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Difficulties in discharging patients driving long waits in Emergency Departments

8 December 2022

Responding to the latest Emergency Department performance figures published by NHS England for November 2022, Dr Adrian Boyle, President of the Royal College of Emergency Medicine, said:

“The Emergency Care crisis remains incredibly challenging. As we head into winter, we know things will get worse before they get better, but making things better requires the political will to drive change and improvement. Patients continue to face dangerously long waits which are harmful to them and are distressing for staff doing their best in difficult conditions.

“It is vital that politicians, policymakers and the public understand that this is absolutely not driven by any increase in people who should not be in Emergency Departments. Demand remains at a steady level – despite a recent surge in childhood presentations – and in fact attendances decreased from October to November. These waits are almost entirely driven by poor flow through our hospitals; significant shortages of staff and beds mean we have dangerously high bed occupancy levels in hospitals, and this is made worse by our inability to discharge patients due to shortages of social care staff. These have all made providing adequate care effectively and efficiently almost impossible.

“We know that patients are concerned, while Emergency Departments are under immense pressure, they remain open to anyone seeking emergency care, and people should not hesitate to go to Emergency Departments if they need it. However, if your condition is not severe, we ask the public to use appropriate channels for their care needs, either calling NHS 111, their GP or local pharmacist. It is also vital that the public, and particularly the elderly and vulnerable, protect themselves this winter by getting a flu jab and a Covid-19 booster vaccination.

“We also know there will be some concern about the nurses and ambulance services industrial action, but the public should be reassured that patient safety is the NHS’s priority and measures will be put in place to ensure their short-term safety.

“However, there is a serious recruitment and retention crisis across the NHS, which if left unaddressed, risks a longer-term decline in patient safety. The College is not a union and cannot comment on terms and conditions of staff, but industrial action is, in part, a consequence of many staff feeling burned out, exhausted and overwhelmed. In any profession overworked staff who do not feel valued will leave, and healthcare is no different. We support the individual right of all NHS staff should they feel it necessary to take industrial action.

“We hope that there is a quick resolution before any industrial action takes place. Our nurses and ambulance services staff are skilled, competent professionals who provide a vital service. It is right that they should feel valued and supported. We want to keep our staff in the NHS, and while we wait for the workforce projections that the Chancellor pledged to deliver and the workforce plan from NHS England, we urge the government to take measures to ensure we retain all our NHS staff who provide excellent care for our patients, for the sake of our patients.”

Notes to editor

The latest Emergency Department performance figures published by NHS England for November 2022 for show:

  • There were 1,396,554 attendances at major Emergency Departments
    • This represents a 4.5% increase compared with November 2021, and a 2.2% increase compared with pre-pandemic levels (November 2019)
    • Type 1 Emergency Departments saw 46,552 attendances per day in November. This makes it the second busiest month (after June 2021) on record per this measure.
    • There were 2,166,710 attendances at all Emergency Care facilities
  • 37,837 patients were delayed for 12-hours or more from decision to admit to admission
    • This is the second highest number of 12-hour waits on record
    • It is 255% higher than the same month last year, November 2021, and it is 3303% higher than November 2019
    • There have now been 293,171 12-hour DTA stays recorded so far in 2022
  • Four-hour performance at major Emergency Departments was 54.5%, this is the worst four-hour performance on record
    • This is a 0.3 percentage point decrease from the previous month, October 2022, and a 7.4 percentage point decrease from November 2021
  • Type 1 admissions stood at 369,066 (a daily average of 12,302)
  • 4% of Type 1 attendances were admitted, this is a 0.2 percentage point increase from October 2022, but 3.44 percentage points lower than November 2019
  • 143,949 patients spent more than four hours in an Emergency Department from decision to admit to admission (also referred to as ‘trolley waits’) this is a 19% increase from November 2021.
  • Delays to admission stood at 27.9%, this is the second highest on record and a 4.1 percentage point increase from November 2021

The latest beds data for November 2022 show:

  • Last month there were 97,208 general and acute beds available, a decrease of 0.08 percentage points from October.
  • The occupancy rate was 94.4%, 0.1 percentage points higher than October, the highest monthly figure on record
  • The occupancy rate for adult general and acute beds was 95.4%, the second highest figure on record.

The latest Hospital Episodic Statistics published by NHS Digital for October 2022 show:

  • Patients leaving the department before being seen stood at 5.8%. This is a increase of 0.6 percentage points from September 2022, but a decrease of 0.1 percentage points from October 2021.
  • Unplanned reattendance rate was 8.4%. This is 0.1 percentage points higher than October 2021.
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