Royal College of Emergency Medicine – Page 4 – The NEN

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.”

Emergency care crisis deepens

The latest Urgent and Emergency Care Daily Situation Reports 2021-22 for week ending 2 January 2022 show:

There was a total of 562,062 instances of staff absences
249,173 instances of staff absences were covid related, an increase of 41% on the previous week
Nearly half of instances of staff absences were covid related
Since the start of December there has been an increase of 198% in covid-related instances of absence
On average 16,906 patients resided in hospital who no longer fit the criteria and were ready to be discharged, of these, on average, 9,858 remained in hospital
This is equal to almost six in 10 patients who were ready to be discharged remaining in hospital
Nearly one quarter of ambulance arrivals were delayed by 30 minutes or more
Almost one in 10 ambulance arrivals were delayed by at least an hour

Dr Katherine Henderson, President of the Royal College of Emergency Medicine, said: “The scale of the pressures facing the health service is highlighted in these figures. Instances of covid-related absence have tripled since the beginning of December. Now the army has been deployed to assist the health service in London.

“Ambulances continue to be delayed in handing over patients on arrival putting patient safety at risk, while high numbers of patients ready to be discharged remain in hospital due to the ongoing social care crisis.

“Promoting flow through the hospital is vital but rests upon timely discharge of patients back home once their treatment is complete. To ensure this social care must be resourced and supported, this will help reduce admissions and free up beds in hospital.

“It is a perilous situation, and an enormous strain is put upon staff working in hospitals, who continue, as ever, to go above and beyond to ensure care continues to be delivered and patients are kept safe.”

RCEM: Health system under enormous strain as Covid impacts emergency care

The latest A&E activity and waiting times for major Emergency Departments in Scotland for November 2021 show:

73.8% of attendances were seen and resulted in subsequent admission, transfer or discharge within four hours – an increase of 3 percentage points compared to the previous month, October 201
There were 103,726 attendances, a 4% decrease when compared to the previous month, October 2021
More than one in four patients were delayed by four hours or more
5,697 patients were delayed by eight hours or more, equal to 5.5% of all attendances
1,729 patients were delayed by 12 hours or more

Responding to these figures, Dr John Thomson, Vice President of the Royal College of Emergency Medicine Scotland, said: “The reality on the ground is that many Boards are under enormous strain, as there has been a significant increase in staff absences due to the surge in covid. Staff are isolating with a positive test or due to a contact with someone with a positive test.

“Emergency Departments were overstretched prior to the new variant. But current winter pressures met with widespread staff absences mean staff are put under more and more strain on each shift which affects the quality of care provided and both the patient and staff experience alike.

“For many staff, there hasn’t been a Festive break, and they have had no rest or respite but continue to work tirelessly in Emergency Departments.

“The pressures are mounting on the health service once again. It is imperative that we are able to continue delivering vital care to patients.

“But the surge of covid across Scotland is affecting all parts of the system, not just Emergency Care.

“It is a deeply concerning situation to be in, and what concerns us most is the functionality of the health system and our ability to continue delivering urgent and emergency care to those who need it.”

NHSGGC issues urgent public A&E appeal as staff struggle to cope with demand

Amidst unprecedented and unsustainable demand on emergency services, NHS Greater Glasgow and Clyde is urging the public not to attend A&E without a very urgent or life-threatening condition and to use more appropriate services instead.

A&Es across the health board remain extremely busy, with all operating well over normal capacity which is having a huge impact on service provision.

Unless very urgent or life-threatening, patients should not attend A&E without first calling NHS24 on 111. This will ensure they are directed to the most appropriate urgent service for their needs and A&Es are safeguarded those who need them.

Commenting Dr Scott Davidson, Deputy Medical Director for Acute Services for NHSGGC, said: “Our A&Es remain open and continue to assess, treat and admit emergency patients, however they are extremely busy and staff are facing huge challenges to ensure we’re able to treat patients safely and as quickly as possible.

“We continue to see large numbers of people attending with symptoms that could be managed by speaking to a GP, local pharmacy, or, by calling NHS24 on 111 before attending A&E.

“As a result of current demand at A&E, people are facing long wait times and our staff are under severe pressure.

“There are other services geared up and ready to see and treat you. If you’ve had a slip, trip or fall, we have numerous Minor Injuries Units (MIUs) across NHSGGC which can look after you, including if you’ve broken a limb.

“More information on MIUs, what they can treat and how to access one can be found on the NHSGGC website (https://www.nhsggc.org.uk/your-health/know-who-to-turn-to/minor-injury-units/archive/minor-injuries-adults/)

“GP practices across Greater Glasgow and Clyde are operating normal hours, and community pharmacies are also open to help you get the treatment you need.

“Unless very urgent or life-threatening, please do not attend our A&Es unless you are referred.”

Across NHS Greater Glasgow and Clyde there are three standalone Minor Injuries Units (MIUs) – at the Vale of Leven Hospital, Stobhill Hospital and the New Victoria ACH.

MIUs operate in a similar manner to A&Es and can take care of a vast range of injuries.

Patients who attend MIUs following a call to NHS24 are far more likely to be seen, treated and discharged quicker than if they present to an A&E. They will also be helping to protect vital frontline A&E services for those people whose lives are at risk.

More information on MIUs, what they can treat and how to access one can be found on the NHSGGC website: https://www.nhsggc.org.uk/your-health/know-who-to-turn-to/minor-injury-units/archive/minor-injuries-adults/

A & E performance reaches record lows once again as fears grow for coming weeks

The latest weekly update of Emergency Department activity and waiting time statistics show:

Four-hour performance was second lowest on record at 69.7%
There were 24,009 attendances
7,285 patients were delayed by four hours or more, equal to one-third of patients
1,803 patients were delayed by eight hours or more
598 patients were delayed by 12 hours or more

Responding to these figures, Dr John Thomson, Vice President of the Royal College of Emergency Medicine Scotland, said:“The latest data is shocking, as performance sinks to record lows once again. Staff are working tirelessly in Emergency Departments, and we anticipate pressures to mount further as covid surges across Scotland, and with this performance to drop even more.

“We are deeply concerned. Our fear is that staff absences due to covid may prevent the health service from delivering effective care. The current pressures are already leading to long waits for patients, ambulance handover delays, dangerous crowding and corridor care. If we lose staff to covid, these consequences will be further exacerbated. We know that long waits in Emergency Departments threaten patient safety and can lead to avoidable harm or death.

“The crisis is extremely worrying. The coming weeks will be a significant challenge, morale is already plummeting as concern for whether the health service in Scotland will be able to cope is escalating.

“We hope the public understand the unprecedented pressures facing the health service and the crisis that is deepening each week. Staff are doing all they can to deliver effective care and to keep patients safe.

“We urge the public to be cautious in the coming weeks, to use face masks, avoid crowded places, get tested and isolate when they have symptoms, and crucially, to get vaccinated or boosted – these steps go a small way to alleviating pressures on Emergency Departments and the wider health service.”

A Deepening Crisis

This winter is already far worse than last winter, says RCEM President

The latest data from The Royal College of Emergency Medicine’s Winter Flow Project 2021/22 show that since the beginning of October 2021 there have been 56,096 patients delayed by 12 hours or more from time of arrival in Emergency Departments.

In comparison, last year’s Winter Flow Project 2020/21 didn’t record over 50,000 12 hour stays from time of arrival in Emergency Departments until February Week 3.

Data also show that in December 2021 Week 2, four-hour performance fell to 56.3%, the lowest ever recorded.

Dr Katherine Henderson, President of the Royal College of Emergency Medicine, said: “The data show a deepening crisis. We’ve now reached 50,000 12-hour delays, a figure we didn’t reach until February last winter.

“It is hard to communicate the enormous strain NHS staff are under and how deeply the pressures affect patient care. The latest Winter Flow Project report details some of the harrowing conditions patients find themselves in and conditions in which staff are delivering care. This winter is already far worse than last winter, with the coming weeks set to take us deeper into crisis.

“Trusts are already doing all they can, opening every last bed where safely possible. The government must ensure adequate support is given to social care, as difficulties in discharging patients following their treatment has knock-on effects throughout the system and causes exit block in Emergency Departments, ambulances handover delays, and prevents ambulance crews from returning to the community and responding to emergencies.

“The public must be cautious and sensible over the Christmas period and take care of themselves and those around them. Using facemasks, washing hands, avoiding spending long periods of time in very crowded places, getting tested if you develop Covid symptoms, and getting boosted – all these practices will make a real difference in the coming weeks.”

RCEM: Current A&E performance trend is ‘extremely worrying’

In October 2021 there were 108,279 attendances to major Emergency Departments across Scotland, the number of attendances dropped by 5,719 patients (5%) compared to the previous month, September 2021.

Despite this, data show that four-hour performance in major departments has once again reached a new record low, with 70.9% of patients being seen, transferred or discharged within four-hours – 2.5 percentage points lower than the previous month, September 2021.

In October 2021 2,533 patients spent 12-hours or more in a major Emergency Department, this is an increase of 30% compared to the previous month, September 2021, and the highest number on record.

Data also show that 8,181 patients spent eight hours or more in a major Emergency Department. This is an increase of 21% compared to the previous month, September 2021 and is also the highest number on record.

Dr John Thomson, Vice President of the Royal College of Emergency Medicine Scotland, said: “Yet again we are reporting on the worst performance figures on record. 1 in 13 patients are now delayed by eight hours are more.

“This trend is extremely worrying and, most of all, dangerous for patients. Each month, the number of patients that have come to avoidable harm grows. So far in 2021, 387 excess deaths have occurred as a direct result of crowding.

“This number will continue to increase unless patient flow is prioritised this winter; this means freeing up beds where possible by ensuring that patients have timely access to social care, utilising the Discharge to Assess model, and avoiding admission when appropriate by maximising the use of Same Day Emergency Care.

“Every winter we know that the increase in demand for unscheduled care, and therefore beds, disrupts elective surgery – this is not a new phenomenon by any means.

“However, with a record number of patients awaiting surgery, ensuring that unscheduled care does not derail progress on the backlog is more crucial than ever. This requires a whole system approach and cannot be tackled in isolation. If poor patient flow in emergency departments is addressed successfully, this will go some way in mitigating the risk of further disrupting elective care.

“We are very keen to work with the Scottish government on what can be done in the short term to alleviate the immense pressures EDs are currently facing.

“Accompanying this, we continue to call on the Scottish government to set out a long-term workforce plan. The required expansion in capacity cannot be safely achieved without both recruiting new and retaining existing staff.

“At present we need an additional 130 EM consultants along with sufficient numbers of both junior and supporting staff and nurses.”

Thousands of elective care operations cancelled amid crisis in urgent and emergency care

Data from The Royal College of Emergency Medicine’s Winter Flow Project 2021/22 reveals that in November 2021 6,726 elective care operations were cancelled and in October 2021 6,335 elective care operations were cancelled.

Dr Adrian Boyle, Vice-President of the Royal College of Emergency Medicine, said: “In its first week of reporting, the Royal College’s Winter Flow project 2021/22 has a stark warning for the months ahead.

“Nearly 7,000 elective care operations were cancelled at reporting sites in November alone. This data comes as the National Audit Office, in their latest report, predict that the elective care waiting list could reach 12 million by March 2025.

“Data show 12-hour stays are twice as high as the same time last year; four-hour performance remains incredibly low averaging at 62% in November; long hospital stays have increased 13% since the beginning of October. Urgent and Emergency Care is verging on crisis and it is impacting and derailing elective care, meaning surgery for patients with serious conditions is delayed.

“The situation is unsustainable; we must see a willingness to address these crises and tackle the problems. The core of the issue is poor patient flow throughout the hospital and exit block caused by difficulties in discharging patients. These blockages cause ambulance handover delays, crowding and corridor care.

“Capacity must be expanded to avoid a hard-hitting impact on elective care. While it is crucial that social care is resourced to enable a timely and supported discharge of patients.

“In the long-term, restoring bed capacity to pre-pandemic levels and publishing a long-term workforce plan are vital to ensuring no parts of the system are compromised or derailed; to promoting good flow throughout the system; and keeping patients safe.”

Health organisations warn of mounting patient safety crisis in Urgent and Emergency Care

Nearly two thirds of A&Es across the UK had ambulances waiting to transfer patients every day in the past week, according to a new survey from the Royal College of Emergency Medicine.

The latest RCEM survey covers the period 8 November to 14 November 2021 and was sent to Clinical Leads in Emergency Departments across the UK and received 70 responses.

The NHS mandates that ambulance handovers ought to be reliably completed within 15 minutes of arrival, but 61% of Emergency Departments in the survey were struggling to meet this standard every day.

The survey also found that over half of Emergency Departments had provided care to patients in non-designated areas such as corridors every day in the past week.

These findings come following a report by the Association of Ambulance Chief Executives (AACE) which found that 160,000 patients may be coming to harm annually as a result of ambulance handover delays.

While a separate report by the Royal College of Emergency Medicine, ‘Crowding and its Consequences’, found that at least 4,519 patients have died as a result of dangerous crowding in Emergency Departments in England in 2020-2021.

The Royal College’s survey also found:

14% of respondents stated that the longest stay they had had in their Emergency Department was between 48 and 72 hours
- 36% of respondents stated the longest stay in their Emergency Department was 24 to 48 hours
- 39% of respondents stated the longest stay in their Emergency Department was 12 to 24 hours
14% of respondents stated that there was no effective Same Day Emergency Care available in their Emergency Department
- 50% of respondents stated that Same Day Emergency Care had limited availability, less than 12 hours a day or weekdays only in their Emergency Department
71% of respondents stated that they were unable to maintain social distancing for patients in their Emergency Department in the past week

Dr Katherine Henderson, President of the Royal College of Emergency Medicine, said: “These results show the serious state that our urgent and emergency care system is in.

“None of us want to have patients held in ambulances, treated in corridors, or waiting very long times to go up to a ward bed. Sadly, these findings support our stark report on crowding and the AACE’s shocking report on ambulance handovers.

“We all need to work together to solve this acute patient safety problem. We believe enacting many of the suggestions we have made in RCEM CARES: The Next Phase will help. We want patients to feel confident that their Emergency Care system is there for them, but this winter is going to be a huge challenge unless we can get flow back into the system.

“RCEM CARES: The Next Phase details our system-wide plan to tackle the current crisis and improve patient care as well as staff wellbeing. In the short-term, to promote flow and to reduce handover delays, capacity must be expanded in a safe way. Same Day Emergency Care must be made available at all Trusts and they must expand its provision, so it is available 12 hours a day, seven days a week. While maximising the service Discharge to Assess will allow patients to be discharged in a timely and supported way.

“In the long-term, we urge the government to publish a long-term workforce plan, this must include actions to retain existing staff as well as recruit new staff. Across the UK there is a shortfall of 2,000-2,500 WTE Emergency Medicine consultants, and crucially, there are also widespread shortages of Emergency Medicine nurses and both junior and supporting staff. At the same time capacity is severely depleted across the UK. The government must restore bed capacity to pre-pandemic levels, this requires an additional 7,170 beds across the UK.

“This is only the beginning of winter and of what may come. We are facing a crisis in urgent and emergency care and a crisis of patient safety. The Secretary of State in the House of Commons spoke of ‘a duty to avoid preventable harm of everyone working in health and social care’, we urge him to act on his own words and prevent avoidable harm and ensure the safety of patients.”

Managing Director of AACE Martin Flaherty OBE QAM said: “These alarming new figures from RCEM underline once again the unprecedented pressures facing the entire urgent and emergency care system.

“We now know that excessive handover delays and crowding in A&E departments are routinely harming patients, some very severely. To resolve this, we need system leaders to further toughen their resolve to deal with this problem once and for all and as a matter of priority and we await details of progress being made in this area, while underlining our commitment to work as part of the solution to this complex issue.”

Tracy Nicholls, Chief Executive of the College of Paramedics, said: “We must not forget that behind all these mounting figures are real people, both staff and patients, who are bearing the brunt of this continuing strain on services.

“Reform must happen to alleviate the intolerable pressure and reduce the guilt many paramedics and Emergency Department staff feel about dealing with patients who are waiting outside Emergency Departments or, more worryingly, in the community.

“We support any efforts to deal with the here and now, but we commit to working with stakeholders and partners to make real change happen.”

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.”

Delayed hospital handovers: RCEM calls for system-wide action

The Association of Ambulance Chief Executives (AACE) has published a report following a structured clinical review of handover delays at hospital emergency departments across England.

This reveals for the first time the extent of potential harm that is being caused to patients when they must wait in the back of ambulances or in corridors before they are accepted into the care of their local hospital.

The review found that the proportion of patients who could be experiencing unacceptable levels of preventable harm is significant. Over eight in ten of those whose ‘handover’ (from ambulance clinician to hospital clinician) was delayed beyond 60 minutes were assessed as having potentially experienced some level of harm; 53% low harm, 23% moderate harm and 9% (one patient in ten) could have been said to have experienced severe harm.

The impact assessment was coordinated by AACE and was undertaken in all ten English NHS ambulance services who reviewed a sample of cases from one single day in January 2021, where handovers exceeded one hour.

Experienced clinicians assessed the range and severity of potential harm experienced by those patients who were already seriously ill, frail or elderly and who waited for sixty minutes or more before being accepted into the care of the hospital from the ambulance crews in attendance.

The nationally defined target for hospitals included in the NHS Standard Contract states that all handovers between ambulance and A&E must take place within 15 minutes, with none waiting more than 30 minutes.

Since April 2018, an average of 190,000 handovers have missed this target every month (accounting for around half of all handovers) while in September 2021 over 208,000 exceeded the 15-minute target.

You can read the report here.

Responding to the latest report ‘Delayed hospital handovers: Impact assessment of patient harm’ published yesterday by the Association of Ambulance Chief Executives, Dr Katherine Henderson, President of the Royal College of Emergency Medicine, said: “This report makes for stark reading but will come as no surprise to Emergency Department staff.

“Patients should never be delayed in the backs of ambulances. Patient safety is being compromised. When there is simultaneously no space in the Emergency Department and ambulances queuing outside the Emergency Department, we are no longer delivering effective urgent and emergency care to the community.

“We support our paramedic colleagues and will continue to work with them to tackle these handover delays and keep patients safe. But these pressures must not be addressed in isolation. The answer does not lie with the ambulance services nor in the Emergency Department. This is a system-wide problem that requires system-wide action and solutions. In particular, the answer is not just to increase physical space in the Emergency department with no additional staff.

“Trusts and Boards must focus on increasing flow throughout the hospital to reduce exit block and ensure patients are moved through the system. In the immediate term, Trusts and Boards must safely expand capacity throughout the hospital where possible to stop patients being delayed in ambulances. Social care must be resourced to ensure patients can be discharged when they have completed their treatment to prevent long hospital stays.

“We entered the pandemic with too few beds in the system and have continually struggled to manage with reduced capacity, now this is unsustainable. It is vital that the government restore bed capacity to pre-pandemic levels to achieve a desirable ratio of emergency admissions to beds. Currently 7,170 beds are required across UK Trusts and Boards.

“Patient safety is at risk and without urgent action avoidable harm will continue to fall upon patients while urgent and emergency care will fall deeper into crisis.”