Emergency Department performance figures – The NEN

RCEM: ‘Now is the time to plan and prepare for winter’

The Royal College of Emergency Medicine has responded to June 2023’s Emergency Department performance figures for Scotland.

The data show:

In June 2023, there were 116,244 attendances at major (Type 1) Emergency Departments across Scotland.
69% of patients were seen within four-hours at major Emergency Departments.
- This is an increase of 1.8 percentage points from the previous month.
36,015 patients waited over four-hours in major Emergency Departments, this is a decrease of 7.7% from the previous month and an 3.8% decrease from June 2022.
- It is encouraging to see performance improving but it is still well below the target to see 95% of patients in four-hours or less. This is the second worst June on record. The number waiting more than four hours was an increase of 296% compared with June 2021.
9,489 (8.2%) patients waited eight-hours or more in an Emergency Department
- This is a decrease of 16.5% from the previous month, and a 0.9% decrease compared with June 2022.
2,991 (2.6%) patients waited more than 12-hours before being seen, admitted, discharged, or transferred
- This figure has decreased by 24.2% from the previous month, and an increase of 30.6% compared with June 2022.

Responding, RCEM Scotland Vice President Dr John-Paul Loughrey, said: “A&E performance in Scotland is slowly trending in the right direction. Our members continue to work hard to reduce delays, mitigate dangerous overcrowding and improve patient care and these figures are in no small part thanks to them.

“To capitalise on these improvements, we hope to have continued engagement with the Health Secretary and support from Scottish Government. Now is the time to plan and prepare for winter and provide adequate resources and beds as well as measures to retain staff.

“Our #ResuscitateEmergencyCare campaign lays out the necessary steps we need to take to ensure the health service is equipped to deliver effective, high-quality care and prevent another catastrophic winter.”

No time to delay: RCEM calls for meeting with new Health Minister

‘The Emergency Care system is not functioning as it should’, RCEM says as Emergency Department performance drops

Responding to the latest Emergency Department performance figures for Scotland for March 2023 Dr John-Paul Loughrey, Vice President of the Royal College of Emergency Medicine Scotland, said: “The data show another drop in performance. This means more patients facing longer waits, more delays to care and more harm.

“We cannot continue to see this occur, we need to be seeing improvements in performance and a reduction in delays to care. This is a signal that the current interventions and actions are not having the time critical impact that we need to be seeing.

“The Scottish Government needs to understand that hesitancy to take the necessary actions will impact on the safety of patients and their care. Emergency care is not functioning as it should, no patient should face a 12-hour wait in an Emergency Department.

“We know what needs to be done: ensuring social care is responsive and able to support the timely discharge of patients; expanding acute bed capacity across Scotland; retaining existing staff while recruiting more staff into Emergency Medicine. These are the solutions laid out in our campaign Five Priorities for UK Governments for #ResuscitatingEmergencyCare.

“We would welcome an opportunity to meet the new Cabinet Secretary for Health and Social Care, Michael Matheson MSP, to put forward these solutions and the means to tackle the crisis in Emergency Care. We cannot consider this to be winter pressure anymore; this is year-round, and it continues to cause harm. We must do better for patients and staff, there is no time to delay.”

The latest performance figures for March 2023 for Emergency Departments across Scotland show:

There were 110,446 attendances at major Emergency Departments
64.5% of patients were seen within four-hours at major (Type 1) Emergency Departments
- This is a decrease of 1.9 percentage points from the previous month, and a decrease of 3.9 percentage points when compared with March 2022
- 39,253 patients waited over four-hours in major Emergency Departments, this is an increase of 22.3% from the previous month
In February 2023, 13,750 (12.4%) patients waited eight-hours or more in an Emergency Department
- This is an increase of 33.9% from the previous month, February 2023, and the highest figure so far this year
- When compared with March 2022, this figure has increased by 24.8%
- This is equal to more than one in eight patients waiting eight-hours or more in a major Emergency Department
5,739 patients waited more than 12-hours before being seen, admitted, discharged, or transferred
- This figure has increased by 25.6% from the previous month, and an increase of 39% compared with March 2022

‘Focus on simple solutions’ RCEM says, as patients continue to face long waits amid crisis in Scotland

Responding to the latest weekly Emergency Department performance figures in Scotland Dr John-Paul Loughrey, Vice President of The Royal College of Emergency Medicine Scotland, said:

“We are deeply concerned about this winter; the crisis continues to escalate. Patients continue to face exceptionally dangerous long waits. We estimate that one in 72 patients waiting between eight to 12-hours in an Emergency Department can die as a result of these waiting times (30-day all-cause mortality).

“But these are data, the reality is Emergency Departments are overcrowded and in extremis. Patients with an array of different needs and care are packed in, facing high-risk and uncomfortable waits on trolleys in corridors. There is a lack of privacy, a lack of dignity, staff are stretched thinly meaning patients find it difficult to get the things they need – be it food or water or bathroom facilities, while they wait hours for a bed. Meanwhile, ambulances queue outside our Emergency Departments with more patients waiting to simply get in.

“Emergency Medicine staff and ambulance crews and paramedics are highly skilled, highly trained competent professionals, but the inability to move patients through the system means they are overstretched and overwhelmed, and unable to provide the high-quality care that they are trained to provide. Patients are worried and anxious, staff are increasingly distressed, unable to provide the real care that they want and should be providing.

“The solutions are simple; bolster the social care workforce to ensure the timely discharge of patients; tackle the recruitment and retention crisis among all health workers; increase capacity by opening an additional 1,000 beds in the acute system across Scotland. These will begin to address the root of the crisis.”

Addressing the concern around Strep A and the increase in attendances at Paediatric Emergency Departments in Scotland, Dr JP Loughrey said: “In recent weeks we have seen a marked increase in the number of children attending our Paediatric Emergency Departments, cases of Strep A remain high.

“We know parents are worried at this time. The College has issued advice and guidance together with the Royal College of Paediatrics and Child Health and the Royal College of General Practitioners.

“Emergency Departments remain open to those who need it. If children have symptoms, or parents are unsure, please seek care first through NHS 24, your GP or local pharmacist. If the symptoms are severe or your child’s condition worsens, do not hesitate to seek the necessary emergency care. We are here to help.”

Scotland’s latest weekly Emergency Department performance figures show:

There were 25,450 attendances at Emergency Departments
Four-hour performance stood at 63.4%, the fourth lowest on record
9,314 patients waited more than four-hours in an Emergency Department
- More than one third of patients were waiting for more than four hours in an Emergency Department
3,048 patients waited more than eight-hours in an Emergency Department
- Nearly one in eight patients were waiting for more than eight-hours in an Emergency Department
1,276 patients waited more than 12-hours in an Emergency Department
- One in twenty patients were waiting more than 12-hours in an Emergency Department

RCEM response to worst Scottish weekly performance figures ever

The latest weekly update of Emergency Department performance figures for Scotland show:

There were 21,163 attendances at A&E services in NHS Scotland.
67.4% of attendances at A&E services were seen and resulted in a subsequent admission, transfer or discharge within 4 hours.
2,079 patients spent more than 8 hours in an A&E department.
690 patients spent more than 12 hours in an A&E department.

This data shows the worst weekly four-hour performance since records began. The highest number of (weekly) eight hour waits since records began, and the highest number of (weekly) 12-hour waits since records began.

More than one in eight patients were delayed in an Emergency Department by eight hours or more.

Responding to this data, Dr John Thomson, Vice President of the Royal College Emergency Medicine, Scotland, said: “This data is deeply concerning and distressing. More than one in eight patients have been delayed by eight hours or more; this is shocking.

The health service is in the middle of a serious crisis. Staff are working exceptionally hard but are burnt out and overwhelmed and face moral injury on every shift.

Patient safety is frequently compromised. We know long waiting times increase the risk of death and patient harm. The exit block that exists in our Emergency Departments which prevents patients moving in a safe, timely manner to an appropriate ward is worsening, causing even more harm to our patients.

“It is a critical time for the health service, and we must see a vision for the future. The government must acknowledge the shortfall in staff and beds as the root of this crisis, and this must lead to a commitment to publish a long-term workforce plan that includes measures to retain existing staff who may be thinking of leaving our NHS following this exceptionally challenging period.

“The government must also commit to opening 1,000 more acute beds across Boards in Scotland, which will promote timely patient flow through the hospital. Lastly, a key cause of exit block are the patients who remain in hospital when they no longer require ongoing Hospital care.

“The ongoing crisis in social care means patients are unable to be discharged home following the completion of their treatment. It is vital social care is resourced and adequately staffed to support the most vulnerable patients in their return to the community.”

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.”

Winter is a looming crisis; effective action must be taken before it’s too late, says RCEM

The latest Emergency Department performance figures for August 2021 show the worst four-hour performance since records began, the worst performance for an August, and the fourth highest number of 12-hour stays ever.

The data show there were 1,342,250 attendances to Type 1 Emergency Departments in England in August 2021, a decrease of 6% compared to the previous month. Despite the decrease in attendances, four-hour performance deteriorated for the fifth consecutive month while the number of 12-hour stays increased for the fourth consecutive month.

In Type 1 Emergency Departments, 66.2% of patients were seen in four-hours or less, the worst four-hour performance on record and equal to over one-third of patients staying in a Type 1 Emergency Departments for over four-hours.

2,794 patients stayed in an Emergency Department for 12-hours or more, this is a 26% increase on the previous month and is the highest ever for August, it is also the fourth highest figure on record.

Data also show there were a total of 71,894 booked appointment attendances, with 34,787 of these booked at Type 1 Emergency Departments. Four-hour performance was at its lowest since records began, with 91.6% of all attendances seen within four-hours, and 82.5% of Type 1 attendances seen withing four-hours.

Dr Katherine Henderson, President of the Royal College of Emergency Medicine, said: “These figures come as no surprise, but they are no less appalling. The health service has been severely struggling in recent months and the College has been vocal in its warnings about this trajectory. We are now in autumn and the workforce is seriously apprehensive about this winter and what it might bring.

“The pandemic has highlighted stark inequalities; different parts of the country have been affected to different degrees of severity – and the continued impact and recovery has been harder in more deprived areas. In particular, the urgent and emergency care systems in the North East and North West are facing particularly extreme pressures.

“Average four-hour performance in the both the North East and North West is 63% while in the South East it is 73%. As part of levelling up, it is vital that these inequalities are properly addressed and not overlooked, and that support is given to those areas and to those patients that need it most.

“Departments also need clarity of focus in terms of priorities, and the priority must be long stays – this month’s fourth worst ever number of 12-hour stays shows the desperate need to improve the flow of patients through hospitals. But England continues to only publish 12-hour data measuring from decision to admit. Good statistics that accurately measure performance are essential in improving systems and publishing 12-hour data from time of arrival would show the true scale of the problem of long stays.

“The data also show that performance against booked appointments has sharply deteriorated. We must properly evaluate the efficacy of NHS 111 ‘talk first’ approach, so we can begin to improve it. There must be an adequate range of services available that NHS 111 to which call handlers are able to direct patients. Patients must be able to be directed to the right place for their care, and any patient booking an appointment at A&E through 111 must not be left waiting for a long period of time.

“At the same time there must be a renewed focus on the workforce. Our survey from July 2021 showed that half of all respondents said they were considering reducing their hours, while a large proportion are thinking of taking a career break or even changing specialty.

“The workforce cannot afford to lose any Emergency Department staff, we must do all we can to retain existing workers. To tackle this there must be a recruitment drive for Emergency Departments, in England 2,500 more consultants are needed – alongside sufficient numbers of nurses, trainees, allied health professionals and SAS doctors.

“To reduce crowding in hospitals, there must be investment in alternative care pathways including same day emergency care and discharge to assess, these will help prevent unnecessary admission.

“The vision for urgent and emergency care must be implemented and Emergency Medicine staff need to be assured that progress is being made. The College has laid out what needs to be done in RCEM CARES, and reports including; Summer to Recover; and Retain, Recruit, Recover.

“Patient safety is at risk and on this trajectory, winter will be far worse than previously forecast – it is a looming crisis – and the health service is on the brink. The cost will be huge. Funding is welcome, but a comprehensive, joined-up plan, that must include short-term actions for the winter ahead together with a long-term strategy is vital.

“We are at a crucial point; Emergency Department performance continues to deteriorate while elective care waiting lists continue to rise steeply. The government must see the iceberg ahead and steer the health and social care service to safety.”