Early signs of a long road to recovery in Emergency Care welcome, but a meaningful workforce plan remains crucial

11 May 2023

Responding to the latest Emergency Department performance figures published by NHS England for April 2023, Dr Adrian Boyle, President of the Royal College of Emergency Medicine, said:

“The improvement in performance is welcome and indicates early signs of a long road to recovery. However, these improvements are only comparative to the past six months which saw the worst performance on record. There are still significant numbers of patients facing dangerously long waits in overcrowded Emergency Departments and hard-working staff continue to be stretched. We cannot be complacent with these data.

“Bed occupancy remains at a dangerous level, significantly higher than the recommended safe level of 85%, as there continue to be high numbers of ‘trolley’ waits. High bed occupancy levels and ‘trolley’ waits are closely linked as delays in discharging patients mean we are unable to admit patients to a bed, causing delays for patients and poor flow through our hospitals. The system continues to be gridlocked.

“It is vital that NHS England implement its Urgent and Emergency Care delivery plan: expanding the bed base; increasing clinical input into NHS 111; and reducing the high bed occupancy and long patient stays in hospitals by improving discharges. These continue to be urgent priorities that must be sustained, we will be looking closely at the implementation of these measures. We are disappointed and puzzled to see that the number of general and acute beds available at Type 1 acute Trusts has actually fallen by 1,600 despite NHS England’s pledge in January to open 5,000 more by next winter – this is evidently a step in the wrong direction that will only exacerbate the delays in Emergency Care.

“Despite shortfalls in the Emergency Medicine workforce, staff continue to stretch themselves to ensure they are delivering for patients. We thank them for their continued hard work and efforts. However, they cannot continue to do more with less, and the threat of an ‘exodus’ of staff from Emergency Medicine remains high as many continue to face burnout. The NHS workforce plan, that has been greatly delayed, is crucial, but it will only be meaningful if it contains figures, projections, and commitments as well as urgent measures to retain existing staff. NHS staff must not be let down with a hollow plan that contains no detail.”

Notes to editor

NHS England: Supplementary ECDS Analysis April 2023 final (12-hour length of stay data measured from the time of arrival) data show:

• In April 2023, 102,445 patients waited 12-hours or more from their time of arrival
  • This accounts for 8.2% of Type 1 Emergency Department attendances
  • This is 3.8 times larger than the number of 12-hour waits measured from decision to admit (26,899)
  • This figure is 30.5% lower than the previous month. March 2023 saw 147,405 12-hour waits measured from the time of arrival
  • The North West had the highest percentage of 12-hour time of arrival waits, 12.7% of type 1 attendances waited 12 hours or more, equal to 20,845 waits.
  • This is 4.5 3.1 percentage points above the national average
  • The South West had the highest number of 12-hour waits measured from the time of arrival, 24,365

The latest Emergency Department performance figures published by NHS England for April 2023 for show:

• There were 1,271,145 attendances at major Emergency Departments
  • This represents a 3.2% decrease compared with April 2022
  • Type 1 Emergency Departments saw 41,005 attendances per day during April. This means attendances decreased between March and April by 7.5% per this measure.
• 26,899 patients were delayed for 12-hours or more from decision to admit to admission
  • This is the lowest figure has been in the past 10 months
  • However, this represents an increase of 11.4% compared with April 2022
• Four-hour performance at major Emergency Departments was 60.9%
  • This represents a 4.1 percentage point increase from March 2023 and 1.9 percentage point increase from April 2022
• Type 1 admissions stood at 363,584
  • This is a daily average of 12,119 which is a 3.0 percentage point increase since April 2022
• 6% of Type 1 attendances were admitted, this is a 0.5 percentage point increase from March 2023
• 133,437 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 14% decrease from April 2022.

Beds data for April 2023 show:

• Last month, there were 98,431 general and acute beds available, a decrease of 0.8% from March 2023, but an increase of 1.8% from April 2022.
• The occupancy rate was 92.6%, 1.5 percentage points lower than March.
• Since September 2022, 1,763 G&A beds have been added
  • However, since it was announced in January this year that 5,000 new beds will be made available by next winter, the number of general and acute beds available at Type 1 acute trusts has fallen by 1,615 beds (-1.6%) between January and April 2023.

Five priorities for UK Governments to #ResuscitateEmergencyCare: https://rcem.ac.uk/resuscitating-emergency-care/