RCEM outlines actions needed to tackle ‘dangerous’ crowding as it returns to A&Es

22 October 2020

The Royal College of Emergency Medicine has called for action after a survey found that over half of A&Es across the UK are caring for patients in corridors due to a lack of beds.

A survey of 89 senior clinicians, representing up to 110 Emergency Departments (EDs), found that in the week ending 11/10/2020:

• 50% of departments are caring for patients in corridors, despite the known risks and national guidance that this should never occur
• 75% of departments have reported that they were unable to maintain social distancing on at least one day per week, with 25% unable to do so every day
• 80% of departments are unable to offload ambulances at least one day per week

Dr Katherine Henderson, President of the Royal College of Emergency Medicine, said: “This survey illustrates the perilous state in our Emergency Departments as we head into winter. We aren’t even into winter yet, but crowding is returning with a vengeance and in the covid endemic era, that will put more lives at risk than it ever did before.

“The rate of infection in the community must be brought down. If covid cases continue to rise EDs are at risk of becoming a hub of transmission. We cannot let that happen. EDs must be safe for patients this winter.

“NHS leaders and organisations must recognise the huge risk that crowding poses and take urgent action so that EDs are sufficiently prepared to deal with covid while remaining open for essential urgent and emergency care.”

The survey comes as the College launches ‘RCEM CARES during the coronavirus pandemic’, its updated plan to make Emergency Departments better in the short and long term.

Focusing on the five key issues of Crowding, Access, Retention, Experience and Safety, the plan calls for:

• an increase in the number of UK hospital beds by at least 19,000 (including restoration capacity to pre-covid levels) to improve the flow of patients through Emergency Departments
• delivery of an additional 2,770 Emergency Medicine Consultants to address the shortage in the workforce
• expansion of primary care services, including a plan to deliver 6,000 extra General Practitioners, and expansion of co-located acute services around EDs
• investment of at least £3.9 billion in adult social care, in England alone, by 2023-24 so hospitals can discharge people promptly when their medical care is complete
• a forward-looking rapid review of the UK’s preparedness for successive waves of the coronavirus pandemic.

“RCEM CARES lays out a framework to tackle the core issues facing Emergency Medicine and presents a vision for the future. We must reduce crowding, increase alternative access to care, work to retain staff, improve patient experience and ensure safety is at the heart of what we do.

“Our priority is safe patient care but without further action from government we worry that Emergency Departments will continue their deterioration into disrepair; compromising their safety, increasing crowding and affecting patient experience.

“Essential action must be taken to forge real, vital change that will significantly improve urgent and emergency care and make it even safer while we are dealing with covid.

“But it is not just the government who must act. By laying out clear pathways to improve emergency medicine, this document calls on various stakeholders and decision-makers to come together and collaborate on a system-wide plan.

“The pandemic has already demanded system wide changes and has showed that these problems are neither insoluble nor insurmountable. To achieve this system-wide transformation we must maintain this momentum. RCEM CARES shows us the way to do this.”