Comment EDITOR’S COMMENTwith LOUISE FRAMPTON THE CLINICAL SERVICES JOURNAL Editor
Louise Frampton
louiseframpton@stepcomms.com
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STEP COMMUNICATIONS ISSN No. 1478-5641
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Patients pay the ultimate price for long waits in A&E
Urgent action is needed to prevent thousands of unnecessary deaths due to long waits in A&E. Following years of underinvestment in the NHS and social care, as well as growing staff shortages, patients are paying the ultimate price – with their lives. New analysis by the Royal College of Emergency Medicine reveals that there were almost 300 deaths a week associated with long A&E waits in 2023. That is despite the Government and NHSE implementing a Delivery Plan for the Recovery of Urgent and Emergency Care (UEC) services in January 2023, following the worst winter the health service has ever experienced. The premise of the plan was to improve waiting times and patient experience by increasing
capacity, growing the workforce, improving discharge, expanding care outside hospitals, and making it easier to access the right care. Just over a year on, RCEM analysed progress against the plan and assessed what improvements have been made to recover emergency care services. This work has revealed that, in 2023, more than 1.5 million patients waited 12 hours or more; 65%
of those were patients awaiting admission. Using a method called the Standard Mortality Ratio – which calculates there will be one additional death for every 72 patients that experience an 8–12- hour wait prior to their admission – RCEM estimates that there were almost 14,000 associated excess deaths related to waits of 12 hours or longer in 2023 – more than 268 per week. The College also found that:
l Hospital bed occupancy remains high, consistently averaging over 94%. More than an additional 11,000 available beds are required to achieve safe occupancy levels of 85%.
l The number of patients admitted into hospital has risen by 10% one year on. l Recent figures show that a daily average of 13,690 patients remain in hospital after a decision to discharge them has been made, only 275 fewer than in January 2023.
l The percentage of answered calls to 111 that had clinical involvement has fallen from 43.6% in January 2023 to 40% in February 2024.
l In February 2024, only 56.5% of patients met the four-hour target, a fall of 1.5 percentage points compared to when the plan was announced.
Dr. Adrian Boyle, President of The Royal College of Emergency Medicine, said: “We talk here about ratios and calculations, but it is vital to remember that each one of these deaths was a person with loved ones and families who will forever be left asking ‘what if?’” RCEM is calling for the implementation of long-term plans to build additional capacity within the health and social care system and to ensure that hospitals never exceed 85% occupancy by opening additional staffed beds, so hospitals have the space and resources available to care for every patient. It is also calling for performance to be managed based on the proportion of patients waiting 12 hours or more from their time of arrival, alongside a four-hour target of 95%. Hospital-level performance figures should also be published to ensure transparency. Sadly, the NHS has not met the four-hour A&E standard at national level in any year since
2013/14 (Source: King’s Fund). It will take significant investment to return to the performance levels previously seen, when the four-hour target was first introduced. It is hard to imagine the feelings of anger, powerlessness and despair that loved ones must feel when they know their family member could have been saved, if the NHS was performing as it should do, can do, and used to. You can read the RCEM’s full reports at:
l Insights: Long waits and excess deaths:
https://tinyurl.com/3saa2r5z l Progress Against Delivery Plan – one year on:
https://tinyurl.com/3uvtue85
louiseframpton@stepcomms.com Get in touch and give us your views, email me:
May 2024 I
www.clinicalservicesjournal.com 5
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