27 April 2023
Data seen by The Royal College of Emergency Medicine from the Summary Emergency Department Indicator Table (SEDIT) and NHS Benchmarking show that in England the number of care hours per Emergency Medicine Consultant (whole-time equivalent) and nurse have doubled since 2019, despite 2019 and 2022 having a comparable number of attendances.
Guidance from the College recommends there should be one whole-time equivalent consultant for every 4,000 patient attendances each year. Data from September 2022 show this ratio stands far below this recommendation, with one consultant for every 7,052 attendances.
Reflecting on these data, Dr Adrian Boyle, President of the Royal College of Emergency Medicine, said:
“These data show the reality on the ground: too many people are spending too long in our Emergency Departments, usually because there are not enough inpatient beds for them.
“We have an ageing population and with that comes a growing proportion who live with multiple morbidities. Staff are delivering more care to patients with increasingly complex conditions for longer periods of time in Emergency Departments. Yet, there is so little urgency to provide meaningful long-term sustained investment for social care. Good social care underpins and effective health service. We must ensure there is preventative and adequate care for our most vulnerable patients, and support for them when they are admitted to and discharged from hospital.
“On top of this the ratio of clinicians to attendances show the drastic delay and dilution of care in Emergency Medicine. While staff continue to deliver effective care, they can only stretch themselves so far, and they cannot continue to do more with less. The delay to care has the biggest impact on our most elderly and frail patients, who often face the longest waits in an uncomfortable environment with little to no privacy.”
The data come as the number of patients waiting for 12-hours or more in Emergency Departments measured from the time of arrival soared in 2022. With more patients waiting for extremely long periods of time in Emergency Departments, stretched Emergency Medicine staff frequently give care to patients in clinically inappropriate areas such as corridors or cupboards converted into cubicles.
Dr Boyle continued “The rise in care hours per consultant is undoubtedly linked to the dangerously high number of 12-hour waits in Emergency Departments and consequential overcrowding. These are a result of the high bed occupancy in hospitals, a low bed base, and the inability to discharge patients in a timely way.
“This crisis is terrible for patients and staff. Patient safety is at risk and existing staff cannot do more than they already are. The situation in Emergency Departments is symptomatic of the far wider and deep-rooted crisis in health and social care. Most of what determines Emergency Department demand lies outside of the Emergency Department. Meaningful action and engagement can only start with recognition that the delays on the front-door are a symptom of the wider crisis and must be viewed system-wide.
“Political and health leaders must not revert to ineffective demand management solutions – that would be like seating fewer passengers on a barely flightworthy plane and deciding not to fix the engine or the wings – it would be a huge misstep and misspend of time and resources.
“Our campaign Five Priorities for UK Governments to #ResuscitateEmergencyCare lays out the solutions we must see to tackle the crisis. The government must expand the acute bed base to ensure hospitals are not run at more than 85% bed occupancy. They must deliver the fully funded long-term workforce plan that they pledged to deliver, prioritising measures to retain existing staff. Crucially, they must provide sustained long-term investment and resource for social care to ensure the timely discharge of patients, freeing up beds and improving flow through our hospitals.”
Notes to editor
Royal College of Emergency Medicine: Five Priorities for UK Governments to #ResuscitateEmergencyCare