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Report shows alarming number of avoidable deaths in Emergency Departments due to crowding in Wales

18 November 2021

Emergency Department performance figures published today by the Welsh Government for October 2021 show four-hour performance has deteriorated for the seventh consecutive month, while 12-hour waits have risen for the sixth consecutive month and eight-hour waits have reached the highest on record.

The figures come as a new report from the Royal College of Emergency Medicine, ‘Crowding and its Consequences’ shows that in 2021, 709 patients of those who stayed in an Emergency Department for eight to 12 hours in Wales have died as a result of crowding and long stays.

Emergency Department performance figures for October 2021 show that there were 65,963 attendances at major Emergency Departments, 480 fewer than in September 2021.

Despite this, four-hour performance fell for the seventh consecutive month once again reaching a new record low at 56%. This is a fall of 1.3 percentage points compared to the previous month, September 2021.

The data also show that 9,419 patients waited 12 hours or more in major Emergency Department, this equal to one in seven patients. This is also over 1,000 more patients waiting for 12 hours or more than the previous month, September 2021.

Furthermore, 15,825 patients waited eight hours or more – the worst performance on record. This is equal to one in four patients. This is also nearly 1,000 patients more, waiting for eight hours or more, than the previous month, September 2021.

The College’s report ‘Crowding and its Consequences’  highlights data from NHS England’s Getting it Right First Time (GIRFT) program that show one in 67 patients staying in the Emergency Department between eight and 12 hours come to excess harm.

Bed occupancy for general and acute beds stood at 89.42%, the highest bed occupancy since the start of the pandemic.

Dr Suresh Pillai, Vice President of the Royal College of Emergency Medicine Wales, said:

“The data once again show a worrying further deterioration in performance. The urgent and emergency care system in Wales is facing a crisis and we are only just entering winter. Patient safety is at risk. We must do all we can to ensure that we continue to provide effective and safe urgent and emergency care.

“The findings of the Royal College’s report into crowding and patient harm are appalling. Crowding and long stays in Emergency Departments have always been dangerous and posed a threat to patient safety and we have consistently expressed our concern about these unconscionable practices. But now we can see in real terms the avoidable harm long waits cause patients. 709 patients in Wales, in 2021 alone, have died as a direct result of crowding and long stays. These deaths were preventable; the government, Boards and NHS leaders must understand and act now to ensure that the current crisis does not deepen and lead to more avoidable excess deaths.

RCEM CARES: The Next Phase outlines system-wide actions that must be taken to improve patient care. In the short-term, Boards must expand capacity where possible and focus on promoting flow throughout the hospital. This is vital to reducing ambulance handover delays, exit block and dangerous crowding.

“For flow to be maintained, patients must be discharged in a timely way once their treatment is complete. Social care must be resourced to support patients leaving hospital on time. This will help reduce long-stay patients, and care in the community will prevent further visits to the Emergency Department.

“Same Day Emergency Care and Home First can help to alleviate pressures on Emergency Departments and reduce avoidable admissions. Resourcing and expanding these services and ensuring they are readily available at Boards must be a priority.

“In the longer term, the Welsh government must restore bed capacity to pre-pandemic levels, in Wales an additional 450-550 staffed beds are required. The government must publish a long-term workforce plan that includes actions to retain existing staff as well as recruit new staff. Currently in Wales there is a shortfall of 100 Emergency Medicine consultants, along with vital Emergency Medicine nurses, junior and supporting staff.

“The Welsh Government have recognised the threat to patient safety, prioritising it in their Winter Plan along with social care. We would welcome the opportunity to meet with the government to discuss actions and solutions to tackle the crisis and get through the winter.”


Notes to Editor

The mortality figure in Wales (709 excess deaths in 2021 so far) is calculated by applying GIRFT findings to Wales performance figures which measure eight and 12 hour waits from time of arrival.

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