Mitigating crisis in Urgent and Emergency Care

‘Bolster the social care workforce to mitigate crisis in Urgent and Emergency Care’, RCEM urges government.

Responding to the latest Emergency Department performance figures published by NHS England for September 2022, Dr Adrian Boyle, President of the Royal College of Emergency Medicine, said:

“The government needs to wake up; the Urgent and Emergency Care system is under severe strain across the country. Multiple critical incidents have been reported at different sites with more patients facing longer waits. We know long waits are associated with harm and even death. Staff are going above and beyond to ensure they are mitigating this harm and continue to deliver effective care.

“Emergency Departments are full because staff are unable to admit patients to a bed. A large number of beds are filled by patients who are medically fit to be discharged but are unable to be discharged due to the lack of social care support. We welcome the reports of a 24-hour target for discharge, but you cannot do more with less. Bolstering the social care workforce is the singularly most urgent short-term action to help with discharges and to improve flow throughout hospitals.

“We welcome the Prime Minister’s commitment at Prime Minister’s Questions on Wednesday to “absolutely” not cut public spending – ensuring the NHS and Social Care is adequately funded, staffed and resourced will be critical this winter. Any cuts to either the NHS or social care would be devastating to a system already in dire crisis.

“The reality as we head into winter is we have record numbers of 12-hour DTA waits monthly, a new record low for patients seen within four-hours, record numbers of patients on waiting lists, large numbers of patients ready for discharge from hospital, and a shortfall of 13,000 NHS beds and over 130,000 NHS staff.

“The government must face up to this reality and recognise that the system is failing patients and demands action. In the medium- to long-term, the government must deliver the fully-funded long-term NHS workforce plan that they pledged to deliver and open 13,000 beds to drive meaningful change.”

The latest Emergency Department performance figures published by NHS England for September 2022 for show:

• There were 1,302,577 attendances at major Emergency Departments
  • This represents a 6% decrease compared with the same month last year, September 2021
  • There were 2,000,493 attendances at all Emergency Care facilities
• 32,776 patients were delayed for 12-hours or more from decision to admit to admission
  • This is the highest number of 12-hour waits on record
  • It is 552% higher than the same month last year, September 2021, and it is 7056% higher than September 2019
  • There have now been 211,542 12-hour DTA stays recorded so far in 2022.
• Four-hour performance at major Emergency Departments was 56.9%, this is the worst four-hour performance on record
  • This is a 1.1 percentage point decrease from August 2022, and a 7.1 percentage point decrease from September 2021
• Type 1 admissions stood at 353,833 (a daily average of 11,794)
• 27.2% of type 1 attendances were admitted
• 131,861 patients spent more than four hours in an Emergency Department from decision to admit to admission (also referred to as ‘trolley waits’)
  • This is a 26% increase from September 2021
• Delays to admission stood at 27%, this is the fourth highest on record
• Last month, there were 96,668 general and acute beds available. The occupancy rate was 93.6%, the highest figure on record
• The occupancy rate for adult general and acute beds was 95.1%, also the highest figure on record.