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12-hour waits hit their peak despite a decrease in A&E attendances

10 December 2020

Responding to publication of performance data for Emergency Departments in England in November 2020, President of the Royal College of Emergency Medicine, Dr Katherine Henderson said:

“These data show that hospitals are struggling and talk of hospitals being empty is nonsense. Empty hospitals do not have long ambulance queues. Empty hospitals do not have patients waiting over 12 hours for a bed.

“With a focus on the NHS like never before, this difficult year was an opportunity to put a permanent end to crowding, but these figures make clear that this opportunity has been wasted.”

Data for November 2020 shows:

  • 2,141 people waited for over 12 hours (from decision to admit to admission) – nearly double the previous month
  • 71,041 trolley waits
  • 4hr performance back to pre-pandemic levels (76.8% at major EDs).

Sitrep data for 30 November to 6 December shows that:

  • average bed occupancy went up from 86.81% to 87.13% on the previous week
  • there were seven instances of A&E diverts
  • 9,956 patients were delayed in being transferred from an ambulance into an ED.

Dr Henderson said: “We have warned endlessly about crowding; how it not only feeds the spread of covid but is dangerous for patients in its own right. Departments were struggling before covid and will continue to until we achieve an adequate hospital bed base – additional monies to improve Emergency department facilities were very welcome but what is needed is flow.

“Emergency patients and staff are being let-down as we head into Christmas. No-one should be waiting for 12 hours, and our own internal data suggests this figure is the tip of the iceberg – the figures reported from NHS England are only measured from when a decision to admit has been made and not time of arrival.

“Staff were rightly lauded earlier during the pandemic for their hard work, but the failure to prevent another winter of crowding means that, for ED staff, these words were ultimately empty. There has been little meaningful action to solve the chronic problem of crowding.

“While the risk of covid will eventually diminish with a new vaccine, we worry that nosocomial infection will be replaced as the number one risk to the lives of patients with crowding and corridor care returning with a vengeance.

“But warnings have been ignored. We keep hearing that this is a whole system problem but the actions always default to the ED team; Trust management is not separate from the ED but we are regularly told by our members that there is a failure of senior management to act.

“Crowding is caused by exit block – where patients needing admission cannot be admitted into the hospital due to a lack of staffed beds – but is causing entrance block as well; ambulances cannot offload and we are once again seeing queues, which is impacting patient care.

“We must build more capacity into the system. Covid has shown that it is possible – Nightingales were rolled out quickly. Funding this year has been welcome but was not near what was asked for. Expansion of EDs is great, but it is whole hospitals that need capacity in the form of more beds. Unfortunately lack of staff to go with these beds is the long-term consequence of under-resourcing.

“Lack of action on social care is also feeding into the crowding problem. If hospitals cannot discharge patients then it impacts the whole system.

“In terms of actions now, Emergency Department performance standards must be a hospital wide priority and acted upon; Trust boards must agree, enforce and evaluate escalation plans during times of crowding; provide alternative access points; and flow from key inpatient wards must be prioritised by concentrating on early discharges during the day.”

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