Emergency Care crisis remains challenging but, as the latest figures show, with a political will improvement is possible

9 February 2023

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

“January’s performance figures show welcome signs of improvement compared with December. However, things remain extremely challenging in emergency care. The figures remain poor and are certainly the worst-ever for January. High-numbers of patients are still facing 12-hour DTA waits; over 42,000 patients faced waits of 12-hours or more from decision to admit to admission. This is unacceptable.

“What the figures do reveal is that a renewed focus on metrics, joined with an expansion of capacity and a political will from our health and political leaders, performance does improve. We know this is fixable and right now we are seeing the right focus on the right things. NHS England’s urgent and emergency care delivery plan is a welcome step towards transformation and change.

“The delivery plan is right on some things but wrong on others, the new target of 76% four-hour performance is unambitious. January’s figures show that four-hour performance across all emergency care facilities was 72.4%. We argue that there must be an incentive to do better, especially for the highest acuity patients who are the sickest that face the longest waits. We think the 76% target for the four-hour access standard target should be much higher.

“Expanding capacity is welcome, we can see that there has been a 5.5% increase in physical general & acute beds in January 2023 compared with last year. NHS England claim that they have actually opened 10% more beds in January. We would like clarification of what beds they are referring to, where these beds have been opened, if these are virtual beds, and where virtual beds can be tracked and counted. Data and transparency are vital to continuing to improve patient care.

“In a new campaign, we have laid out five priorities for UK Governments to #ResuscitateEmergencyCare to tackle the urgent and emergency care crisis covering: beds; workforce; social care; and more. We urge political and health leaders to hear our calls and implement our recommendations to tackle the crisis in emergency care – so that we can continue moving in the right direction and improve the service for patients and staff.”

Commenting on ongoing industrial action by nurses and ambulance services and plans for industrial action by junior doctors, Dr Boyle said:

“We understand and recognise the serious challenges in Emergency Medicine and the pressures that our colleagues and peers face. We believe that all health workers should feel valued, respected, supported, and heard. We know that there is a serious retention crisis in the health service and existing staff are stretched more than ever before and are working in ever-increasingly-difficult conditions. Our members and colleagues have an individual right to take industrial action as appropriate. It is our sincere hope that any ongoing negotiations that may be taking place are successful and that things can be resolved without the need for any further action. It is right for political leaders to recognise the challenges facing staff and it is right for both sides to engage in good faith to find a resolution.

“Patients can be assured that while emergency care could be disrupted, staff in hospitals will continue to deliver emergency care and ensure their safety and protection.”

Notes to editor

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

• There were 1,244,815 attendances at major Emergency Departments
  • This represents a 0.2% decrease compared with Jan 2022, and a 13.5% decrease compared with December 2022.
  • Type 1 Emergency Departments saw 40,155 attendances per day during January. This made it the quietest month since March 2021 per this measure.
• 42,735 patients were delayed for 12-hours or more from decision to admit to admission
  • This is the third highest number of 12-hour waits on record
  • This is 158% higher than January 2022 and a fall of 21.6% from December 2022
• Four-hour performance at major Emergency Departments was 58.0% – this is an 8.4 percentage point increase from December 2022, but a 4.2 percentage point decrease from January 2022.
  • 4 percentage points is the biggest month to month improvement since April 2020 (10.9%). Outside of 2020 and 2021, the previous largest such increase was 5.9% (April 2018).
• Type 1 admissions stood at 364,393 (a daily average of 11,755)
• 3% of Type 1 attendances were admitted, this is a 3.0 percentage point increase from December 2022, and the highest figure recorded since December 2021.
• 142,139 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 16.1% increase from January 2022, but 16.5% fewer than December 2022.

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

• Patients leaving the department before being seen stood at 7.6%. This is an increase of 1.6 percentage points from November 2022, and 2.6 percentage points higher than December 2021.

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