivery of emergency care.

“We need meaningful action now – sticking plasters like setting up tents or handover units will do nothing to resolve these long-waits and may actually cause more harm to patients. We know we need to be able to admit patients, we know ambulances need to handover patients quickly, we agree that it is vital that ambulances must return to Urgent and Emergency calls in the community – but to achieve this we must tackle the issue of poor flow in our hospitals.

“Many patients in hospital no longer meet the criteria to reside, they are occupying beds to which we could be admitting patients. Around 13,000 people are in hospital unable to be discharged. We urgently need an effective social care workforce to help with the discharge of these patients, so we can admit patients, receive patient handovers promptly, and get ambulances back out to the community.

“It is crucial that those in power understand that this is not a demand issue, attendances are not causing crowding and long waits. Crowding and long waits are a consequence of the inability to move patients through the hospital, a consequence of patients who are unable to be discharged because of severe cuts to social care.

“If you can’t discharge patients, beds are indefinitely occupied and the whole system is blocked. The government must get a grip of the social care crisis to fix flow.”

Commenting on the news that the RCN have voted in favour of strike action, Dr Adrian Boyle said: “In Emergency Medicine there is a retention crisis, particularly amongst our nursing colleagues.

“Emergency Medicine nurses are a critical part of the workforce – EM is a team sport. We know and understand that many EM staff, including nurses, are burned out, exhausted and overwhelmed.

“They are skilled, competent professionals who deliver excellent care for our patients. It is vital that our nursing colleagues feel valued and appreciated.”

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

  • There were 1,399,916 attendances at major Emergency Departments
    • This represents a 7.5% increase compared with September 2022, and a 1.7% increase compared with pre-pandemic levels (October 2019)
    • There were 2,000,493 attendances at all Emergency Care facilities
  • 43,792 patients were delayed for 12-hours or more from decision to admit to admission
    • This is the highest number of 12-hour waits on record
    • It is 520% higher than the same month last year, October 2021, and it is 5932% higher than October 2019
    • There have now been 255,334 12-hour DTA stays recorded so far in 2022 – three times as many as were recorded in the 137 months prior to 2022
  • Four-hour performance at major Emergency Departments was 54.8%, this is the worst four-hour performance on record
    • This is a 7.1 percentage point decrease from October 2021, and a 19.7 percentage point decrease compared with October 2019
  • Type 1 admissions stood at 366,964 (a daily average of 11,838)
  • 26.2% of type 1 attendances were admitted, this is a one percentage point decrease from September 2022
  • 150,922patients spent more than four hours in an Emergency Department from decision to admit to admission (also referred to as ‘trolley waits’)
    • This is the highest figure on record and is a 14.5% increase from September 2022
  • Delays to admission stood at 29.8%, this is the highest on record and a 2.8 percentage point decrease from September 2022

The latest beds data for October 2022 show:

  • Last month there were 97,350 general and acute beds available, an increase of 0.71% from September. The occupancy rate was 94.3%, 0.7 percentage points higher than September, the highest monthly figure on record
  • The occupancy rate for adult general and acute beds was 95.6%, also the highest figure on record.

The latest Hospital Episodic Statistics published by NHS Digital for September 2022 show:

  • Patients leaving the department before being seen stood at 5.2%. This is a decrease of 0.2 percentage points from August 2022, but a decrease of 0.7 percentage points from September 2021. 
  • Unplanned reattendance rate was 8.5%. This is 0.4 percentage points lower than September 2022, but 0.3 percentage points higher than September 2021.  
  • Median time in department for admitted patients was 404 minutes. This is an increase of 29% compared with September 2021 (314 minutes). For all patients, the median wait was 192 minutes. 

Patients in mental health crisis twice as likely to spend 12-hours or more in Emergency Departments than other patients

A new report from The Royal College of Emergency Medicine finds that patients presenting with mental health problems are twice as likely to spend 12-hours or more in Emergency Departments than other patients.

National data show that nearly one in eight (12%) mental health patients presenting to an Emergency Department in crisis face a 12-hour stay from time of arrival, compared with nearly one in 16 (6%) of all attendances.

A recent SNAP survey of Emergency Departments found that more than one third of clinical leads reported patient stays of 72 hours or more in the last week, for patients with mental health needs.

‘Mental Health Emergency Care’ is the latest report in our series of explainers looking at the web of issues facing Emergency Departments. The report highlights that while patients with mental health presentations account for a very small proportion of Emergency Department attendances, they spend a disproportionate amount of time waiting for a mental health bed if they need admission.

Often, it is the patients who are most unwell and vulnerable that wait the longest. Those of greatest concern are patients waiting for a mental health bed, patients waiting for an assessment under the Mental Health Act, and Children and Young People presenting in crisis.

The prevalence and complexity of the mental health needs of children and young people increased during the pandemic, while capacity is struggling to meet surging demand.

Half of Emergency Departments in England reported waits of 12 to 24 hours for a child or young person to see a specialist mental health professional, despite the accepted standard for adults being a one hour wait to be seen.

If admission is needed, 46% of Emergency Departments reported that children and young people will wait more than 48 hours for a bed, with two respondents reporting a wait of five days in the Emergency Department.

The report looks in detail at factors contributing to these long waits, such as the reduction in mental health beds, inadequate numbers of children and adolescent mental health professionals, and poor organisation of professionals to assess patients under the Mental Health Act. It also examines the consequences for patients and departments and makes wide reaching recommendations.

Commenting on the findings of the report, Dr Katherine Henderson, President of the Royal College of Emergency Medicine, said: “The system is failing patients who present to Emergency Departments in mental health crisis.

“Those waiting the longest are children and young people, patients waiting for admission to a bed, and patients waiting for assessment under the Mental Health Act. It is unacceptable.

“We know long waits in a busy and crowded environment are harmful for any patient, but for these patients it can cause deep distress and upset and worsen their mental state. We must do more to ensure that these patients are seen, treated, and directed to the right care quicker.

“These patients presenting to Emergency Departments are extremely vulnerable, they are in crisis and seeking Emergency Care, yet are left waiting for hours and even days, before being treated and admitted.”

The explainer also shows that the UK has only 37 psychiatric beds per 100,000 population – far lower than the OECD average of 71 psychiatric beds per 100,000 population – and that since 1987, over 48,000 NHS mental health beds have been cut in England, with 5,000 mental health beds having been cut since 2011 alone.

Dr Henderson said: “Data show that bed occupancy at mental health trusts averaged nearly 90% between 2017-20, 5 percentage points higher than the recommended 85%. The NHS mental health bed numbers are clear; capacity does not meet demand.

“While the move towards a provision of community mental health care has been positive, the cuts to emergency mental health care beds have been devastating. Now, the most vulnerable and desperate patients are truly suffering.

“We urgently need to see an increase in mental health bed capacity, so we are able to admit these patients to a bed and provide the care they urgently need. We regularly hear heart-breaking stories of young people being admitted a long way from their home and family.

“We urge the new Prime Minister and new Health Secretary to prioritise Mental Health care provision in Emergency Departments, especially ahead of winter.

“We are failing these patients and they are suffering; our report and supporting survey show the extent of this crisis. We need urgent action now. To ensure we are able to quickly and effectively help vulnerable patients in crisis the government must increase mental health bed capacity in Trusts.

“Capacity for Children and Adolescent Mental Health Services (CAMHS) is especially important, and CAMHs should be expanded to 24/7 so that children and young people can be assessed and triaged whenever they present at Emergency Departments, rather than face long waits for these services to open.”

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Persistent understaffing of NHS a serious risk to patient safety, warns Westminster committee

‘We now face the greatest workforce crisis in history in the NHS and in social care’

The NHS and social care face the greatest workforce crisis in their history, compounded by the absence of a credible government strategy to tackle the situation, say MPs in a new Health and Social Care Committee report.

In the NHS, persistent understaffing poses a serious risk to staff and patient safety in routine and emergency care.

The Workforce: recruitment, training and retention report outlines the scale of the workforce crisis: new research suggests the NHS in England is short of 12,000 hospital doctors and more than 50,000 nurses and midwives; evidence on workforce projections say an extra 475,000 jobs will be needed in health and an extra 490,000 jobs in social care by the early part of the next decade; hospital waiting lists reached a record high of nearly 6.5 million in April.

The report finds the Government to have shown a marked reluctance to act decisively. The refusal to do proper workforce planning risked plans to tackle the Covid backlog – a key target for the NHS.

The number of full-time equivalent GPs fell by more than 700 over three years to March 2022, despite a pledge to deliver 6,000 more. Appearing before the inquiry, the then Secretary of State Sajid Javid admitted he was not on track to deliver them. The report describes a situation where NHS pension arrangements force senior doctors to reduce working hours as a “national scandal” and calls for swift action to remedy.

Maternity services are flagged as being under serious pressure with more than 500 midwives leaving in a single year. A year ago the Committee’s maternity safety inquiry concluded almost 2,000 more midwives were needed and almost 500 more obstetricians. The Secretary of State failed to give a deadline by when a shortfall in midwife numbers would be addressed.

Pay is a crucial factor in recruitment and retention in social care. Government analysis estimated more than 17,000 jobs in care paid below the minimum wage.

A separate report by the Committee’s panel of independent experts (Expert Panel) published today rates the government’s progress overall to meet key commitments it has made on workforce as “inadequate”.

Health and Social Care Committee Chair Rt Hon Jeremy Hunt said: “Persistent understaffing in the NHS poses a serious risk to staff and patient safety, a situation compounded by the absence of a long term plan by the government to tackle it.

“We now face the greatest workforce crisis in history in the NHS and in social care with still no idea of the number of additional doctors, nurses and other professionals we actually need. NHS professionals know there is no silver bullet to solve this problem but we should at least be giving them comfort that a plan is in place.

“This must be a top priority for the new Prime Minister.”

‘Pandemic-level response’ is needed to address the energy bills crisis, says Holyrood’s Net Zero Committee

A targeted emergency response, on a par with action taken during the pandemic, is needed to address the energy bills crisis, says Holyrood’s Net Zero, Energy & Transport Committee in a report published today.  

The report, which lays out the Committee’s findings following an inquiry into rising energy prices, says the Scottish and UK Governments must provide more immediate, carefully targeted support to those struggling with increasing fuel bills.

The report highlights three areas where the Committee believe immediate action and targeted support for the most vulnerable could be improved. These include additional financial help for households, better energy education and advice services and acceleration of programmes to retrofit and insulate homes.

It also says that medium and long-term plans and strategies must accelerate to reduce future exposure to volatile energy prices and help meet net zero targets.

Dean Lockhart MSP, Convener of the Committee, said: “This is a crisis unfolding in real time and one which we are told threatens ‘a catastrophic loss of life’ if swift action is not taken.

“We recognise some of the actions taken by the UK and Scottish Governments even over the short period of our inquiry, but more can and must be done now and in a more targeted way to get help to those most in need.

“Over the medium to longer term, it is also clear that we need to escape dependence on volatile international energy markets and accelerate all our efforts to enable this.

“For now, our message is clear: the Scottish Government must demonstrate a targeted emergency response to this crisis, on a par with action taken during the pandemic, to ensure the least well off are not vulnerable to death or serious ill-health due to rising energy costs and associated cost of living expenses.”

In the report, the Committee agrees with the Scottish Government on the need to take action through available welfare provisions but asks them to set out how social security and other assistance will be targeted specifically at lower-paid families with young children, those with disabilities and health conditions, older people, and those identified as experiencing or at risk of experiencing fuel poverty.

The report says that a national publicity campaign – akin to those used during the pandemic – and increased support and funding for those providing advice and advocacy at a local level is needed, so that everyone in Scotland looking for help can find it. 

The Committee also recommends that plans for a programme of home heating and insulation, towards which the Scottish Government has committed an investment of £1.8bn, be accelerated and targeted at those most in need.

The Committee is writing separately to the Minister of State for the UK Government, Greg Hands MP, calling for similar urgent action in relation to matters for which he is responsible. 

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Infamy, infamy … defiant Boris says goodbye – but not just yet

PRIME MINISTER BORIS JOHNSON statement 7th July 2022:

Good afternoon everybody,

It is now clearly the will of the parliamentary Conservative party that there should be a new leader of that party and therefore a new Prime Minister, and I have agreed with Sir Graham Brady, the chairman of our backbench MPs, that the process of choosing that new leader should begin now and the timetable will be announced next week

And I have today appointed a cabinet to serve – as I will – until a new leader is in place so I want to say to the millions of people who voted for us in 2019 – many of them voting Conservative for the first time.

Thank you for that incredible mandate, the biggest Conservative majority since 1987, the biggest share of the vote since 1979 and the reason I have fought so hard for the last few days to continue to deliver that mandate in person was not just because I wanted to do so but because I felt it was my job, my duty, my obligation to you to continue to do what we promised in 2019.

And of course I am immensely proud of the achievements of this government from getting Brexit done and settling our relations with the continent after half a century reclaiming the power for this country to make its own laws in parliament, getting us all through the pandemic, delivering the fastest vaccine rollout in Europe, the fastest exit from lockdown and in the last few months leading the west in standing up to Putin’s aggression in Ukraine.

And let me say now to the people of Ukraine that I know that we in the UK will continue to back your fight for freedom for as long as it takes and at the same time in this country we have at the same time been pushing forward a vast programme of investment in infrastructure, skills and technology – the biggest for a century – because if I have one insight into human beings it is that genius and talent and enthusiasm and imagination are evenly distributed throughout the population but opportunity is not, and that is why we need to keep levelling up, keep unleashing the potential of every part of the United Kingdom. And if we can do that in this country, we will be the most prosperous in Europe.

And in the last few days I have tried to persuade my colleagues that it would be eccentric to change governments when we are delivering so much and when we have such a vast mandate and when we are actually only a handful of points behind in the polls even in mid term after quite a few months of pretty unrelenting sledging , and when the economic scene is so difficult domestically and internationally and I regret not to have been successful in those arguments.

And of course it is painful not to be able to see through so many ideas and projects myself but as we’ve seen at Westminster, the herd is powerful and when the herd moves, it moves and and my friends in politics no one is remotely indispensable.

And our brilliant and Darwinian system will produce another leader equally committed to taking this country forward through tough times not just helping families to get through it but changing and improving our systems, cutting burdens on businesses and families and – yes – cutting taxes, because that is the way to generate the growth and the income we need to pay for great public services.

And to that new leader I say, whoever he or she may be, I will give you as much support as I can and to you the British people I know that there will be many who are relieved but perhaps quite a few who will be disappointed and I want you to know how sad I am to give up the best job in the world, but them’s the breaks.

I want to thank Carrie and our children, to all the members of my family who have had to put up with so much for so long

I want to thank the peerless British civil service for all the help and support that you have given our police, our emergency services and of course our NHS who at a critical moment helped to extend my own period in office, as well as our armed services and our agencies that are so admired around the world and

[Political content omitted]

I want to thank the wonderful staff here at Number Ten and of course at Chequers and our fantastic protforce detectives – the one group, by the way, who never leak .

And above all I want to thank you the British public for the immense privilege you have given me and I want you to know that from now until the new Prime Minister is in place, your interests will be served and the government of the country will be carried on.

Being Prime Minister is an education in itself I have travelled to every part of the United Kingdom and in addition to the beauty of our natural world I have found so many people possessed of such boundless British originality and so willing to tackle old problems in new ways that I know that even if things can sometimes seem dark now, our future together is golden.

Thank you all very much.

With so much still uncertain, there’s no doubt those will NOT be Boris Johnson’s last words as Prime Minister …

Just another day at the office?

Boris Johnson ‘gets on with the job’ as his government collapses around him

IT was perhaps the most remarkable day in British political history. Seldom, if ever, has so much drama been packed into twenty-four hours.

What happened yesterday? In summary:

  • New Chancellor of the Exchequer Nadhim Zahawi does the early morning round of media calls: business as usual, getting on with the job, etc. etc.
  • An uncomfortable Prime Minister’s Questions sees Boris Johnson ridiculed by Opposition party leaders and attacked by members of his own party
  • PMQs is followed by a damning statement to parliament by outgoing Education secretary Sajid Javid
  • Boris Johnson leaves Westminster to attempt to appoint new ministers. This proves impossible as there is a steady stream of resignations – more than 40 by the end of the day – as well as new flood of letters of no confidence.
  • If PMQs was painful. an appearance in front of the high-powered Liaison Committee later in the afternoon was excruciating, with politicians from all sides taking the opportunity to heap further misery on a clearly flustered Prime Minister.
  • Asked by a committee member how his week was going, Boris Johnson replied: ‘Terrific’. I assume he was joking – but then, with this Prime Minister, you can never be really sure …

You might have thought the Prime Minister’s ‘terrific’ day couldn’t have got any worse … but this was no ordinary day.

Awaiting the PM at Downing Street was a group of Cabinet ministers, including newly-appointed Chancellor Nadhim Zahawi-, the vast majority of whom urged him to stand down.

The chairman of the Tory Party’s 1922 committee also patiently awaited his audience with the PM – and it’s not breaking any confidences to say that Sir Graham Brady was not the bearer of glad tidings of great joy either …

Johnson met each of them individually, but rather than heed their considered advice that the game was up, the Prime Minister instead sided with the views of arch-loyalists Nadine Dorries and Jacob Rees-Mogg and decided instead to fight on … and as a parting shot for the evening fired arch-conspirator Michael Gove!

Putting all those internal difficulties aside, The Prime Minister found time to ‘get on with the job’ and fired off a letter to Scotland’s First Minister Nicola Sturgeon to confirm that no, I won’t be agreeing to another referendum …

A busy day at the office indeed, and a day on which Wimbledon really couldn’t match Westminster for excitement and drama.

Who knows what surprises today will bring as the Prime Minister attempts to salvage his government from the remnants of his deeply divided party?

Can his ‘terrific’ week really get any worse? Resignation looks inevitable but could this serial survivor really escape once again?

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BREAKING NEWS: JOHNSON TO RESIGN

The BBC is reporting that Boris Johnson will resign as Conservative leader today and will continue as prime minister until the autumn.

It’s understood Mr Johnson will publicly announce his resignation later today.

Crisis facing our swimming pools

RLSS: Why more people could drown

The energy crisis is hurting swimming pool operators up and down the country, with many fearing for their future, seriously impacting their ability to help their community enjoy water safely. Soaring fuel costs could herald a reduction in pool programmes and even threaten the closure of much loved and needed community pools. 

It couldn’t have come at a worse time for the sector. The lasting impact of coronavirus disease (COVID-19), staff shortages, and now sharp and severe price hikes are putting operators under extraordinary pressure and presenting real threats to the nation’s stock of swimming pools.

Our friends at some of the most influential groups in the industry have written to Michael Gove and Nadine Dorries – Secretary of State for the Department for Levelling Up, Housing and Communities and Secretary of State for Department for Digital, Culture, Media, and Sport, respectively. The letter voices their concerns and calls for urgent support to save leisure facilities from closure. Read more here.

At the Royal Life Saving Society UK (RLSS UK), we foresee the impact of swimming pools closing as an increase in drownings. 

In 2020 swimming pools were closed due to COVID-19, and people flocked to beaches, rivers, lakes, and other waters to have fun. Many children hadn’t had swimming lessons for some time and had missed out on their regular visits to the pool with friends or family. This resulted in a drop in water confidence and swimming ability and has unfortunately ultimately resulted in a year-on-year increase in UK accidental drownings through 2020 and 2021. 

We know swimming pools are one of the safest places to enjoy water. Many pools have lifeguards and staff trained to educate users to enjoy the facilities in a safe and fun manner. Swimming pools are such an important part of a community. It is unthinkable that pool closures will mean more children potentially losing out on the life skills of learning to swim and how to enjoy water safely – simply because they do not have a pool to learn and swim in! 

We are working with the sector to help navigate these challenging times, particularly by supporting operators to keep their pools open by ensuring they have highly qualified lifeguards in post.

A shortage of lifeguards is an additional challenge that pools are facing. Lifeguards are critical to the safe operation of swimming pools and providing a secure environment for people to enjoy the water and learn to swim. 

Our National Pool Lifeguard Qualification (NPLQ) ensures the highest of standards and is the most awarded lifeguard qualification in the UK and Ireland (95% of all UK pool lifeguards).

In recent RLSS UK surveys, 99 per cent of RLSS UK candidates told us they felt proud to hold a RLSS UK regulated qualification, and almost three-quarters (71 per cent) of lifeguards told us they felt proud to know how to save a person’s life, with 60 per cent also gaining satisfaction from being part of a highly respected profession. Rightly so, as a recent consumer survey revealed five in six UK adults think that it is important that an indoor pool has trained lifeguards present.

Any swimmer aged 16-years or older can become a NPLQ lifeguard in just five days, and there are currently 350 lifeguard courses advertised throughout the country in June and July. 

A lifeguard qualification is a fantastic springboard for a range of careers, from the emergency services and the military to the leisure sector. #IStartedAsALifeguard

Lifeguards and public swimming pools play a unique role in our society. They provide affordable access to one of the most universally accessible forms of exercise, offering huge benefits for mental and physical health. They are also places where both children and adults learn the skills that could one day save their life. We cannot afford to lose them. That is why we will continue to lend our support to the sector and raise awareness in government of the challenges facing pool operators to help prevent the loss of these valuable assets.

At RLSS UK, we work tirelessly to educate people to enjoy water safely. 

To download our free water safety education resources click here.

For information on RLSS UK’s Drowning Prevention Week, click here.

Follow us on Twitter – @RLSSUK

Visit our Facebook page – facebook.com/RLSSUK 

Call – 0300 323 0096

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-DepartmentDownload

RCEM: ‘Now is the time for an Urgent and Emergency Care plan’

Responding to the latest Emergency Department performance figures published by NHS England for April 2022, Dr Katherine Henderson, President of the Royal College of Emergency Medicine, said: “The crisis in Urgent and Emergency Care continues to deteriorate.

“The data show 24,000 patients were delayed in an Emergency Department for 12-hours or more (from decision to admit to admission). This is a staggering and grim number and should seriously alarm all political and health leaders. Patients are coming to harm; now is the time for an Urgent and Emergency Care plan to tackle this crisis.

“The situation is more serious than it has ever been. Patients face long waits for an ambulance, long waits in an ambulance outside an Emergency Department, and long waits in the Emergency Department. These long waits delay care and treatment to patients who may be in a critical condition, and they prevent our highly skilled paramedics from returning to the community and responding to urgent and emergency calls.

“At the heart of the issue are reduced bed capacity in hospitals mixed with an increase in the number long-stay patients – social care patients who do not have sufficient support to return home or to the community – and widespread workforce shortages throughout the system.

“To tackle the crisis the government must publish a fully funded workforce plan that includes measures to retain existing staff, and open 10,000 more beds across the UK.”

Responding to the government’s announcement of more funding for nursing in care homes, Dr Henderson continued: “This announcement is welcome. Social Care nurses have long been undervalued and under-acknowledged. This increase in pay is a welcome step towards showing them the appreciation and gratitude they highly deserve.

“However, it is a shame to see that this increase in funding is limited to NHS-funded nursing care. The entire social care workforce deserves the same acknowledgement and reward. It is critical that during this crisis we attract and retain social care workers and value their time and effort by paying a wage that reflects the significance of their role.

“Good social care supports an efficient health service. Good social care can help prevent A&E attendances. Good social care will support patients moving in and out of hospital in a timely way. Crucially, good social care frees up space for other patients and increases flow throughout the hospital.”

Emergency Department performance figures worst on record – YET AGAIN

‘Health system remains in dire crisis’

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

  • There were 111,996 attendances at major Emergency Departments
  • 68.4% of patients were seen within four-hours
  • This is the lowest four-hour performance since records began
  • This meant that over 35,000 patients were waiting more than four-hours to be seen, admitted, discharged, or transferred.
  • 10,475 patients were waiting more than eight-hours before being seen, admitted, discharged, or transferred
  • This is the highest number of eight-hour waits since records began
  • It is a 65% increase on the previous month, February 2022
  • It means that around one in 10 patients were waiting eight-hours or more in a major Emergency Department
  • 3,889 patients were waiting more than 12-hours before being seen, admitted, discharged, or transferred
  • This is the highest number of 12-hour waits since records began
  • It is almost a 70% increase on the previous month, February 2022
  • It means that around one in 28 patients were waiting 12-hours or more in a major Emergency Department

Responding to the latest Emergency Department performance figures for Scotland, Dr John Thomson, Vice President of the Royal College of Emergency Medicine Scotland, said:

“Once again, the figures show the worst performance since records began, meaning record numbers of patients facing extremely long waits. March 2022 also saw the highest number of attendances since September 2021.

“There are immense pressures on our health system. Patient safety is compromised, staff are burnt out, ambulance services are severely struggling, and Emergency Departments are dangerously over-crowded.

“During this difficult time, we commend all staff in our Emergency Departments for their resilience and hard work. These are unprecedented and extremely challenging circumstances, a result of a broken health system in dire crisis. We know morale is very low right now, and we know the challenges in providing effective care, but frontline staff across all grades continue to do their very best to keep patients safe.

“Opening 1,000 beds in the health system in Scotland and addressing the staffing crisis in social care is urgently needed to begin to tackle the current situation and to move patients appropriately and timeously through the system. This is an unsustainable situation, month-on-month performance deteriorates, and patients are coming to harm as staff face severe moral injury.”