Growing concern about the looming winter as Emergency Department performance sinks to new low in England

BMA lambasts UK Government’s ‘Rescue Package’

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.”

Record winter funding package as NHS and social care prepare to face “toughest winter ever”

“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 trade dispute was lodged in June following the Scottish government’s decision to implement a single-year NHS pay deal for 2021-22 for Agenda for Change staff, without further discussing RCN members’ overwhelming rejection of the pay award.

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.”

Latest Accident & Emergency Activity report highlights scale of health inequalities

The latest Hospital Episodic Statistics (HES): Hospital Accident and Emergency Activity 2020-21 published by NHS Digital and NHS England show that attendance rates in the most deprived areas of England were almost double the attendance rates in the least deprived areas.

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.”

Survey shows patient experiences in A&Es overall ‘very good’ – but improvements are needed

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.”

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

RCEM Scotland: Performance deteriorates further as four-hour target falls to record low

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.”

Health and Social Care: Johnson bites the bullet

Prime Minister Boris Johnson’s statement at yesterday’s press conference on health and social care:

Good afternoon, I’m joined by the Chancellor of the Exchequer and the Secretary of State for Health and Social Care, because today we’re setting out our plan to help our NHS recover from the pandemic and build back better by fixing the problems in health and social care that governments have avoided for decades.

We all know someone whose test, scan or hip replacement was delayed or who helped to protect the NHS amid the immense pressures of Covid by putting off treatment for a new medical condition.

And now, as people come forward again, we need to pay for those missed operations and treatments; we need to pay good wages for the 50,000 extra nurses we are recruiting, we need to go beyond the record funding we’ve already provided to the NHS, and that means going further than the 48 hospitals and 50 million more GP appointments.

So today, following the most successful vaccine programme in the world, we’re beginning the biggest catch-up programme in the history of the NHS, increasing hospital capacity by 110 per cent, and enabling 9 million more appointments, scans and operations.

I have to level with people – waiting lists will get worse before they get better, but compared with before Covid, by 2024/25 our plan will allow the NHS to aim to treat 30 per cent more patients who need elective care – like knee replacements or cancer screening.

A recovery on this scale cannot be delivered by cheese-paring budgets elsewhere and it would be irresponsible to cover a permanent increase in health and social care spending with higher day to day borrowing.

For more than 70 years, we’ve lived by the principle that everyone pays for the NHS through our taxes, so it’s there for all of us when we need it.

In that spirit, from April we will have a new UK-wide 1.25 per cent Health and Social Care Levy on earned income, with the money required by law to go directly to health and social care across the whole of our United Kingdom, and with dividends rates increasing by the same amount.

This will raise almost £36 billion over the next three years, not just funding more care but better care, including better screening equipment to diagnose cancer earlier and digital technologies allowing doctors to monitor patients in their homes.

The levy will share the cost as fairly as possible between people and businesses: because we all benefit from a well-supported NHS and all businesses benefit from a healthy workforce.

And those who earn more will pay more, including those who continue to work over the State Pension Age.

The highest earning 14 per cent of the population will pay around half of the revenue raised; no-one earning less than £9,568 will pay a penny, and most small businesses will be protected, with 40 per cent paying nothing extra at all.

And this new investment will go alongside vital reform, because we learned from the pandemic that we can’t fix the NHS unless we also fix social care.

When Covid struck, there were 30,000 hospital beds in England occupied by people who would have been better cared for elsewhere, and the inevitable consequence was that patients could not get the hip operations or cancer treatment or whatever other help they needed.

And those people were often in hospital because they feared the costs of care in a residential home.

If you suffer from cancer or heart disease, the NHS will cover the costs of your treatment in full.

But if you develop Alzheimer’s or Parkinson’s, then you have to pay for everything above a very low threshold.

Today, 1 in 7 of us can expect to face care costs exceeding £100,000 in our later years, and millions more live in fear that they could be among that 1 in 7.

Suppose you have a house worth £250,000 and you’re in a care home for eight years, then once you’ve paid your bills, you could be left with just £14,000 after a lifetime of work, effort and saving – having sacrificed everything else – everything that you would otherwise have passed on to your children – simply to avoid the indignity of suffering.

So we are doing something that, frankly, should have been done a long time ago, and share the risk of these catastrophic care costs, so everyone is relieved of that fear of financial ruin.

We’re setting a limit to what people will ever have to pay, regardless of assets or income.

In England, from October 2023, no-one starting care will pay more than £86,000 over their lifetime.

Nobody with assets of less than £20,000 will have to pay anything at all, and anyone with assets between £20,000 and £100,000 will be eligible for means-tested support.

And we’ll also address the fear many have about how their parents or grandparents will be looked after.

We’ll invest in the quality of care, and in carers themselves, with £500 million going to hundreds of thousands of new training places, mental health support for carers and improved recruitment, making sure that caring is a properly respected profession in its own right.

And we’ll integrate health and social care in England so that all elderly and disabled people are looked after with the dignity they deserve.

No Conservative Government wants to raise taxes, but nor could we in good conscience meet the cost of this plan simply by borrowing the money and imposing the burden on future generations.

So I will be absolutely frank with you: this new levy will break our manifesto commitment, but a global pandemic wasn’t in our manifesto either, and everyone knows in their bones that after everything we’ve spent to protect people through that crisis, we cannot now shirk the challenge of putting the NHS back on its feet, which requires fixing the problem of social care, and investing the money needed.

So we will do what is right, reasonable and fair, we’ll make up the Covid backlogs, we’ll fund more nurses and, I hope, we will remove the anxiety of millions of families up and down the land by taking forward reforms that have been delayed for far too long.

Chancellor Rishi Sunak’s statement on health and social care, delivered on 7 September 2021

Good afternoon.

I want to address straight away the following question:

Why do we need to raise taxes?

Three reasons.

First, we need to properly fund the NHS as we recover from the pandemic.

Senior NHS leaders have made clear that without more funding we will not properly be able to address the significant backlog…

…in people’s cancelled operations, delayed treatments, or missed diagnoses.

To get everyone the care they need is going to take time – and it is going to take money.

The second reason is that social care plans announced today have created an expanded safety net.

Instead of individuals having to bear the financial risks of catastrophic care costs themselves, we as a country are deciding to share more of that risk collectively.

This is a permanent, new role for the Government.

And as such we need a permanent, new way to fund it.

The only alternative would be to borrow more indefinitely.

But that would be irresponsible at a time when our national debt is already the highest it has been in peacetime.

And it would be dishonest – borrowing more today just means higher taxes tomorrow.

The third reason we need to raise taxes is to fund the Government’s vision for the future of health and social care.

Properly funded, we can tackle not just the NHS backlog and expand the social care safety net, we can afford the nurses pay rise;

Invest in the newest, most modern equipment;

Prepare for the next pandemic;

And provide one of the largest investments ever to upskill social care workers.

In other words, we can build the modern, more efficient health and social care services the British public deserves.

To fund this vital spending, we will introduce a new UK-wide Health and Social Care Levy.

From next April, we will ask businesses, employees and the self-employed to pay an extra 1.25% on earnings.

All the money we raise will be legally ringfenced, which means every pound from the Levy will go directly to health and social care.

The Levy is the best way to raise the funds we need.

It is fair: the more you earn, the more you pay.

It is honest: it is not a stealth tax or borrowed – the Levy will be there in black and white on people’s payslips.

And it is UK-wide, so people in England, Scotland, Wales and Northern Ireland will all pay the same amount.

To make sure everyone pays their fair share, we will also increase dividend tax rates by the same amount.

And, from 2023, people over the age of 66 will be asked to pay the Levy on their earnings too.

No Government wants to have to raise taxes.

But these are extraordinary times and we face extraordinary circumstances.

For more than 70 years, it has been an article of faith in this country that our national health service should be free at the point of use, funded by general taxation.

If we are serious about defending this principle in a post-Covid world …

… we have to be honest with ourselves about the costs that brings …

… and be prepared to take the difficult and responsible decisions to meet them.

Thank you.

PM Boris Johnson’s letter to the First Ministers of Scotland, Wales and Northern Ireland and Deputy First Minister of Northern Ireland on the new health and social care reform:

National Insurance Contributions increase ‘adds insult to injury’ for families facing devastating cut to Universal Credit

New Joseph Rowntree Foundation analysis estimates that around 2 million families on low incomes who receive Universal Credit or Working Tax Credit will pay on average around an extra £100 per year in National Insurance contributions under the Government’s proposed changes.  

Peter Matejic, Deputy Director of Evidence & Impact at JRF said: “We are concerned that around two million families on low incomes who receive Universal Credit or Working Tax Credit will pay on average around an extra £100 per year in national insurance contributions under the Government’s proposal. 

“This extra cost adds insult to injury for these families who are facing a historic £1,040 cut to their annual incomes when Universal Credit and Working Tax Credit are reduced in less than a month on 6 October. If it presses ahead, this Government will be responsible for the single biggest overnight cut to social security ever.  

“With inflation rising, the cost of living going up and an energy price rise coming in October, many struggling families are wondering how on earth they will be expected to make ends meet from next month. 

“The Chancellor is in denial if he seriously believes this cut will not impose unnecessary hardship on millions of families – the majority of whom are in low-paid work. 

“Any MP who is concerned about families on low incomes must urge the Prime Minister and Chancellor to reverse this damaging cut, which will have an immediate and devastating impact on their constituents’ living standards in just a few weeks’ time.”

RCEM welcomes Government funding, but warns it won’t be enough

Responding to the announcement of an extra £5.4 billion of funding for the NHS, Dr Katherine Henderson, President of the Royal College of Emergency Medicine, said: “The announcement of this additional funding for the NHS over the next six months is very welcome.

“It comes at a crucial time when the health service enters what will likely be its most challenging winter ever, as it exits the pandemic, seeks to recover the elective backlog and faces the worst ever levels of performance in the summer.

“It is particularly welcome to see the investment in improving infection prevention control measures in hospitals, as this will continue to be of the utmost importance in the coming months. It is also pleasing to see funding to continue to improve the timely discharge of hospital patients. It is vital for Emergency Care that there is good flow throughout the hospital, which includes making sure patients have a smooth discharge from the hospital.

“While this short-term funding is appreciated, there must also be an adequate response to the sharp increase in demand and equivalent deterioration in performance. It is unlikely that this funding will be enough to help enable longer term recovery.

“The challenges that our Emergency Departments face stem from workforce shortages and capacity issues. A shortage of beds can lead to crowding, corridor care and poor flow through the hospital. Workforce shortages spread existing staff thinly and put them under severe pressure.

“These are long term issues and the only way to tackle them will be via a long-term funding plan for the health service, including a workforce plan to recruit nurses and doctors by expanding student medical and nursing places and training places.”

Dr Katherine Henderson, commenting on the announcement of a three-year settlement for health and social care, continued: “The three-year funding settlement announced for health and social care is welcome.

“But the scale of the challenges faced across the health and social care service at a crucial time of recovery mean this will likely not be enough – and the government must be realistic in the colossal task ahead for the health and social care service. It is essential that a plan to address the workforce crisis is prioritised.

“It is also welcome to see the long overdue the first steps towards a plan for social care. There has been a crisis within social care for some time, so it will be good to see the government fulfil its pledge to reform and tackle the social care crisis.

“For that to happen, it is vital that an adequate proportion of the settlement is allocated to social care.”

Commenting on Tuesday’s social care announcement by the Prime Minister, TUC General Secretary Frances O’Grady said: “We need a social care system that delivers high-quality care and high-quality employment. 

“New funding for social care is long overdue. But today’s announcement will have been deeply disappointing both to those who use care, and to those who provide it. 

“The Prime Minister promised us a real plan for social care services, but what we got was vague promises of money tomorrow. 

“Care workers need to see more pay in their pockets now. Nothing today delivered that. Instead, the only difference it will make to low-paid care staff is to push up their taxes. 

“This is so disappointing after the dedication care workers have shown during this pandemic keeping services running and looking after our loved ones. 

“Proposals to tax dividends should have been just once piece in a plan to tax wealth, not an afterthought to a plan to tax the low-paid workers who’ve got us through the pandemic. 

“We know social care needs extra funding. But the prime minister is raiding the pockets of low-paid workers, while leaving the wealthy barely touched. 

“We need a genuine plan that will urgently tackle the endemic low pay and job insecurity that blights the social care sector – and is causing huge staff shortages and undermining the quality of care people receive.” 

The TUC published proposals on Sunday to fund social care and a pay rise for the workforce by increasing Capital Gains Tax. 

The union body says increasing tax on dividends is a welcome first step to reforming the way we tax wealth, but that it won’t generate the revenue needed to deliver a social care system this country deserves. 

Instead, by taxing wealth and assets at the same level as income tax, the government could raise up to £17bn a year to invest in services and give all care staff a minimum wage of £10 an hour. 

TUC analysis shows that seven in 10 social care workers earn less than £10 an hour and one in four are on zero-hours contracts. 

Polling published on Sunday by the TUC showed that eight in 10 working adults – including seven in 10 Conservative voters – support a £10 minimum wage for care workers. 

“Shocking”: Ambulance handover delays are threatening patient safety, experts warn

A new snapshot survey by the Royal College of Emergency Medicine has found that in August 2021 half of respondents stated that their Emergency Department had been forced to hold patients outside in ambulances every day, compared to just over a quarter in October 2020 and less than one-fifth in March 2020.

The survey, sent out to Emergency Department Clinical Leads across the UK, also found that half of respondents described how their Emergency Department had been forced to provide care for patients in corridors every day, while nearly three-quarters said their department was unable to maintain social distancing every day.

One-third said that the longest patient stay they had had in their Emergency Department was between 24 and 48 hours, with seven per cent reporting the longest stay to be more than 48 hours.

Dr Ian Higginson, Vice President of the Royal College of Emergency Medicine, said: “It is shocking to see the extent of the challenges faced by Emergency Departments across the UK.

“Holding ambulances, corridor care, long stays – these are all unconscionable practices that cause harm to patients. But the scale of the pressures right now leaves doctors and nurses no options.

“We are doing all we can to maintain flow, maximise infection prevention control measures, and maintain social distancing. Our priority is to keep patients safe, and ensure we deliver effective care quickly and efficiently, but it is extremely difficult right now.

“The data is stark, and this is August. Our members are really worried about what may come in autumn and winter. We have a duty to our patients and staff. Currently there is extremely high demand – for a number of reasons – but demand is not the whole picture.

“Demand presents a challenge because of the limitations of hospital space, workforce shortages, difficulties arranging quick ambulance handovers, smooth care and safe discharge of patients from wards, and a lack of services and alternatives to admission, particularly in the evenings and at weekends.

“The health service entered the pandemic short of staff, with less beds, and underprepared. Throughout the pandemic these shortages have been felt, but with demand higher than ever before, and with a workforce that is burned out, these shortages are felt more acutely than ever.”

Commenting on the increase in ambulance handover delays, Tracy Nicholls, Chief Executive of the College of Paramedics, said: “The College of Paramedics’ members also speak passionately about the potential for harm to those patients who, as a consequence of these lengthy ambulance handover delays, can wait an unacceptably long time for help. It is deeply concerning.

“Like the Royal College of Emergency Medicine, we recognise that all partners are working exceptionally hard to manage this situation and current demand. The reality is, however, that unless effective actions are taken now to ease the system pressures, more and more patients will face these delays as we head into another difficult winter, and both paramedics and ambulance clinicians across the UK will face the brunt of any further increase in demand.

“We urge NHS leadership to take action now to mitigate this risk wherever possible and protect both patients and our collective workforce from the inevitable pressure that we face if nothing is done.”

The survey also found that over 80% of respondents had little or no confidence in their organisation’s ability to safely and effectively manage the current or predicted combination of pressures as we head into winter.

Dr Higginson continued: “The final response that found an overwhelming lack of confidence signals something deeply troubling.

“The College has consistently warned of the upcoming winter and ongoing pressures. It is time we saw leadership and an equivalent response. There must be a comprehensive plan for the current demand and upcoming winter that include short- and long-term solutions to tackle these serious challenges.

“If ambulance services and Emergency Departments cannot cope with ongoing pressures, then it is patients and the workforce looking after them who will suffer. The winter could lead the health service into a serious crisis. Patients and staff must have assurance that they, their Emergency Department and their hospital will get what they need to manage.”

Lowest ever levels of A&E performance show NHS ‘near boiling point’

‘the reality is that the NHS is really struggling’

Responding to the latest set of performance figures released by NHS England for July 2021, President of the Royal College of Emergency Medicine, Dr Katherine Henderson, said: “The NHS has been running hot for months now and these figures show we are nearly at boiling point.

“We are worried that the public think that things are getting back to normal on the virtual eve of a further reduction in restrictions, and messages from the centre that says things are OK are disingenuous – the reality is that the health service is really struggling.

“Four-hour performance has sunk to its lowest ever level, we have levels of 12 hour waits we would usually associate with winter, and July saw the second highest ever number of attendances across emergency care units. Yet there is no sign of rescue ahead of winter. Despite our calls for action, crowding is back with us and is compromising patient care.”

Performance figures for Emergency Care for the NHS in England in July 2021 showed that:

  • there were 1,431,499 attendances at major Emergency Departments – the second highest on record
  • 67.7% of patients waited less than four hours from arrival to admission, transfer, or discharge in Type 1 EDs – the lowest percentage on record
  • the number of patients waiting more than four hours after a decision to admit them stood at 89,768 – this is a 30% increase compared to June 2021 (66,619) and is the third highest ever
  • the number of patients waiting more than 12 hours after a decision to admit them stood at 2,215 – by far the highest July figure on record (second highest is 451 from July 2019).

Dr Henderson said: “The NHS was in a pretty dreadful state going into the pandemic – we were seeing record waits across the board, due to insufficient resourcing – but the sheer determination of an overstretched workforce, combined with a ‘whatever it takes’ approach, got us through.

“The problems that were with us before the pandemic have not gone away. Not only do they remain but are now much worse due to the impact of Covid, as these figures make crystal clear.

“The ambulance service saw thehighest ever number of ambulance callouts for life threatening conditions in July, and we saw ‘trolley waits’ in hospitals go up by 30% on the previous month. This means there have been delays offloading ambulances and patients have experienced long waits to be seen and moved to a bed if they need admission.

“Emergency Departments are very, very busy.

“There has also been a steady rise in Covid presentations and even though numbers are still low all the infection risk concerns remain in hospitals, further depleting capacity. Staff have had no let up and are worried about what the winter will be like if this is where we are in the summer.

Demand is driven by multiple factors – difficulties accessing primary care, complications of chronic conditions, new presentations of significant illness and waiting list patients with on-going symptoms and no sign of getting their care sorted any time soon.

“NHSE recommends patients to access help via 111 but unless the system is responsive and clinically supported and other options available that advice too often defaults to go to the Emergency Department. Local health systems must ensure adequate urgent care facilities for their communities, letting Emergency Department have capacity to treat the seriously ill and injured.

“The other side of this is problems with supply – we do not have enough staff, beds, or equipment. There is still no plan for social care, which has a huge impact on the NHS. These have been issues for some time, but on top of this is the growing waiting list for elective care, staff absence due to a combination of leave and necessary self-isolation, and an even lower bed capacity due to infection prevention control measures.

“We fear for what winter may hold; we know it will be worse than now but a heavy flu season, another potential Covid surge and an understandable desire not to cancel elective care this winter could cripple us and put patient safety at risk.

“NHS Trusts must do all that they can to wring out every drop of capacity ahead of winter and the Department of Health and Social Care must extend ‘discharge to assess’, which made a significant difference freeing up beds during the pandemic. There has been a sustained rise in the number of patients experience long stays in hospital, and this funding is critical to freeing beds and maintaining flow in hospitals.

“We also need clarity in terms of performance – we are currently in a performance vacuum with Trusts uncertain about what they need to focus on. Implementing some of the metrics proposed by the Clinical Review of Standards is vital ahead of winter. We need to operationalise the metric of a maximum of a 12 hour stay from point of arrival. This will be a small step to reducing exit block, and allow timely ambulance offloads.

“While the NHS rollout of the vaccine has been an incredible success, parliament must not take its eyes off the ball regarding the state of the NHS. This autumn’s spending review – one which has not been put out to consultation – is an opportunity for the government to further signal it’s ‘peace time’ commitment to NHS funding and help prevent the NHS from boiling over this winter.”

The situation in Scotland is also giving cause for alarm. Lothian MSP, Miles Briggs is ‘very concerned’ A&E waiting times aren’t showing signs of improvement.

Miles Briggs MSP said: “NHS Lothian is in desperate need of an injection of funds to alleviate pressure on services. 

“Years of chronic underfunding and a global pandemic has left staff on their knees, struggling to meet the increased numbers of patients attending A&E. 

“SNP Ministers must take responsibility for allowing the situation to get to this point and immediately fund NHS Lothian properly to start getting services back to normal.”

https://www.publichealthscotland.scot/publications/nhs-performs-weekly-update-of-emergency-department-activity-and-waiting-time-statistics/nhs-performs-weekly-update-of-emergency-department-activity-and-waiting-time-statistics-week-ending-1-august-2021/

RCEM: ‘It is absolutely essential that masks are worn by everyone in A&Es’

Dr Katherine Henderson, President of the Royal College of Emergency Medicine has stated that it is absolutely essential that patients and visitors in Emergency Departments continue to protect themselves and others with face masks, hand washing and social distancing.

Dr Katherine Henderson said: “While restrictions have been eased, it is absolutely essential that we continue to keep everyone safe in hospital settings and in Emergency Departments. Patients and visitors must therefore expect to wear a mask and maintain social distancing.

“Emergency Departments regularly see vulnerable patients. We must do all we can to keep those patients safe, but also to ensure that these patients feel safe coming to the hospital and the Emergency Department if, and when, they need help.

“We ask patients and visitors to kindly respect and co-operate with this guidance and help to keep everyone safe. Staff will not tolerate any abuse whatsoever. They absolutely do not deserve it, but it is a sad reality that we are already hearing and seeing abusive behaviour towards staff. It is clear these measures will help protect the most vulnerable patients, so it is right that all patients and visitors follow them.

“Staff will request all patients and visitors to put a mask on when in an Emergency Department and they will not be engaging in any debate on the guidance.

“It is a matter of public health and infection prevention control to keep all our patients safe.”