Royal College of Eemergency Medicine – The NEN

Three quarters of A&E staff witness violence and aggression at work at least once a week

‘Safe to Care’ campaign launched

Around three in four UK Emergency Department staff have told the Royal College of Emergency Medicine that they experience or witness violence and aggression in their department on a daily or weekly basis.

That’s according to new survey data, revealed today (7 September) as part of the launch of RCEM’s Safe to Care campaign.

‘Safe to Care‘ aims to highlight the appalling levels of violence and aggression that doctors, nurses and other healthcare staff in Emergency Medicine continue to face while at work.

In the coming weeks and months, RCEM will be sharing testimonies of those who have experienced violence or aggression at work and will be calling on the four UK governments to take immediate action to ensure Emergency Department (ED) staff feel safe, and are safe, to provide care.

Levels of violence towards NHS staff has become intolerable: RCEM surveyed over 2,000 ED staff, with 96% of respondents saying they experienced violence or aggression in their ED from patients or members of the public.

More than three quarters (73%) said it was a weekly, or even daily, occurrence and around two thirds said the incidents they experienced were of a discriminatory nature.

One anonymous resident doctor told the survey: “Working in the ED, you brace yourself for a lot, but nothing truly prepares you for direct, hateful verbal abuse, especially when it’s racially charged.”

Meanwhile, an ED consultant told the survey that they had been kicked in the face by an aggressive patient lying on a trolley.

Just four per cent told RCEM that they always felt safe working in ED, and barely more than half (57%) felt safe most of the time.

If left to continue, the impact this will have on the workforce could be devastating for Emergency Medicine, with 75% of staff reporting short-term stress and anxiety, 40% experiencing burnout, 14% taking time off work – and 28% experiencing long-term stress or anxiety.

Meanwhile, many staff said they had little confidence that reporting incidents will lead to action, with fewer than half (41%) of staff who made a report saying their trust took ‘meaningful action’.

Dr Ian Higginson, President of the Royal College of Emergency Medicine, said: “No one should go to work fearing or, worse, expecting, to be attacked, intimidated or abused. Nor should they lack confidence that their employers have their backs, or that the judicial system will kick in.

“Yet, that’s the reality faced by the majority of my colleagues in EDs across the country. They often do not feel safe to care for patients. It is an appalling state of affairs which is contributing towards many people seriously considering whether Emergency Medicine – or even healthcare in general – is for them.

“Tackling violence and aggression is crucial for the wellbeing of staff, whose dedication to the NHS is all too frequently being repaid in kicks, punches and abhorrent verbal abuse.

“We know that long waits and crowding are key drivers of this, but that is not the fault of staff – that’s on our governments. Every hour of every day, our Emergency Medicine teams are there for patients. It’s time staff received the respect and safety they deserve.

“This should not be a novel concept to anybody. Much has been said by us and other organisations over the years about violence and aggression towards healthcare staff. But the problem seems to be getting worse, not better.

“It’s time for action, time for governments, employers and organisations stand up for NHS staff, and time to ensure that those who intimidate, abuse or assault those who are trying to care for them face meaningful consequences for their actions.”

Violence and aggression is not always an isolated problem. Many survey respondents pointed out that long waiting times (90%), overcrowding (85%), staff shortages and corridor care (both 65%) was making the problem worse.

Tackling these issues will undoubtedly create a calmer environment in A&E, which provokes fewer incidents.

In a new briefing, RCEM is calling on government in the four nations, and NHS leaders, to make Emergency Departments safe to care by:

Preventing violence and abuse before it occurs – starting with the eradication of long waits to be seen, crowding and corridor care, whilst strengthening security standards
Supporting staff through better training, reporting, follow-up, and links with the police
Improving accountability of organisations to protect and support NHS staff, with better working across systems to ensure perpetrators face justice

Dr Catherine Hayhurst, co-chair of the RCEM Quality in Emergency Care Committee, said: “Safe to Care has a very clear goal: make EDs a place in which you can work without fear of intimidation or attack.

“Some of the stories that our members have told the campaign so far have been heartbreaking – but not surprising.

“Whilst most patients and relatives continue to be a pleasure to treat, it is true that we are seeing increasing levels of unacceptable behaviour from a significant minority.

“Anyone who works in ED knows that violence and aggression towards healthcare staff has become normalised. That must end and we call on policymakers and NHS leaders to help us make EDs a safer place for staff.”

RCEM_Safe-to-Care_VA_Briefing_Media_0926 Download

RCEM: Scottish government must act now to avoid a “truly ugly winter”

12-hour waits in EDs joint worst on record for October

The Scottish government must take urgent action on overcrowding and delayed discharges, or Emergency Departments (EDs) in Scotland will be completely swamped – and patients will be the ones who suffer.

ED performance figures, released today (2 December 2025) by Public Health Scotland (PHS) for October 2025, showed that one in 16 (7,362) patients waited 12 or more hours before being admitted, transferred or discharged in that month.

That is the same proportion as last October, which was the worst since records began in 2007 for 12-hour waits.

The figures also showed:

16,659 patients, or 14.1% of all attendances, waited eight or more hours, the worst of any October on record, and an increase of 1,211 on last year

Only 62.8% of patients were seen within four hours at major (Type-1) Emergency Departments, which is the worst four-hour performance for any October since records began and far below the target of 95%

There was an average of 1,981 beds each day occupied by patients medically fit to be discharged

These figures come shortly after the publication of the Scottish government’s winter plan, in which it pledged £20m to tackle delayed discharges across the devolved nation.

Dr Fiona Hunter, RCEM Vice President for Scotland, said: “The figures for October demonstrate the unacceptable pressures our departments are under, and just how bad things are as we go into winter.

“Now, seasonal pressures such as flu are beginning to hit EDs and the system is starting to crack under pressure,which means patients and staff are suffering. And we are only in the early stages of winter so it will likely become even worse for patients if nothing changes.

“As our hospitals deal with the inevitable strains and stresses on vital resources that the colder weather brings we’ll once again see the consequences of the failure to properly tackle the issues EDs face; overcrowding, long delays and avoidable deaths.

“The number of patients experiencing the longest waits is utterly unacceptable and something must change. Clinicians, through no fault of their own, are struggling to provide our patients with the care they deserve and need.

“Last month, we welcomed the government’s £20 million funding announcement to boost social care capacity this winter, and its accompanying plan for the health service to tackle the cold months.

“This showed that the government understood the issue. But we need that understanding to translate into further meaningful short and long-term action. Urgent action is needed to ensure that health boards can make the improvements that are needed to improve patient flow and tackle delayed discharges.

“Our EDs will only get through the coldest months if the government steps in – or we all need to brace ourselves for a truly ugly winter.”

Graphs of the data can be found on the RCEM website.

#ResuscitateEmergencyCare

RCEM: ‘Evidence to address delayed discharges continues to mount’

The issue of people who are well enough to leave being stranded in hospital wards and occupying increasingly scarce inpatient beds must be addressed if Emergency Care in Scotland is to improve.

That’s the response of the Royal College of Emergency Medicine Scotland as new data reveals that May 2025 was the second worst May on record for so called ‘delayed discharges’.

Published today (1 July 2025) the figures from Public Health Scotland, which detail A&E performance, show a daily average of 1,852 beds were occupied by people who were considered to no longer need inpatient care – the second highest for any May since guideline changes in 2016.

And when compared to the previous month (April 2025) – it’s an improvement of just two beds.

If patients cannot be discharged, this affects the flow of people through the hospital – and people end up stranded in A&E, often waiting extreme hours on a trolley in a corridor, for a ward bed to become available.

Covering May 2025, the figures reveal that:

125,779 people visited a major A&E Department (Type 1) in Scotland. A 6.7% increase compared to April.

Of these, one in three patients (40,261) waited four hours or more to be treated, admitted or discharged (32%).

Meanwhile, just fewer than one in 10 patients (12,672) waited eight hours or more in major EDs – the second highest number for the month of May.

And 4,863 patients waited 12 hours or more – the equivalent to one in every 26 patients. Which is a slight improvement on the previous month when 5,139 patients endured this wait.

The figures come just a week after Public Health Scotland released data revealing there were 720,119 days spent in hospital by people whose discharge was delayed during the year 2024/5 – the highest annual figure reported since guidelines changed in 2016.

Of the total number of delayed discharge bed days, 73% were due to health and social care and patient and family related reasons (522,599).

Vice President of RCEM Scotland, Dr Fiona Hunter, said: “Yet again, the evidence to address delayed discharges continues to mount.

“As I’ve said before, and I will say it again, the situation at our hospitals’ ‘backdoor’, where we unable to discharge people, is deeply concerning and distressing for both patients and the workforce.

“Patients when they are well enough to leave want to do just that – leave, to continue their recovery. But often they can’t because of a lack of social care.

“Meanwhile in A&E, seriously unwell people are left waiting for that elusive ward bed to become available, watching the clock tick by and counting the hours they have spent on a trolley in a corridor.

“This is the reality for thousands of patients every month, while Emergency Medicine clinicians try their best to treat patients in areas that weren’t designed to deliver care in. And it’s not just an issue confined to the winter months – it’s year-round.

“So it is hard to celebrate slight improvements in extreme waiting times when every day my colleagues are struggling to admit vulnerable patients that need further care.

“Until available inpatient bed numbers increase the crisis in our EDs will continue.”

Graphic visualisations of the data compiled by RCEM can be found here.

RCEM calls on Scottish government to address long, dangerous A&E waits

‘We need more than apologies, we need action’

As Scotland’s hospitals experienced the second worst January on record for A&E performance, the Royal College of Emergency Medicine has told the government ‘we need more than apologies, we need action’.

The figures, released last week (4 March) by Public Health Scotland, come after the First Minister, John Swinney and Health Secretary, Neil Gray, apologised to patients who have experienced extremely long stays in A&Es.

The PHS data, for the month of January, reveals 8,401 patients waited 12 hours or longer in an Emergency Department before being admitted, discharged or transferred.

Since January 2018, the number of people waiting 12 hours or more in major A&Es has increased by 11 times (767 to 8,401), eight hours or more by six times (2,816 to 16,684) and four hours or more by 2.6 times (15,401 to 40,552).

Patients are often stuck in Emergency Departments, on trolleys in corridors, experiencing extremely long stays because there are no in-patient beds available.

This is caused because people who are well-enough to go home cannot be discharged, often due to a lack of social care support.

Therefore, the system grinds to a halt, with ambulances queued outside EDs, waiting to handover their vulnerable patients.

So called ‘delayed discharges’ meant that an average of 1,964 patients each day were in hospital, waiting to be discharged, despite being deemed medically well enough to go home. This is the highest number since 2016, when guidelines changed.

Dr Fiona Hunter, Vice President of RCEM Scotland said: “This data provides a glimpse into the levels of pressure major hospitals in Scotland were under during the depths of winter.

“Each figure, a person who was seeking urgent care in a system that is well off being described as ‘gold standard’.

“And behind each person, is a team of hard-working and burnt-out Emergency Medicine clinicians who are trying to deliver the best care they can to patients who are often on a trolley in a corridor.

“The time for warm words and apologies from policy makers has passed, we need action. Long stays are not just inconvenient – they are dangerous. This is where the real harm lies for patient safety.

“The government’s operational improvement plan, set to be delivered this month, is a golden opportunity to detail how it will address this vitally important issue.

“Until a meaningful plan is put in place, staff and patients will continue to bear the brunt of a system that is in crisis.”

The Scottish Liberal Democrats recently revealed that an 87-year-old woman waited around 12 hours at A&E on separate occasions after she fell and broke her hip.

Her experience was highlighted as the party released data showing 12,438 people aged over 85 waited more than 12 hours in A&E in 2024.

After hearing the patient’s experience, First Minister John Swinney apologised to her and her family for the wait.

Earlier last month, Health Secretary Neil Gray MSP apologised on BBC’s ‘Reporting Scotland’, stating “anybody that is waiting for too long to receive services, either in an Accident and Emergency Department or waiting on elective procedure, I apologise to them. It’s not an acceptable situation.”

Scottish government urged to heed A&E ‘alarm bells’

The Scottish government must heed the ‘alarms bells’ as new A&E data suggests another very challenging winter ahead.

That’s the call from The Royal College of Emergency Medicine (RCEM) Scotland as new data for Emergency Department performance in August reveals it was the worst August since records began in 2011, for patients experiencing extremely long waits.

The figures released yesterday (Tuesday 1 October) by Public Health Scotland, show that the number of patients waiting 12 hours or more in August was higher than in any January or February from 2012 to 2022, despite it being a month in summer when Emergency Department performance tends to improve.

More than a third of people (34.2%) waited over four hours, more than one in 10 (11.3%) waited eight hours or longer, while 4.65% of patients waited over 12 hours in a Scottish ED.

The data shows long waits have increased significantly since the 2010’s.

Since August 2017, for example, the numbers waiting four hours or more has increased by six times (6,743 to 39,096), eight hours or more by 37 times (347 to 12,954), and 12 hours or more by 127 times (42 to 5,312). This is despite attendance only decreasing by 0.7% in the same period.

Dr John-Paul Loughrey, RCEM Vice President for Scotland said: “It once was that the summer months provided some respite from the stresses experienced in Emergency Departments, but those days are long gone.

“Yet again the figures show the reality of the pressure we have been dealing with this summer, which is on a level with what we would have experienced during the busiest winter months just a few years ago. Overcrowding in our A&Es is now at winter crisis levels all year round.

“The alarm bells are sounding loudly as winter approaches, and the government must respond.

“Last week’s Winter Preparedness plan however gives me little hope that they will respond in the ways we have recommended. It lacks any specific measures to address the inevitable spikes in demand for Emergency Care which comes during the colder months, or the lack of capacity in the acute care system as a whole.

“Once again Scottish people seeking emergency care this winter are facing extreme waits and, for many, the indignity of so called ‘corridor care’. These are not just inconvenient, they are dangerous and potentially life threatening.

“The Scottish government must bolster its winter planning to ensure that people who need to be admitted to hospital from A&Es can be, without excessive waits, and that when they are well enough to leave there is the necessary social care in place for them to do so.

“Failure to do so puts us on course for a harmful and incredibly difficult winter which is not what we or our patients want or deserve.”

A graphical representation of the data can be found here.

The full data set can be found on the RCEM website.