28 February 2023
A new briefing by the Royal College of Emergency Medicine, RCEM Explains: Long waits and excess deaths, reveals that in 2022 1,656,206 patients waited 12-hours or more from their time of arrival in an Emergency Department. This is equal to over 4,500 12-hour time of arrival waits per day in 2022 and equal to 10.2% of all Type 1 attendances.
In 2022, NHS England reported that 347,703 patients waited 12-hours from decision to admit to admission (DTA), equal to 2.1% of Type 1 attendances. Significantly, the total number of 12-hour time of arrival waits for 2022 is 4.8 times the total number of 12-hour decision to admit (DTA) waits for 2022. This demonstrates how the DTA metric is misleading and only the tip of the iceberg.
Using the total number of 12-hour time of arrival waits for 2022 and the best available scientific research we can calculate that there were an estimated 23,003 excess patient deaths in England in 2022 associated with long waits in the Emergency Department.
Commenting on the FOI findings Dr Adrian Boyle, President of the Royal College of Emergency Medicine, said:
“These data, while shocking, are unsurprising. For a long-time we have known that the true scale of long waits in Emergency Departments has been hidden. Long-waiting times are associated with serious patient harm and patient deaths – the scale shown here for 2022 is deeply distressing. The data show how necessary it is to have transparent figures. We are pleased that both the Department of Health and Social Care and NHS England have heeded our calls and will be publishing the 12-hour data from time of arrival in the Emergency Department regularly from April this year. We look forward to seeing this data be published then.
“We believe that being honest with the data will be a service to patients and staff. It will lead to a better understanding of patient flow and to both transformation and change in the emergency care system. However, this transformation and change can only come if we have the staff, beds and resources we need. We urge the government to publish the fully funded long-term NHS workforce plan that they pledged to deliver. This must include measures to retain existing staff who are burned out and may be considering leaving the NHS.
“Alongside the publication of this 12-hour data we must see a renewed focus on the four-hour access standard. We believe the new four-hour target of 76% is unambitious and is too low, it presents the risk that the sickest and most vulnerable patients will continue to face the longest waits. We urge this target to be revised to a more ambitious figure.
“The delays to admission in Emergency Departments are a symptom of a hospital wide problem. We know that 14,000 beds are occupied by patients who should be discharged but are unable to be due to the shortages in social care. We must see sustained and continued investment in social care and a bolstering of the social care workforce. Enabling the timely discharge of patients will help free up beds and in turn help reduce these long-waits in Emergency Departments.”
Notes to editor
RCEM Explains: Long waiting times and excess deaths: https://rcem.ac.uk/wp-content/uploads/2023/02/RCEM_Explains_long_waits_and_excess_mortality.pdf
The 12-hour time of arrival data for England for 2022 were obtained through Freedom of Information requests (FOIs) to NHS Digital.
Scientific evidence shows delays to care and long waits to admission to hospital increase a patient’s risk of harm and death, even after leaving an Emergency Department. A large observational study of more than five million NHS patients showed an increase in all-cause 30-day mortality, adjusted for age and co-morbidity. This study quantified the harm, demonstrating that there was one additional death for every 72 patients that spend eight- to 12-hours in the Emergency Department (this is called the Standard Mortality Ratio or SMR).
By applying the Standard Mortality Ratio (SMR) to the total number of 12-hour time of arrival waits for 2022, we can calculate that there were an estimated 23,003 excess patient deaths in 2022 in England associated with long waits in the Emergency Department.
An extra or excess death is a death that might not have occurred if there were not X amount of delays to admission. If 72 patients did not wait eight- to 12-hours from their time of arrival in Emergency Departments, there would not be an ‘extra’ or excess death.
It’s important to recognise that while some patients have always faced long waits, the scale of patients now facing extremely long waits is a new phenomenon – and every death as a result is an extra or excess death because they could have been prevented, and we can see in years prior the extremely long waits for admission weren’t happening and so the deaths weren’t occurring.