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RCEM Vice President warns against becoming “immune to the human impact of what the numbers mean” as performance declines again in Winter Flow Project

15 February 2019

The latest weekly performance data from over 50 Trusts and Health boards shows the need for “sufficient resources for emergency care” as RCEM Vice President, Dr Chris Moulton warns against losing sight of the human stories behind the numbers.

Responding to data from the College’s Winter Flow Project for the week ending 10 February 2019 showing average four-hour performance at just 75.54% Dr Chris Moulton, Vice President of the College said:

“As has been the case for the duration of this year’s Winter Flow Project, full compliance with the NHS Constitution commitment that at least 95% of patients attending A&E departments should be admitted, transferred or discharged within four hours remains a distant prospect. At 75.54%, performance is 2.41 percentage points lower than was the case in the previous week and 4.15 percentage points lower than was the case in 2017-18. This is the most adverse performance that we have recorded at this point in February and is very close to being the lowest performance ever recorded in the four years that the Winter Flow Project has been in operation.”

The lowest four-hour performance score to date was 74.23% – recorded in the first week of January 2016-17. Performance has declined in eight of the last 11 weeks and shows little sign of staging the kind of recovery that has been seen in previous years. It is noteworthy that several contributors this week have recorded performance scores of less than 55%.

Dr Moulton said: “Of course, none of this means that the contributors to the Winter Flow group, and the staff that work within their hospitals, are not trying to do something about performance. The group as a whole opened an additional 200 acute beds this week alone, and within the group, bed numbers have risen more or less consistently since the end of December. Unfortunately, while these efforts are laudable, the evidence of the NHS England Winter Sitrep data suggests that they remain inadequate. The Sitrep data shows that bed occupancy rates were above 95% this week; higher than was the case at the same point last year (94.97%), and that the number of available beds across the week was 556 lower than was the case in 2017-18.

“Similarly, contributors are continuing to make every effort to provide the staff required to maintain patient safety. The number of locum and agency doctors and nurses within the Winter Flow group remains near historic highs and is 107 higher than was the case at the same point last year.

“The problem with this kind of reporting – and similar reporting from NHS England and others – is that it is often easy to get lost in the numbers and become immune to the human impact of what they mean. The reality of reporting four-hour performance at this level is that large numbers of vulnerable patients are suffering unnecessarily, and that staff are working in often unpleasant conditions to prevent patients from coming to harm.

“It is surely time to acknowledge that this issue is both unacceptable and avoidable. Moreover, avoidable should not mean removing reporting around these time-based system metrics so that patients languishing on trollies can be conveniently forgotten by political decision makers. The answer is to ensure that there are sufficient resources for emergency care as a national priority. With the right numbers of staff, an adequate number of acute hospital beds and sufficient capacity in social and community care, long delays for patients in A&E departments could become a thing of the past.”

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