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RCEM Election Manifesto outlines actions for the next government to help A&Es after worst ever performance figures

14 November 2019

In response to data for October that shows A&E performance at its worst ever level, the Royal College of Emergency Medicine has launched its election manifesto that outlines what must be done to repair Emergency Medicine.

Performance against the four-hour standard was at 83.6% at all types of Emergency Department, and just 74.5% at major A&Es.

President of the Royal College of Emergency Medicine, Dr Katherine Henderson said: “We have reached a new low in terms of hospital performance against Emergency Care standards. The risk is that this is ignored, ignoring the human stories behind the numbers.

“These figures should be a source of shame for politicians of all stripes. Patients have been let down repeatedly by a parliament that has consistently failed to grasp the scale of the problem.

“Our staff are stretched beyond their limits. Staff find themselves running wards in corridors as there are too few beds for the patients needing admission. Areas designated for Same Day Emergency Care are filled with people waiting to be admitted; effectively blocking their ability to deliver ambulatory care. Patients are suffering.

“The worst part of this is that winter is only just beginning. This will almost certainly get worse.

“This election is an opportunity for political parties to commit to do what is necessary in the long term to resolve the chronic problems facing emergency care. Our manifesto shows how.”

Among its recommendations, the RCEM Manifesto calls for:

  • At least an extra 4,000 beds to help maintain flow in Emergency Departments (EDs) and get bed occupancy back to safe levels.
  • Publication of a social care white paper that addresses the £2.3bn shortfall in council social care budgets.
  • Improvement of primary care provision via the expansion of the GP workforce and their hours of availability.
  • Sufficient capital funding to improve outdated buildings and equipment and transform the emergency care system.
  • A clear strategy to address emergency medicine staff shortages, in particular supporting adequate numbers of nurses.
  • Many of our departments are not adequately designed for the delivery of 21st century emergency medicine. Many departments need to be rebuilt.

Dr Henderson said: “At its simplest we need more beds, we need more staff, we need more social care. Politicians must make this happen.

“No more excuses. No more distractions. Our next administration must put the health of our country above all else.

Dr Henderson also said that the wider health service must work together to reduce pressure on EDs: “Corridor care is unacceptable; we need collaboration and we are working with other Royal Colleges to find a way to do this.

“While it is entirely legitimate to review NHS targets, the review of standards has led to uncertainty and left trusts wondering where their focus should be.

“We are working with NHSE to ensure that the outcome of the review process is of actual benefit to patients. We are very keen that the review results in it being unacceptable to have patients waiting a long time in the ED for a bed.

“But in the short term Trusts will have to stretch every sinew to find more beds and staff, to ‘rescue A&E performance’. Given the record level of vacancies and the chaos the current pension taxation arrangements have caused, this is a near impossible task.

“Emergency care teams don’t want to be ‘rescued’ – we want to deliver great patient care in an adequately resourced environment.

“We hope that candidates and parties commit to our manifesto actions so that the NHS never again has to go into another winter in such a state.”


Notes to Editors
The full RCEM Election Manifesto can be read in pdf form here or online at

Its recommendations in full are below.

  • Increase the bed capacity in hospitals to maintain flow in Emergency Departments. We estimate that at least 4,000 extra staffed beds are needed in England alone this winter to achieve 85% bed occupancy.
  • Immediately publish a Social Care White Paper, with the view of expanding social care provision to improve patient flow and address delays in transfers of care in Acute Hospitals. Additional funding must address the £2.3 billion shortfall in social care faced by councils, as advocated by the Local Government Association
  • Improve primary care provision through expanding the GP workforce advocated by the Royal College of General Practitioners and their hours of operation to ensure primary care is available into evenings and weekends. Round-the-clock support also needs to be developed to support frail elderly people in care homes.
  • Expand Same Day Emergency Care and co-locate primary care services with Emergency Departments to allow patients to be routed to the best place to obtain their care.
  • Introduce investment in the workforce to meet RCEM guidelines for safe staffing levels for all staff working in Emergency Departments. This should be reviewed every five years in order to ensure staffing levels are keeping pace with changing demand.
  • Ensure the NHS People Plan provides a clear framework for addressing Emergency Medicine staff shortages for various staffing groups and introduce a clear strategy to recruit and retain staff, including nursing staff. As part of this, expand ‘returnship’ programmes that are currently available for allied health professionals to support Emergency Medicine staff returning to work after career breaks.
  • Ensure patient safety is protected by reforming pension legislation, this will prevent further attrition of the Consultant workforce.
  • Work with the College to develop an effective measure for patient experience in Emergency Departments.
  • Build on the commitments outlined in the Forward View for Mental Health and NHS Long-Term Plan and accelerate the expansion of mental health services.
  • Ensure sufficient capital funding is available for trusts to transform the emergency care system at pace to ensure it is fit for purpose.
  • CQC does not carry out any reviews of integrated primary and secondary care. The incoming Secretary of State for Health and Social Care should immediately commission CQC to carry out integrated health and social care system reviews.
  • Many of our departments are not adequately designed for the delivery of 21st century emergency medicine. Many departments need to be rebuilt.
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