System wide approach is essential to save a health and social care system in need of intensive care, RCEM says

20 October 2023

The Royal College of Emergency Medicine says a ‘system-wide approach’ is essential to save a health and social care system itself in need of intensive care.

RCEM has called on the government to provide the staff, investment and capacity needed for meaningful improvement and change.

The State of Care report published today (20 October 2023) by the Care Quality Commission found an ongoing problem of ‘gridlocked’ care with ‘people facing longer waits to be seen in urgent and emergency care’.

The State of Care report shows:

• People who spent longer than four hours in A&E reported poorer than average experiences.
• Delays in the wider health and care system mean people are spending longer in an emergency department.
• People’s experience in urgent and emergency care continues to be poor and the problems are pointing to issues that require a local system level response.
• The effectiveness of urgent and emergency care services can indicate how effectively health and care services are co-ordinated across a local system.
• Winter pressures often focus on emergency departments, but this is symptomatic of a much wider capacity problem across the whole health and care system.
• Staff regularly reported being overworked, exhausted and stressed – sometimes to the point of becoming ill, injured or leaving their job altogether. Staff reported this can affect their ability to provide safe and effective care to people.

Elsewhere in the report it highlighted issues with the wider system, including around social care, maternity care, mental health care, all of which are under severe strain. It also highlighted particularly concerning issues around inequitable access to care.

And says that there is a risk these are leading to a two-tier system where people who can afford to pay will seek private treatment while those who cannot face long waits and reduced access.

Welcoming the report’s findings, Dr Adrian Boyle, RCEM President said:

“Once again, this important report makes for difficult reading – especially the parts around emergency care, laying out a litany of serious challenges facing a health and social care sector itself in need of intensive care.

“Patients are not getting the care they deserve, despite the best efforts of hard-working staff to deliver it, who themselves are burned out and exhausted. All this is deeply concerning as we stand on the cusp of what looks set to be another challenging winter.

“The report clearly shows a system-wide approach is essential to tackle the deep-rooted issues facing health and social care.

“The government must recognise this and provide the staff, investment and capacity needed to empower the system to make meaningful change and improve care for patients and staff.

“Continuing with the status quo will mean more delays for patient care and a system perpetually stuck in ‘gridlock’ as it has been for years.”

Data in the State of Care report show:

• In 2022 51% of patients reported that they waited more than an hour before being examined by a nurse or doctor, up from 28% in 2020.
• In July 2023, over half a million patients waited more than four hours in A&E.
• In July 2023 there were almost 24,000 people waited over 12 hours from the decision to admit to admission.

The State of Care report highlights the number of patients who waited 12-hours in A&Es from decision to admit to admission, rather than the number of patients who waited 12-hours in A&Es from their time of arrival.

It is more meaningful and transparent to measure 12-hour patient waits from their time of arrival at A&E – as is recorded and published in Wales, Northern Ireland, and Scotland.

NHS Digital Hospital Accident & Emergency Activity figures show that from April 2022 to March 2023, 1,789,130 patients waited 12-hours or more from their time of arrival in A&E.