Publication of true 12-hour length of stay data a welcome and significant step for Emergency Medicine

13 April 2023

Commenting on the inaugural publication of 12-hour length of stay data measured from the time of arrival by NHS England for February 2023, Dr Adrian Boyle, President of the Royal College of Emergency Medicine, said:

“We thank NHS England for taking the initiative in publishing these data. This is a welcome and significant step for Emergency Medicine and for the College, which has been campaigning for this for a long time. I am grateful to my predecessors for their work in paving the way for this outcome. We will work with NHS England to ensure these data lead to transformation and improvement of patient care. We are pleased that NHS England is implementing their Urgent and Emergency Care delivery plan, we will continue to look at the progress of this with interest.

“As the data show, there are large numbers of patients waiting 12-hours from their time of arrival. Now, we must get to work and reduce and eliminate these dangerous delays and overcrowding in Emergency Departments – that we know are harmful to patients. This is a more patient centred metric and seeing these data give us better clarity and granularity around issues of patient flow through our departments and hospitals and will allow us to better tackle the crisis, root and branch.”

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

“Emergency Care remains in crisis. NHS England’s Urgent and Emergency Care delivery plan is a welcome step towards the recovery of Emergency Care. As part of this, we welcome NHS England’s initiative on publishing 12-hour length of stay data measured from the time of arrival, but further action cannot be delayed.

“Emergency Department performance remains poor, acute bed numbers are low while bed occupancy numbers remain dangerously high. Flow through our hospitals is exceptionally slow, leading to delays to admission and delays in Emergency Departments. The continued lack of responsive social care means we are unable to discharge patients in a timely way – keeping patients in hospital longer than necessary. We are hugely disappointed that the government has chosen to halve funding pledged for social care, this is a significant misstep that threatens the recovery of Emergency Care. Good social care underpins an effective health service and cuts will only have a further detrimental impact on patients.

“Bed occupancy at Trusts is dangerously high. We must see an the expansion of the acute bed base, the NHS Urgent and Emergency Care delivery plan pledges ‘funding of £1 billion for additional capacity, including 5,000 new beds as part of the permanent bed base for next winter’ – since this pledge was made in January the acute bed base has marginally decreased. NHS England and the Department of Health and Social Care must prioritise this to reduce delays to admission and overcrowding in Emergency Departments.

“Alongside this, we reiterate the urgent need for the publication of the fully-funded long term workforce plan that the government have pledged to deliver. This must contain workforce projections and figures and crucial measures to retain our existing workforce.

“High bed occupancy, poor performance, delays to admission, delayed discharges and overcrowding in Emergency Departments are deep rooted and long-standing problems. They are not new problems caused by recent events and disruption. These can only be tackled with medium- and long-term solutions that we lay out in our five priorities for UK Governments to #ResuscitateEmergencyCare – namely a renewed focus on beds, social care, and both workforce retention and long-term workforce planning.”

Notes to editor

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

• In February 2023, 125,505 patients waited 12-hours or more from their time of arrival
  • This accounts for 10.59% of Type 1 Emergency Department attendances
  • This is 3.6 times larger than the number of 12-hour waits measured from decision to admit (34,976)
  • The worst performing region was the North West. 13.7% of type 1 attendances waited 12 hours or more, 3.1 percentage points above the national average.

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

• There were 1,373,575 attendances at major Emergency Departments
  • This represents a 3% decrease compared with March 2022
  • Type 1 Emergency Departments saw 44,309 attendances per day during March. This means attendances increased between February and March by 2.7% per this measure.
• 39,671 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 an increase of 76.3% compared with March 2022, this represents the smallest such increase in two years
• Four-hour performance at major Emergency Departments was 56.8%
  • This is the fourth worst four-hour performance on record
  • This is same figure as February 2023 and a 1.8 percentage point decrease from March 2022.
• Type 1 admissions stood at 381,682
  • This is a daily average of 12,312 which is an increase of 1.5% from February 2023 and a 2.0% increase from March 2022
• 8% of Type 1 attendances were admitted, this is a 0.4 percentage point decrease from February 2023
• 144,292 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 5.9% increase from March 2022, also the smallest increase in the last two years.

Beds data for March 2023 show:

• Last month, there were 99,223 general and acute beds available, a decrease of 0.2% from February 2023, but an increase of 3.4% from March 2022.
• The occupancy rate was 94.1%, 0.2 percentage points lower than February.
• Since September 2022, 2,555 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 0.8% between January and March 2023.

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