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RCEM warns ‘This is only the beginning of the crisis’ as latest data shows severe deterioration in performance

18 November 2021

Quarterly Emergency Department performance figures published today by the Department of Health Northern Ireland for July to September 2021 (Quarter 2 2021) show that performance sunk to a record low as four-hour performance dropped to 47% during August. 12-hour waits increased for the seventh consecutive month, reaching a record high for the third consecutive month.

In Q2, 2021 there were 164,892 attendances to Type 1 Emergency Departments across Northern Ireland. This is a decrease of 14.3% of attendances compared to the previous quarter, Q1 2021.

In Q2 2021 20,565 patients waited in a Type 1 Emergency Department for 12 hours or more. This is an increase of 45% compared to the previous quarter and is equal to almost 1 in 7 patients in Q2.

Four-hour performance has deteriorated significantly. In Q2 only 48.4% of patients were treated and discharged or admitted from a Type 1 Emergency Department within four hours of their arrival. This is fall in 6.4 percentage points compared to the previous quarter, Q1.

Quarter 2 performance figures come as a new report by the Royal College of Emergency Medicine – ‘Crowding and its Consequences’ – shows that excess deaths are associated with delays in Emergency Departments.

Dr Paul Kerr, Vice President of the Royal College of Emergency Medicine Northern Ireland, said:

“The data show the stark reality in Emergency Departments across Northern Ireland. The current situation is extremely challenging – long stays; ambulance handover delays; dangerous crowding; poor flow throughout hospitals; exit block – these are posing a serious threat to patient safety.

“The new report by the Royal College of Emergency Medicine clearly highlights the harm caused by crowding and delays. We have known for a long time that these shocking delays in moving admitted patients to a bed can lead to avoidable harm of patients and even death.

“Staff are demoralised and exhausted and under the current pressures they are struggling to deliver the quality of care they would like to provide. It is incredibly challenging, but they continue to work incredibly hard to try and keep patients safe and deliver effective care.

“We hope the Assembly’s £16.5 million winter funding for ‘No More Silos’ will help support urgent and emergency care. But in order to move patients beyond the Emergency Department and help facilitate timely discharges of patients, it is imperative that all 10 key actions in ‘No More Silos’ are acted upon. The difficulty in discharging medically fit patients is causing exit block in hospitals. Discharging patients in a timely way cannot be achieved without adequately funding and resourcing local, community and social care services so patients have the support they need to return home and recover in the community. Action points six, seven, nine and 10 in ‘No More silos’:

  • Regional anticipatory care model for nursing homes
  • Acute care at home
  • Enhanced framework for clinical and medical input to care homes
  • Times discharge from hospital

“these are vital to supporting the most vulnerable patients in the community, preventing admission to hospital, and reducing long-stays at hospital.

RCEM CARES: The Next Phase details our system-wide plan to improve patient care. In the short term, Trusts must safely expand capacity where possible, provided there is adequate workforce available to staff the beds. Trusts must focus on reducing exit block and promote flow throughout the hospital. This in turn will help reduce ambulance handover delays by increasing the number of available beds to move patients into.

“We face workforce shortages throughout the system. In the long-term it is vital to see a multi-year workforce plan. In Emergency Medicine in Northern Ireland, there is a shortfall of 100 Emergency Medicine consultants, but crucially there are widespread shortages of Emergency Medicine nurses, and other junior and supporting staff.

“Urgent and emergency care is in crisis; and patient safety is at risk. The government must understand this and take effective action now before things deteriorate even further. We are keen to work with the government to discuss actions to tackle the crisis and get through the winter. As one health leader said ‘we are on the edge of being able to manage’ – we fear without urgent action patients will come to avoidable harm.”


Notes to Editor

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