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.”
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.
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.”
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.”
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.
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.”
The latest Emergency Department performance figures for September 2021 published today by NHS England show the highest number of 12-hour stays on record, the highest number of four-hour stays on record, and the worst four-hour performance ever recorded.
The latest figures were published on the day the UK Government set out it’s Plan to improve access for NHS patients and support GPs.
The data show in September 2021 there were 1,392,542 attendances to Type 1 Emergency Departments in England.
Four-hour performance has deteriorated for the sixth consecutive month, once again reaching a record low. Just 64% of patients in Type 1 Emergency Departments were admitted, transferred or discharged within four-hours.
A record breaking 5,025 patients stayed in an Emergency Department for 12-hours or more from decision to admit to admission. This is an 80% increase on the previous month, August 2021, and it is the highest number of 12-hour stays since records began and is almost a third higher than the previous highest, recorded in January 2021. The number of 12-hour stays from time of arrival is not published but is likely to be significantly higher.
Dr Katherine Henderson, President of the Royal College of Emergency Medicine, said: “This data is bleak and is a stark warning of the crisis that we are heading towards this winter.
“Dangerous crowding has returned to Emergency Departments, exit block is preventing a flow of patients through the hospital, and there have been widespread reports of ambulances queuing outside hospitals facing long handover delays.
“For patients, this means long and potentially frustrating waiting times in the Emergency Department. For staff it is incredibly challenging, as they do all they can to continue to deliver care quickly amid rising attendances and pressures.
“At the same time the health service continues to manage covid as cases have been rising steeply, with the NHS now treating around 14 times as many patients as the same time last year.
“Trusts also continue to deliver elective care but there is a real threat that in the coming months this may once again have to be paused to manage pressures on urgent and emergency care and the rising number of covid cases.
“The winter presents a significant challenge for the health service; staff are increasingly worried about the NHS’ ability to cope. The Government need to recognise the potential crisis and support the health and care service as it tackles the challenges ahead.
“NHS England’s Urgent and Emergency Care Recovery 10 Point Action Plan is a blueprint on how to manage these pressures in the short and medium term. Trusts must do all they can to follow this guidance to mitigate pressures across the system and prevent further deterioration in performance.
“But the underlying cause of all of the problems facing the NHS is a decade of underfunding. The health service has for a long time struggled to meet the demand of the population. It is short on staff across the board; capacity has not risen in line with demand. Existing staff are exhausted, with many looking to leave after having to shoulder an ever-increasing workload.
“So far promises to increase the workforce have fallen short. The forthcoming spending review is an opportunity for the government to signal it’s intent to boost staffing with a long-term workforce plan and rescue the NHS in the long run.”
Meanwhile the NHS, working closely with the Department of Health and Social Care, has today published a blueprint for improving access to GP appointments for patients alongside supporting GPs and their teams in England.
Surgeries will be provided with additional funding to boost their capacity to increase the proportion of appointments delivered face to face, as part of a major drive to support general practice and level up performance, including additional efforts to tackle abuse against staff.
The measures, including a £250 million winter access fund from NHS England, will enable GP practices to improve availability so that patients who need care can get it, often on the same day if needed. The investment will fund locums and support from other health professionals such as physiotherapists and podiatrists, with a focus on increasing capacity to boost urgent same-day care. This is in addition to £270 million invested over the previous 11 months to expand capacity and support GPs.
Amanda Pritchard, chief executive of the NHS, said: “Improving access to high quality general practice is essential for our patients and for the rest of the NHS too.
“It is a personal priority and today NHS England is taking both urgent and longer term action to back GPs and their teams with additional investment and support.”
Secretary of State for Health and Social Care Sajid Javid said: “I am determined to ensure patients can see their GP in the way they want, no matter where they live. I also want to thank GPs and their teams for their enormous efforts in the most challenging times in living memory.
“Our new plan provides general practice teams with investment and targeted support. This will tackle underperformance, taking pressure off staff so they can spend more time with patients and increase the number of face-to-face appointments.
“Alongside this we are setting out more measures to tackle abuse and harassment so staff at GP surgeries who work so tirelessly to care for patients can do so without having to fear for their safety.”
The NHS England document makes clear that every GP practice must seek patients’ input and respect preferences for face to face care unless there are good clinical reasons to the contrary.
The extra investment will help to increase the number of appointments delivered, while local health systems will be free to determine how best to tackle particular challenges to access and provision of care in their own community, which could include putting in place additional resource for walk-in consultations.
Local plans will need to deliver these improvements in access, with practices that do not provide appropriate levels of face to face care not able to access the additional funding, and instead offered support to improve.
Under the plan, the NHS will also support upgrades to telephone systems, ensuring that more patients can quickly and easily speak to general practice staff, and help the public avoid long waits when contacting a surgery by phone.
The government will also reduce administrative burdens on GPs by reforming who can provide medical evidence and certificates such as FIT notes and DVLA checks – freeing up time for more appointments.
UKHSA will complete its review of infection prevention and control (IPC) guidance in general practice and set out practical steps on IPC measures in GP settings which could increase the number of patients that can be seen.
As part of this package, the NHS will increase its oversight of practices with the most acute issues in relation to access, and GP appointment data will be published at practice level by spring next year. This will enhance transparency and accountability, as monthly data is currently only published by clinical commissioning group.
In addition, patients will get the opportunity to rate their practice’s performance, via text message, based on their most recent experience of accessing support. This survey, which has been previously agreed with the profession, is being piloted in around 60 practices and will be rolled out next year.
Together with the government and Academy of Medical Royal Colleges, the NHS will also develop a zero-tolerance campaign on abuse of NHS staff, including GP teams.
General practice teams have delivered more than 300 million appointments over the last year as well as delivering the vast majority of Covid vaccinations, saving lives and protecting millions of people against the virus at speed.
Health Minister Maria Caulfield said: “As a nurse on the frontline during the pandemic I know how hard GPs and their teams have worked, while recognising how badly so many people want to see their GPs in person.
“This plan will give our dedicated general practices the support needed to increase capacity, boosting the number of appointments for patients to see and speak to their GP practice.
“I look forward to continuing to work with the sector to ensure patients can get the care they need.”
Patients will also be able to see different types of clinicians in general practice, who can best meet their needs and conditions, including pharmacists, paramedics, advanced nurse practitioners and nursing associates.
NHS England will also work with the government to consider how far and fast the role of pharmacists can be increased in the supply of medication, as part of relieving workload on GPs.
Government’s ‘rescue package’ for GPs is flawed and patient care will suffer as result, warns BMA
“It’s truly frightening that we have a government so ignorant to the needs of such a core part of the NHS”
Responding to the publication by the Department of Health and NHS England and NHS Improvement today, outlining their plans to improve access for NHS patients and support for GPs, BMA GP committee chair Dr Richard Vautrey said: “After weeks of promising an ‘emergency package’ to rescue general practice, we’re hugely dismayed that whilst additional funding has been promised, the package as a whole offers very little and shows a Government completely out of touch with the scale of the crisis on the ground.
“GPs and their teams will now be facing the worst winter for decades, and as a result, patients’ care will suffer. Appointments will be harder to book, waiting times will get longer, more of the profession could leave and GPs will struggle to cope.
“It is also disappointing to see that there is no end in sight to the preoccupation with face-to-face appointments; we need a more intelligent conversation about the variety of appointments and care that are available to patients to meet their needs.
“While in-person consultations are a key feature of general practice and absolutely necessary for some patients and certain conditions, the pandemic has proven that in many other cases, phone or video appointments are entirely appropriate and appreciated by patients, and a crude focus on percentages or targets is completely unhelpful.
“Throughout our discussions with ministers and NHS England in recent weeks, the BMA has been clear that without a concerted effort to reduce bureaucracy, admin and red tape in practices, patient access and care was at risk.
“Unfortunately, today’s offer merely tinkers around the edges, and will not reduce the unnecessary burden practices carry and therefore free up any more time for doctors to see more patients. We need an end to target-driven, payment-by-results, care and allow practices to look after patients in a way that is flexible and right for the person in front of them and the Government have missed an opportunity to tackle this.
“Reducing the administrative burden on GPs by reforming who can provide medical evidence and certificates such as Fit notes and DVLA checks, won’t happen for some time and is a mere drop in the ocean as what is needed is urgent action now to free up sufficient time for more appointments.
“While the additional £250m is welcome, it must be easy for practices to access rapidly and they must not be forced to have to produce reams of plans or try to meet unattainable targets to get it – which has often happened in the past.
“We had four simple asks – and only one appears to have been fully answered. Increased sentencing for assaulting healthcare workers is something we asked for, but meaningless if the same Government refuses to address the crisis fuelling such abuse. The Secretary of State has started to address a second, by talking more positively about general practice but he needs to do much more to publicly support the profession when we are under such pressure and facing a torrent of abuse on a daily basis.
“These proposals will only confirm the profession’s belief that ministers and NHS England fail to understand the dire state of general practice – or that they, not hardworking GPs, are to blame.
“It’s truly frightening that we have a government so ignorant to the needs of such a core part of the NHS. GPs want to improve the care we offer to our patients, but today’s offer will not enable us to do that as we had hoped.
“GPs across England will be truly horrified that this is being presented as a lifeline to general practice, when in reality it could sink the ship all together. There can be no doubt that this lack of action at such a critical time will force many GPs to hang up their stethoscopes and leave the profession for the last time.”
“The current situation is not sustainable; it is dangerous for patients and becoming incredibly difficult for staff.” – Dr John Thomson, Vice President of the Royal College of Emergency Medicine Scotland
A substantial new investment of over £300 million in hospital and community care has been unveiled to help tackle what is anticipated to be the toughest winter the NHS and social care system has ever faced.
The new multi-year funding will support a range of measures to maximise capacity in our hospitals and primary care, reduce delayed discharges, improve pay for social care staff, and ensure those in the community who need support receive effective and responsive care.
The NHS and Care Winter Package of additional funding includes:
Recruiting 1,000 additional NHS staff to support multi-disciplinary working
£40 million for ‘step-down’ care to enable hospital patients to temporarily enter care homes, or receive additional care at home support, with no financial liability to the individual or their family towards the cost of the care home
Over £60 million to maximise the capacity of care at home services
Up to £48 million will be made available to increase the hourly rate of social care staff to match new NHS band 2 staff
£20 million to enhance Multi-Disciplinary Teams, enable more social work assessments to be carried out and support joint working between health and social care
£28 million of additional funding to support primary care
£4.5 million available to Health Boards to attract at least 200 registered nurses from outwith Scotland by March 2022
£4 million to help staff with their practical and emotional needs, including pastoral care and other measures to aid rest and recuperation
Health Secretary Humza Yousaf said: “As the winter period approaches, it is vital that we do all we can to maximise the capacity of the NHS and social care system. That’s why I’m setting out our £300 million NHS and Care Winter Package today.
“We cannot look at the NHS in isolation we must take a whole systems approach and these measures will help alleviate pressure across the NHS and social care.
“This significant new investment will help get people the care they need as quickly as possible this winter. Bolstering the caring workforce by increasing their numbers, providing them with additional support, and increasing the wages of social care staff.
“We’ve previously provided funding to ensure that adult social care staff are paid at least the real living wage. Today we’re going further and our new investment will ensure that adult social care staff who are currently paid the real living wage will get a pay rise of over 5%
“Measures I have announced today will help patients whose discharge has been delayed waiting for care and help get them out of hospital and on to the next stage in their care. This helps the individual by getting them the right care, and helps the wider system by ensuring the hospital capacity is being used by those who need that specialist level of clinical care.
“This £300 million of new funding will also fund increases in social care capacity in the community and in primary care – helping to ease the pressure on unpaid carers.
“Our NHS, social care staff and social work staff have been remarkable throughout the pandemic and today’s additional investment will help support them to deliver care to people across Scotland this winter.”
Meanwhile,the latest Emergency Department performance figures for Scotland published by the Scottish Governmentyesterday for August 2021 show that four-hour performance has deteriorated for the fourth consecutive month, again reaching a record low – while the number of patients staying in a major Emergency Department for 12-hours or more reaches a record high.
In August 2021 there were 117,552 attendances to major Emergency Departments across Scotland.
Data show that four-hour performance reached a new record low, with 75.4% of patients being seen within four-hours. One in four patients stayed in a major Emergency Department for four-hours or more before being admitted, transferred or discharged.
The number of 12-hour stays in August 2021 nearly doubled when compared to July 2021. 1,346 patients stayed in a major Emergency Department for 12-hours or more, compared to 760 in July 2021. This figure increased for the fourth consecutive month and it is the highest number of 12-hour stays since records began.
Data also show that 5,279 patients spent eight hours or more in a major Emergency Department. This is the highest figure since records began. The number of patients delayed by eight-hours or more increased for the fourth consecutive month.
Dr John Thomson, Vice President of the Royal College of Emergency Medicine Scotland, said: “The challenge for health care workers is growing significantly. In Scotland, the army have been called in to assist the ambulance services.
“In Emergency Departments, long stays are rising drastically, and one in four patients are staying in an Emergency Department for more than four-hours. It is extremely worrying. These pressures are likely to mount further, and performance deteriorate even more as we head into winter.
“We are seriously concerned about patient safety. Long stays put patients at risk, particularly vulnerable patients, and especially with covid still present in the community. We urgently need a plan to increase flow throughout the hospital, to reduce exit block, to prevent crowding, and to ensure that patients who need it can quickly be moved into a bed for their care.
“The current situation is not sustainable; it is dangerous for patients and becoming incredibly difficult for staff.
“We welcome this afternoon’s announcement by the Secretary of State for Health and Social Care, Humza Yousaf MSP, including the recruitment of more staff and funding for hospital and community care. We hope that these measures will begin to alleviate pressures across the health system, and in particular reduce ambulance handover delays, long stays in Emergency Departments and exit block in our hospitals.
“However, while we welcome this investment, short-term cash injections do little to resolve long-term problems. We must see a long-term workforce plan that includes measures to retain health workers, particularly Emergency Medicine staff, as well as a long-term strategy for social care.”
Responding to the Scottish Government’s announcement to uplift care workers pay to just over £10 an hour, GMB Scotland Secretary Louise Gilmour said:“If we want to tackle the understaffing crisis in social care then we need to substantially increase the basic rate of pay, and for GMB that mean’s a £15 an hour minimum.
“Many of our frontline services are already being delivered on the back of wages of just under or over £10 an hour, and we know this isn’t nearly enough.
“To transform social care for the people who need it and the people who deliver it, particularly as we roll-out a national care service, then we must go further.”
The Scottish Government may also be facing industrial action from nursing staff over the winter …
NHS pay dispute in Scotland: Royal College of Nursing members to be asked about willingness to take industrial action
RCN members working for NHS Scotland are to be asked what industrial action they would be willing to take in support of their ongoing trade dispute with the Scottish government and NHS employers over pay.
The indicative ballot will open on 12 October and close on 8 November.
Eligible members will receive information on the different forms of industrial action.
The indicative ballot will be run by Civica, the independent scrutineer that organised the consultative ballot earlier this year. Eligible members will receive an email from Civica with a personal link to the online voting site on Tuesday 12 October. Weekly reminder emails will also be sent.
The result of the indicative ballot will not formally authorise industrial action. It will be used to inform the next steps RCN members might take.
Julie Lamberth, Chair of the RCN Scotland Board, said: “Industrial action is always a last resort but the current staffing challenges are causing unacceptable risks to patients and staff. The Scottish government has the opportunity to do the right thing by nursing.
“I would urge all eligible RCN members to seek out the available information on what taking industrial action means and what the implications of doing so might be. We need each member to make up their own mind and have their say in the ballot.”
Colin Poolman, RCN Scotland Director, added: “This is your chance to speak up – for your patients and your colleagues. Many of you rejected the pay offer and you know the link between fair pay and safe staffing.
“This is your opportunity to tell us what action you are prepared to take. To let the Scottish government know that the time to protect patient safety and value the safety critical role of nursing is now.”
The data show in 2020-21 in the most deprived areas of England there were 39,161 attendances per 100,000, while in the least deprived areas this figure is almost halved to 20,784.
Dr Katherine Henderson, President of the Royal College of Emergency Medicine, said:“The pandemic has highlighted the scale of health inequalities across the country. The data show that those from the most deprived area are almost twice as likely to visit their Emergency Department than those from the least deprived area.
“We welcome NHS England’s willingness to engage on the issue and address health inequalities, but we must see real action taken. We also look forward to the formation of the Office for Health Improvement and Disparities (OHID) and would welcome the opportunity to input into their agenda.
“The health inequalities are clear and tackling them will be a serious challenge. On a fundamental level, if the government is serious about levelling up and tackling these inequalities, the first steps must be to fund and support local authorities and Integrated Care Systems and invest in preventative health.
“The scale of health inequalities means tackling homelessness; immigrant health; domestic violence; and youth violence. While supporting those with; mental health illnesses; learning disabilities; and both drug and alcohol addiction.”
There were also 1.39 million reattendances in 2020/21 which is equal to 10.4% of all unplanned attendances. This is the highest figure on record and up 1.7 percentage points when compared to the previous year 2019/20.
Dr Henderson continued:“It is also deeply concerning that one in ten patients reattended the Emergency Department (ED), it is vital that patients have the appropriate information and support available to manage their condition following their visit to the ED. We need better data on this issue to understand what is driving people to reattend.”
In 2020/21 302,784 patients stayed in an Emergency Department for 12-hours or more from time of arrival, this is 21 times higher than the 12-hour figure from decision to admit, which is 14,150.
Dr Henderson concluded:“Utilising the right metrics in Emergency Departments is crucial to improving patient safety. It is vital that we measure health equalities, reattendances, and 12-hour stays from time of arrival across the country.
“Analysing these metrics will help us, NHS England and the government to take effective action to support the patients, communities and areas that need it most. That means fewer reattendances, closing the gap on health inequalities, reducing long stays, and improving the patient experience.
“This data paints a very real picture of the state of health and the state of healthcare in this country. We welcome the engagement of NHS England and the government’s agenda on these matters, but we must now see the tangible actions taken to tackle these issues.”
Responding to the latest urgent and emergency care survey published this week by the Care Quality Commission (CQC), Dr Katherine Henderson, President of the Royal College of Emergency Medicine, said:“The survey is welcome as it provides an invaluable insight into the patient experience and confirms that Emergency Departments are doing an incredible job in difficult circumstances.
“We are appreciative of patients engaging and providing this feedback in the middle of the pandemic in September 2020. Managing to continue these core assurance processes is a challenge but continues to be very important.
“It is encouraging to see improvements in many areas compared to previous years. It is particularly pleasing to see one-third of patients using type 1 services rate their experiences 10 out of 10, and also that 94% of patients had confidence and trust in the doctors and nurses examining and treating them. This is a testament to the dedication, commitment, expertise, and compassion of Emergency Medicine staff.
“While there are many positives to highlight in this report, understandably there are some areas for improvement. Many of the areas that are a source of frustration for patients are largely a result of staff shortages and the existing workforce’s ability to dedicate ample time to each patient.
“It is important that patients have the opportunity to talk through their treatment or condition, that all patients receive the help they need when they need it whether before, after or during their care, and that their pain or condition is managed throughout their time in A&E.
“The current challenges facing the health service are no doubt affecting clinicians’ ability to deliver the highest quality of care that they strive to provide. Current workforce numbers do not match current demand, and workforce shortages crossed with increases in demand mean existing staff are stretched thinly.
“To meet current demand the workforce needs 2,500 more consultants in England along with sufficient numbers of nurses, trainees, allied health professionals and SAS doctors.”
Dr Katherine Henderson continued:“It is interesting to see that 41% of patients contacted NHS 111 before going to A&E and 32% contacted their GP before going to A&E.
“This highlights the importance of NHS 111 as a resource for patients. It is absolutely essential that the efficacy of NHS 111 is properly evaluated so we can learn how best to resource it and wider services. Call handlers must have the tools they need to provide sound guidance to patients, and they must have an adequate range of services and pathways to which they can direct patients.
“It is also significant that 32% of patients also contact their GP before going to A&E. This highlights the crucial link between primary and urgent and emergency care and makes clear that both are under-resourced. Plans to tackle the challenges facing urgent and emergency care must include a joined-up approach that include ways of supporting and resourcing primary care.”
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.”
The latest Emergency Department performance figures for Scotland published by the Scottish Government yesterday for July 2021 show that performance has deteriorated once again with four-hour performance reaching its lowest since records began, and the number of patients delayed in major Emergency Departments continues to rise steeply.
In July 2021 there were 114,392 attendances to major Emergency Departments across Scotland. This is a three per cent decrease compared to June 2021, an 18% increase when compared to July 2020.
Four-hour performance reached its lowest since records began, having deteriorated for the third consecutive month. 79.5% of attendances to major Emergency Departments in Scotland were seen within four hours. 23,493 patients were delayed by four-hours or more in a major Emergency Department, this is the highest figure since records began.
This is equal to more than one in five patients delayed by four hours or more in a major Emergency Department. The number of patients delayed by four-hours or more reached its highest ever figure having increased for the fifth consecutive month.
In July 2021, 755 patients spent 12-hours or more in a major Emergency Department, this is the highest figure since February 2020. This is nearly a 50% increase on the previous month, June 2021. It is a 3,000% increase compared to July 2020 and it is a 200% increase compared to July 2019. The number of patients delayed by 12-hours or more increased for its third consecutive month.
Data also show that 3,477 patients spent eight hours or more in a major Emergency Department. This is the second highest figure since records began. It is an increase of 50% compared to the previous month, June 2021.
It is an increase of over 1,000% compared to July 2020, and it is an increase of 200% compared to July 2019. The number of patients delayed by eight-hours or more increased for its third consecutive month.
Dr John Thomson, Vice President of the Royal College of Emergency Medicine, said: “These figures show an ongoing deterioration in performance. Current pressures are equal to or worse than normal winter pressures – but these figures are for July.
“Among staff there is serious concern and low morale, winter is fast approaching and quite simply there is low confidence that our hospitals and staff are going to be able to cope.
“The number of patients delayed in Emergency Departments has risen steeply for three consecutive months, the pressures on this trajectory could lead the health service into a crisis.
“It is unacceptable that patients are delayed for so long, in one Emergency Department a patient was delayed by 48 hours – these are dangerously long waits that are likely to adversely affect patient outcomes.
“We have a duty to keep patients safe and treat them quickly and effectively. The current challenges are hindering our ability to achieve that, and for both patients and staff alike it is incredibly difficult.
“The entire health service is under severe strain. Our primary care colleagues are facing record demand, the elective care waiting lists continue to grow, all departments and specialties are facing these unprecedented challenges.
“Yet, while demand is high, the numbers of patients are not the challenge – the challenges stem from capacity issues, across-the-board workforce shortages, and the limitations and deterioration of hospitals and equipment – resourcing has not met demand for some time.
“It would be irresponsible to look on these consistently decreasing monthly performance figures and not recognise the potentially looming crisis fast approaching this winter. Now is the time for an appropriate response.
“We need the Scottish Government to take action, to develop and communicate a joined-up plan on how the health service is going to manage ongoing demand and prepare the workforce, hospitals and Emergency Departments for the upcoming winter.”
