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?

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.”

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.”

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.”

Scots charity ships thousands of donated items to Ukraine crisis

A SCOTTISH charity has shipped two tonnes of donations destined for Poland’s mobile clinics helping those escaping the ongoing conflict in Ukraine. 

Working in partnership with NHS Scotland Global Citizenship, Artmedis and K&N, Kids Operating Room (KidsOR) has secured the transportation of eight pallets worth of goods from its global logistics centre in Dundee to Krakow, Poland where it will be put to good use by the emergency medics caring for the influx of refugees.

KidsOR is a global organisation focused on providing dedicated operating rooms for children’s surgery with bases in Edinburgh and Dundee.

The donation includes medical products, clothing and footwear as well as items specific items to help in a conflict situation, such as air chambers to assist with ventilation.

Dave Tipping, Director of Global Operations at KidsOR heads up the Dundee logistics centre. He said: “As events continue to unfold in Ukraine, donations are playing a vital role in supporting those most impacted by the conflict.

“That’s why a shipment of medical items once destined for Northern Iraq and Syria, but delayed for two years and eventually unable to be processed due to lack of documentation was, has been redirected to Poland.

“Over the next week, the shipment including blankets, clothing, sheets and gloves – all urgently required – will begin its travel and is expected to reach the mobile clinics within the next week.

“Under such terrible circumstances, we are proud to be able to help in a small way and know these items will be life changing for many.”

The seven-strong team at KidsOR’s Dundee warehouse typically facilitates large shipments of medical equipment to completely fit our paediatric operating rooms. Recent shipments have reached Tanzania, Ivory Coast, Democratic Republic of Congo, Senegal, Zambia and Nigeria.

Founded by Garreth and Nicola Wood, it is the only global organisation focused on the single task of providing dedicated operating rooms for children’s surgery. They work in more than 40 countries to provide world-class surgical facilities and won’t stop until every child has equal access to safe surgery.

For more information on KidsOR, please visit: www.KidsOR.org

Crisis: Scottish Government asleep at the wheel on crisis in NHS dentistry

   
The British Dental Association Scotland has greeted the unanimous support of opposition parties, while accusing the Scottish Government of failing to take needed action to halt an exodus from NHS dentistry and restore access to millions. 
 
In a debate in Holyrood today Scottish Government MSPs voted against a motion on support for NHS dentistry tabled by the Scottish Conservatives and backed by both Scottish Labour and Liberal Democrats.

Ministers have been planning to cut pandemic support from April. While the Government has recently indicated that there will be no “cliff edge”, the BDA has consistently warned that the plans to end Covid support payments and return to a low margin/high volume model of care would devastate dental services across the country.
 
Morale in the profession is at an all-time low, with more than a third of dentists saying they intend to leave the profession in the next 12 months, and 80% planning to reduce their NHS commitment if the Government reverts to pre-pandemic arrangements. Failure to act risks sparking an exodus from the workforce which would mean families across Scotland losing access to NHS dentistry for good.   
 
Over 3.5 million NHS dental appointments were lost in Scotland as a result of the pandemic. As infection prevention and control measures continue to limit the number of patients dentists can see, this unprecedented backlog continues to grow and will likely take years to clear. 
 
The BDA has warned the SNP’s 2021 election pledge of free NHS dentistry for all will be unrealisable without meaningful support and real reform. It is pressing for a workable interim funding model, and long-term change to a system that prioritises prevention, is patient-centred and reflects modern dentistry.   
 
David McColl, Chair of the British Dental Association’s Scottish Dental Practice Committee said: “NHS dentistry in Scotland is facing crisis, but sadly Ministers seem asleep at the wheel. 
 
“Opposition parties are all seeing the plain facts that Scottish Government plans could devastate services millions depend on and widen already unacceptable health inequalities. 
 
“Promises have been made to the voting public that simply that can’t be kept unless we see meaningful support and real reform as we head out of the pandemic.” 

Urgent action needed to address critical issues in delivery of social care

Action is needed now to change how Scotland’s social care services are delivered so that it meets the needs, and improves the experience of, people relying on care and support, say Scotland’s spending watchdogs.    

The joint briefing by the Accounts Commission and the Auditor General for Scotland says fundamental issues and threats to the future sustainability of Scotland’s social care system need to be addressed. The pandemic has exacerbated long-standing challenges, highlighting the precarious situation of many vulnerable people who rely on social care or support.  

Over £5 billion a year is spent on delivering social care services, yet some services are at near crisis point. There needs to be a shift in how this money is used, with a far greater emphasis needed on preventative care that meets the needs of individual people. Service users do not always have a choice or say about what support works best for them. Nor are carers getting all the support and advice they need, despite existing legislation.  

Now the Scottish Government, together with its partners, must listen and bring together the views and experiences of service users and carers. This will support the delivery of their long-held ambitions for social care. 

The 200,000-strong workforce is under immense pressure and feels undervalued. There is a high vacancy rate and a continuing problem of recruiting and retaining this workforce into roles which often have low pay and poor conditions of employment. At the same time demand for social care services continues to increase. 

Commissioning social care services tends to focus on cost, rather than quality or outcomes. Worrying limitations in social care data has created major gaps in the information needed to inform improvements.  

William Moyes, Chair of the Accounts Commission, said: “There are significant problems with the delivery of social care services. These services are vital, yet we have a workforce that’s not adequately valued or regarded.

“Staffing shortages are a major issue across the sector and not all people’s needs are being met. Too often a focus on costs comes at the expense of delivering high quality services that aren’t at the heart of the needs of individuals. The additional funding to achieve this will be significant. Not taking action now presents a serious risk to the delivery of care services for the people who depend on them.

Stephen Boyle, Auditor General for Scotland, said: “We cannot wait another five years until the planned National Care Service is in place. Action must happen now, and at speed, by the Scottish Government.

“There must be clear timescales for delivery, demonstrating that lessons have been learnt from previous reforms of health and social care services. This will create a strong foundation for the government’s vision to create a National Care Service.”

COSLA’s Health and Social Care Spokesperson, Councillor Stuart Currie, responded to the Audit Scotland report on social care: ‘The Audit Scotland report sets out many of the challenges that Local Government has consistently highlighted for many years now.

“There is an urgent need to address these challenges – many of which have been exacerbated by the pandemic – by working with our partners across Scottish Government, in the third and independent sector, and most importantly, people with lived experience.  

“We agree with Audit Scotland  that Social Care reform cannot wait for a National Care Service to be implemented. Local authorities are central to delivering the right care at the right time in the right place.

“Local Government recognises that we cannot stand still if we want to create meaningful change for our communities. We continue to work with Scottish Government to progress our shared commitments outlined in our Joint Statement of Intent so that we can now begin to implement much of the reform that was called for in the Independent Review of Adult Social Care.

“Fundamental to these shared commitments is a recognition that through empowering people, valuing our workforce and embedding a human rights-based approach in social care, we can begin to deliver real solutions for our local communities, unpaid carers, and our workforce.”

Health Emergency: Worst ever four-hour performance “must be a call to action”

The health service is in the middle of the biggest crisis it has ever faced

The latest monthly Emergency Department (ED) performance figures published by NHS England for December 2021 show that four-hour performance at major Emergency Departments reached its lowest since records began at 61.2%, meaning nearly two in five patients were delayed by four-hours or more and nearly 1 in 4 admissions experienced a wait of at least four hours from the decision to admit them to admission.

The data also show the highest number of 12 hour waits ever recorded: 12,986 patients spent 12 hours or more from decision to admit to admission. This is a 22% increase on the previous month, November 2021, and it is 250% higher than December 2020.

Responding to the publication of NHS England quarterly and monthly performance figures, Dr Katherine Henderson, President of the Royal College of Emergency Medicine, said: “The situation on the ground is extremely bleak. Staff are overwhelmed and burned out; it is increasingly challenging to provide timely and safe patient care.”

Latest Quarterly performance figures published by NHS England show that in 2021-2022 there were a total of 43,218 12-hour delays which is more than all the 12-hour delays over the previous ten years put together (39,608).

The data does not paint the full picture as NHS England record 12-hour waits from decision to admit. Our Winter Flow project, which started at the beginning of October 2021, has so far recorded 71,965 12-hour waits from time of arrival.

It is critical that NHS England commit to reporting 12-hour data from time of arrival and implement the Clinical Review of Standards.

Dr Henderson said: “The health service is in the middle of the biggest crisis it has ever faced, and staff are working harder than ever before with fewer staff and fewer beds.

“When the health service is overwhelmed, it does not cease to function, it is the standards and quality of care that fall. The figures published today show the extent to which these standards have fallen already.

“Performance metrics are intended to hold clinical services to account. They are meant to identify areas in which services are failing with the aim of improving them quickly and effectively.

“The consistent and continuous decline of urgent and emergency care performance, standards, patient experience and patient safety show how this intended function is now entirely lost. With each publication around performance, we commentate with shock and dismay at the latest decline, but our comments are, more often than not, met with inaction or short-term fixes. There needs to be acknowledgment that there is a major public health crisis in emergency care.

“It is the core ability and function of the health and social care service to deliver high-quality and effective care to the acutely ill or injured that is at risk.

“We must now see a vision for recovery and a vision for the health service that includes a vital transformation of the urgent and emergency care system. There must be a plan to implement a framework that is centred around patient care, that drives action and improvement.

“The current framework is simply documenting the health system’s failure to deliver a quality service, and the failure of this framework leaves urgent and emergency care in a performance vacuum.

“We need a decision about either a phased implementation of the findings of the Clinical Review of Standards or an honest discussion about how we performance manage urgent and emergency care differently.

The current challenges facing the health and social care service are the result of years of stagnation and decline, they are made worse by, but are not just a consequence of, the pandemic. Recognising this is vital to any step towards transformation.

“It is time we saw bolder political willingness to engage on these critical issues. Without action, performance will continue to decline, and this would be a disservice to patients and staff.”