Introduction
The publication of NHS England’s Urgent and Emergency Care (UEC) Plan 2025 has triggered discussion and reflection across the UK’s healthcare landscape. The Royal College of Emergency Medicine (RCEM), representing frontline clinicians and experts in emergency medicine, has undertaken a thorough review of the proposed plan. This document sets out RCEM’s response, offering both support of key aims and constructive criticism.
Executive Summary
RCEM welcomes NHS England’s commitment to system-wide improvement in urgent and emergency care and data transparency. The plan’s emphasis on patient flow, alternative care pathways, and digital transformation aligns with many recommendations RCEM has consistently advocated. However, the College expresses concern about the scale, pace, and likelihood of effective implementation, especially given ongoing challenges such as lack of social care reform, physical capacity constraints, and poor in hospital productivity. The RCEM calls for a stronger and more focused approach towards exit block and long stays in emergency departments.
RCEM’s Appraisal of the Plan
ED Overcrowding and Patient Flow
ED overcrowding is a symptom of system-wide inefficiencies, especially in the interface between acute and community care. The UEC Plan’s focus on improving patient flow is welcome, but RCEM cautions that without tangible investment in physical capacity—both in hospital beds and in the community—targets for ambulance handovers and four-hour standards are unlikely to be met. There is a lack of commitment to increase the number of beds in our acute hospitals, even England has almost the lowest number of beds of any European country.
Metrics
RCEM is very disappointed by the lack of meaningful commitment to reduce 12 hour stays. Setting a target threshold of no more than 10% of people staying more than 12 hours represents a failure to meaningfully grip this problem. The proportion of 12 hours stays in 2024 was about 10% and several times worse than before the pandemic.
Furthermore, the direction to maintain the four hour access standard at a lower level of 78% is also harmful. Setting the threshold this low has perverse and unintended consequences. Operations staff are incentivised to focus their efforts on people who can be treated and discharged within four hours. Meanwhile, people who need admission (who are sick) continue to stay on trolleys.
NHSE might be forgiven for downplaying the importance of metrics, except they push very hard on eradicating ambulance handover delays. It is unreasonable and ineffective to expect short ambulance handover times (which everyone supports) with a weak direction on 12 hours and long stays.
Same Day Emergency Care and Admission Avoidance
RCEM supports the prioritisation of SDEC and other alternatives to hospital admission, noting their potential to reduce crowding and improve patient outcomes. However, the College warns that SDEC cannot be a substitute for fully functioning EDs and must not be used to mask underlying capacity shortfalls. Investment is required in both workforce and diagnostic infrastructure to ensure these services are safe, effective, and consistently available.
Senior Decision Makers
There are good recommendations about increasing the amount of ‘call before convey’ whereby a paramedic can seek support from a senior clinician and reduce unnecessary transfer to hospital. The variability in performance suggests that the NHSE should go harder on this intervention.
Digital Transformation and Data
The commitment to single site reporting and increased transparency is very welcome, and something that RCEM has advised for several years.
Vaccination and Infection Prevention and Control
NHSE is right to focus on this as a priority area. Staff vaccination rates show unacceptable site variation, implying that staff have variable access to vaccination. Trust leaders should make it as easy as possible for staff to get vaccinated in advance of next winter. Some attempt to standardise Infection Prevention and Control measures is clearly overdue.
Mental Health
There is welcome recognition and understanding of how this patient group are disadvantaged within UEC. However, we are sceptical that initiatives to reduce attendance rates among high impact users are effective, as this patient group tends to access health care in episodic clusters. The amount of money allocated to Mental Health is small, but still welcome.
Concerns and Risks Identified by RCEM
Implementation. This plan, like many before, is loud on the ‘why’, but is quieter on the ‘how.’
The plan’s ambitions, though generally sensible, may be undermined by turbulence within NHSE, funding constraints, and limited estate.
Staff Wellbeing: Without immediate action on staff wellbeing and retention, further exodus of experienced clinicians could occur.
