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Performance figures indicate the beginning of a crisis for urgent and emergency care, as RCEM publishes system-wide plan

11 November 2021

The latest Emergency Department performance figures for October 2021 published today by NHS England show that monthly performance has consistently and drastically deteriorated for six months from April 2021 as one in four admissions face long stays in the Emergency Department.

The data show in October 2021 there were 1,419,072 attendances to Type 1 Emergency Departments in England.

Total four-hour and 12-hour stays from decision to admit are equal to 23.5% of admissions. This means that nearly one in four admissions faced a considerably long stay in the Emergency Department.

October 2021 performance figures show the highest number 12-hour stays on record, 7,059 patients stayed in an Emergency Department for 12-hours or more from decision to admit to admission. This is 40% higher than the previous month, September 2021 and 456% higher than the same month last year, October 2020.

NHS England records 12-hour stays from decision to admit to admission – Hospital Episodic Statistics show the number of 12 hour stays from time of arrival arrival is 21 times the number of 12 hour stays from decision to admit. This means we can estimate that there were 148,239 12 hour stays from time of arrival in October 2021, this is equal to 10% of Type 1 Emergency Department attendances.

Four-hour performance has deteriorated for the sixth consecutive month, once again reaching its lowest on record. Just 61.9% of patients in Type 1 Emergency Departments were admitted, transferred or discharged within four-hours. 121,251 patients stayed in an Emergency Department for four-hours or more from decision to admit to admission, this is 16% higher than the previous month, September 2021.

Dr Katherine Henderson, President of the Royal College of Emergency Medicine, said:

“As the data show this is the beginning of a gruelling winter and a crisis for the health service. For half a year now, we have seen a consistent fall in performance and rise in long stays. The reality of pressures on the urgent and emergency care system is stark. Patient safety is very much at risk – long waiting times and long stays, ambulance handover delays, dangerous crowding – these are appalling practices that can lead to avoidable harm or death.

“The Government must recognise the serious risk that these severe pressures on the system pose to patients. It is disappointing that, given current situation in urgent and emergency care, we have not had the opportunity to meet with the Secretary of State for Health and Social Care to discuss solutions and actions to tackle the current challenges.

“To address the current challenges facing urgent and emergency care the College has launched RCEM CARES: The Next Phase. This outlines our system-wide plan to improve patient care by addressing crowding, access, retention, experience and safety.

“In the short-term, Trusts must put all their focus on preventing exit block and increasing flow through the system, this relies on discharging patients in a timely way when they’ve finished their treatment. In turn this relies on social care being adequately resourced to support patients in their return to the community and prevent recurring trips to the Emergency Department. Without adequate support to leave hospital patients may have long hospital stays and delayed discharge after their treatment is complete and be unable to return home.

“It is vital the Government provide funding for social care to meet the needs of the population. Discharge to Assess must be maintained and expanded to ensure patients are discharged safely and promptly. Same Day Emergency Care (SDEC) is another a crucial service that can help alleviate pressures and reduce admissions. The government must make funding available for SDEC and NHS Trusts must look to provide it seven days a week.

“In Emergency Departments utilising the right metrics can promote patient flow and help prioritise the care of the most seriously ill. We need to see the data published on 12-hour stays from time of arrival, currently NHS England only publish data on 12-hour stays from decision to admit.

“In the medium-term restoring staffed bed capacity to pre-pandemic levels is critical to preventing crowding and promoting flow, across the UK an additional 7,170 beds are required, these must come with sufficient number of health care workers to staff the beds.

“While the Spending Review provided a necessary boost in funding, we have yet to see any allocation to Health Education England. Failing to expand NHS recruitment exacerbates pressures on existing staff which may lead to existing staff reaching burnout and leaving, leading to a further reduced workforce.

“The government must publish a long-term workforce plan with a commitment to growing the number of staff working in Emergency Departments. For a long time, workforce numbers have not matched demand for urgent and emergency care services. We identified earlier this year that there is a shortage of 2000-2500 Emergency Medicine Consultants across the UK and shortages of Emergency Medicine nurses, SAS doctors, and both junior and supporting staff. These shortages must be addressed to achieve safe staffing.

“Emergency Medicine staff and many other health care workers are exhausted and demoralised; winter and the current challenges look bleak. Now is the time to see the will from our political and health leaders to acknowledge and tackle deep-rooted problems and provide a vision for the health service. RCEM CARES: The Next Phase provides our vision for urgent and emergency care; we look forward to discussing this vision with the Secretary of State.”


Notes to Editor

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