NHS performance figures highlight the true scale of Emergency Department crisis

Feb 15 2019

Responding to the release of performance figures for January 2019 which show worst ever four-hour performance and the highest ever number of emergency admissions, President of the Royal College of Emergency Medicine, Dr Taj Hassan said:

These are the worst figures on record, showing that despite the positivity around the NHS Long Term Plan, the suffering affecting our patients in Emergency Departments in England has not gone away at all.

Sadly the situation afflicting our Emergency Departments has become seemingly normalized with a 'chronic crisis mode' that does not allow staff to deliver the quality of care they would wish and patients should rightly expect. The evidence on resultant crowding in departments is clear - it adds to the risk of harm to patients leading to excess deaths and disability.

These figures make clear the true scale of this crisis facing our systems. Despite a relatively mild winter, with lower rates of norovirus, nearly one in four people are waiting over four hours and nearly a third of all attendances require admission; the need for more beds could not be clearer.

We strongly encourage all hospitals to see four-hour Emergency Care system performance as a whole hospital issue, rather than merely a departmental one. As part of this they should be looking to implement full capacity boarding, where patients are sent to wards before being admitted to a bed, in order to share risk evenly rather than just in the Emergency Department. It is also important to have additional medical and nursing staff to support patients waiting for a bed in crowded departments. Instead too many Clinical Directors are having to cope with clinical rota gaps and nursing levels remain woefully inadequate to cope.

The Long Term Plan will have many positive impacts, but it is clear that resources for staffed beds will not be forthcoming, focussing instead on redirection. Even with the best intentions, this may not have the desired impact of improving flow within hospitals. The systemic issues need addressing urgently. In the meantime, the suggestion that perhaps the NHS in England should find ways to change the best measure of system flow we have – the four-hour standard – seems wholly inappropriate.  

Good quality data and metrics that are timely, robust and simple to understand are vital for measuring flow, and by proxy patient safety. We are sceptical of the need for change but eagerly await NHS England’s proposals for the standard’s replacement and hope we can work together to find a solution that actually puts the patient’s interest first.

If we are to really improve flow, we will need a fully funded, long term plan for social care and an increased acute bedbase to help reduce bed occupancy levels. This strategic approach is the one that the College is most keen to collaborate with NHS England to help address and would go a very long way to easing problems of poor safety in our departments and improvements in the quality of care for our patients."