New report reveals shocking number of deaths caused by crowding in Emergency Departments last year

A new report by the Royal College of Emergency Medicine ‘Crowding and its Consequences’ has found that at least 4,519 patients have died as a result of crowding and 12 hour stays in Emergency Departments in England in 2020-2021.

The new report investigates the extent of harm that crowding causes and applies NHSE’s own findings from the Getting It Right First Time (GIRFT) program which found that one in 67 patients staying in the Emergency Department for 12 hours come to excess harm.

The report also provides comprehensive analysis on a variety of data points:

  • Four-hour target
  • 12-hour waits
  • Decision-to-admit (DTA) waits and admissions
  • 12-hour DTA waits vs. 12-hour time-of-arrival waits
  • Time to initial assessment for ambulance arrivals
  • Time to treatment
  • Median total time patients spend in Emergency Departments
  • Ambulance handover delays
  • Bed availability
  • Length of hospital stays

Dr Adrian Boyle, Vice President (Policy) of the Royal College of Emergency Medicine, said: “To say this figure (4,519 excess deaths) is shocking is an understatement. Quite simply, crowding kills.

“For many years we have issued warnings about the harm that dangerous crowding causes, but now we can see the number of excess deaths that have occurred as a result. This will not surprise any member or fellow of the Royal College.

October 2021 saw an unimaginable 7,059 12-hour stays from decision to admit, the highest number ever recorded, 40% higher than September 2021 which was the previous highest on record. The number of 12-hour stays has risen drastically for six months and is very likely to rise again in coming months.

“The picture is more bleak as Hospital Episodic Statistics show that 12-hour stays from time of arrival are 21 times higher than 12-hour DTA stays. We now know that at least one in 67 of these patients are coming to avoidable harm. It is appalling.

“The situation is unacceptable, unsustainable and unsafe for patients and staff. Political and health leaders must realise that if performance continues to fall this winter: more and more patients will come to avoidable harm in the Emergency Department; staff will face moral injury; and the urgent and emergency care system will be deep into the worst crisis it has faced.

“This potential trajectory is supported by the recent report by the Association of Ambulance Chief Executives that found that as many as 160,000 patients annually, may be coming to harm as a result of delayed ambulance handovers. We continue to urge the Secretary of State to meet with us to discuss patient safety and the unprecedented pressures facing the urgent and emergency care system.

RCEM CARES: The Next Phase outlines our system-wide plan to improve patient care. In the short-term Trusts must safely expand capacity where possible. They must maximise the use of services such as Same Day Emergency Care and Discharge to Assess. Trusts must focus on promoting flow through the hospital, ensuring patients are discharged in a timely way once their treatment is complete.

“In the long-term, the government must restore bed capacity to pre-pandemic levels, across the UK an additional 7,170 beds are required. The government must ensure that social care is resourced to support patients both when leaving hospital and once they are back in the community, this would help to reduce long hospital stays and prevent successive trips to the Emergency Department.

“Lastly, as a matter of urgency the government must publish a long-term workforce plan, this must include actions to retain existing staff who are reaching burnout as well as to recruit new staff. Across the UK there is currently a shortfall of 2,000 – 2,500 WTE Emergency Medicine consultants, as well as shortages of essential Emergency Medicine nurses and junior and supporting staff.

“This is the beginning of a long winter and an extremely challenging time for the current workforce as pressures will rise and patient safety will continue to be put at risk. These pressures may currently be facing urgent and emergency care and the ambulance services, but the solutions and actions must be system-wide and joined-up.

“It is up to the government, NHS leaders, and all of us to work together to put a stop to dangerous crowding; avoidable harm; preventable deaths; ambulance handover harm; and to ensure that we keep patients safe and deliver effective urgent and emergency care.”

TUC: Employers are “massively under-reporting” Covid deaths

  • Employers claim just 2.5% of working-age Covid deaths are from exposure to Coronavirus at work 
  • System for reporting workplace deaths and infections is “letting bad bosses off the hook”, says TUC 
  • Under-reporting has badly undermined health and safety regulation and enforcement during the pandemic 

The number of people who have died from exposure to Covid at work is being “massively under-reported” by employers, according to a new TUC report published yesterday (Sunday). 

The report highlights a huge discrepancy between Covid work-related deaths reported by employers and data from the Office for National Statistics (ONS) and Public Health England. 

Between April 2020 and April 2021 the ONS reported that 15,263 people of working age died from Covid.  But according to reports filed by employers just 387 (2.5 per cent) of these deaths came from workers contracting Covid at work. 

The union body says this under-reporting has badly undermined health and safety regulation enforcement during the pandemic with employers less likely to face action from regulators for putting staff at risk. 

Under-reporting in at-risk sectors 

The TUC’s report shows that in sectors with high numbers of deaths during the pandemic –  like food production and transport – only a small fraction of deaths have been reported as work-related by employers. 

Figures from the ONS show that between March 2020 and December 2020 more than 600 people working in the transport sector died.  

But according to reports filed by employers (over the longer period of April 2020 to April 2021) just 10 deaths in the transport sector were work-related. 

And figures from the ONS show that 63 food production workers died between March 2020 and December 2020. 

But according to data supplied by employers (over the longer period of April 2020 to April 2021) just three of these deaths were the result of work. 

The TUC believes the true number of work-related deaths in these and other sectors are much higher, especially considering the high number of breaches of safety protocols we have seen during the pandemic and the high numbers of outbreaks.  

Reporting system “letting bad bosses off the hook” 

Employers are required by law to report deaths, injuries and illnesses that take place at work or in connection with work.   

This is done through a mechanism called RIDDOR (The Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013) which logs work-related deaths, illnesses and injuries for the Health and Safety Executive (HSE). 

But under the current reporting system employers are given “free rein” to decide whether a Covid-19 diagnosis is the result of occupational exposure or from exposure outside of work premises. 

The TUC says this loophole has led to employers not reporting the true scale of Covid work-related deaths and infections to the HSE, despite this information being vital to containing the spread of the virus. 

Enforcement crisis 

The TUC says that for the HSE to do its job effectively it must possess an accurate and up-to-date picture of where and when work-related deaths and infections are taking place. 

But during the pandemic it has only been provided with very partial information from employers.  

This has prevented the HSE from carrying out potentially urgent inspections and ensuring employers take the necessary action to keep workers and the public safe, says the report. 

TUC analysis shows that just 1 in 218 workplaces has been inspected by the HSE (between March 2020 and April 2021) and not one single employer has been prosecuted for putting staff at risk.  

The union body says this “crisis of regulation and enforcement” has allowed bad bosses to get away with flagrant labour rights abuses – adding that the pandemic has highlighted Britain’s enforcement system’s long-standing deficiencies. 

New approach needed to health and safety 

As well as calling for improvements in the way work-related delated deaths and infections are reported, the union body says government must reverse cuts to the HSE of the past decade, which it says left the country “under-prepared and vulnerable” to the pandemic.  

The last ten years has seen real term cuts of 50 per cent to the HSE budget, on top of local authority budgets being slashed.  

There has also been a dramatic decline in inspections. There were 27 per cent fewer HSE inspections carried out in the UK in 2019 than 2011, amounting to a fall of over 5,700 a year. 

TUC General Secretary Frances O’Grady said: “Everybody deserves to be safe at work. But this pandemic has exposed a crisis in health and safety regulation and enforcement. 

“Employers have massively under-reported Covid work-related deaths and infections. This has made it much harder for regulators to track where outbreaks are happening and allowed bad bosses to get away with flagrant labour rights abuses. 

“It’s staggering that not a single employer has been prosecuted for putting workers at risk of contracting Covid-19.  

“The government must fix the deficiencies in how workplace deaths, illnesses and injuries are reported. The current system is letting bosses off the hook. 

“And ministers must fund enforcement bodies properly so they can recruit and train qualified workplace inspectors, inspect more workplaces, and prosecute companies who don’t keep their workers safe.”

A copy of the report can be found at: https://www.tuc.org.uk/sites/default/files/2021-05/Underreporting%20of%20RIDDOR%20report%20-%20May%2021.pdf

Call The Midwife: RCM Scotland launches publication showcasing varied role of midwives

RCM also calls for investment in maternity services

Midwifery in Scotland – into the 2020s A5 16pp_1-final-page-0

A new publication published today by the Royal College of Midwives in Scotland highlights the breadth of roles of Scottish midwives. Continue reading Call The Midwife: RCM Scotland launches publication showcasing varied role of midwives