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Existing A&E figures belie ‘true scale’ of lengthy waits for care

RCEM’s first set of winter flow data for this year indicate numbers of people waiting 12+ hours are three times higher than official stats

Caroline White

Monday, 09 December 2019

The numbers of people waiting 12 or more hours for care in A&E are actually three times higher than existing official indicate, reveals the first set of figures issued from the Royal College of Emergency Medicine’s (RCEM) Winter Flow Project for 2019-20.

The figures belie the true scale of the problem facing emergency care departments across the UK, says the College.

The Winter Flow Project, which runs from October 2019 to March 2020, publishes anonymised weekly data from the emergency departments of a sample of 50 trusts and health boards.

The first set of data show that in the first week of December over 5000 patients waited longer than 12 hours at these sites, which, between them, are equivalent to a third of acute beds in England.

From the beginning of October 2019 over 38,000 patients have waited longer than 12 hours for a bed at the sampled sites. Yet data from NHS England report that in England a total of only 13,025 patients have experienced waits of over 12 hours since 2011-12. 

President of the RCEM, Dr Katherine Henderson, said: “In a nine-week period, at only a third of trusts across the UK, we’ve seen nearly three times the number of 12 hour waits than has been officially reported in eight years in England. This must be fixed.”

The discrepancy arises because of the way in which the data are reported, she explained.

“Our data measures the number of patients waiting over 12 hours from the moment they arrive at an [emergency department], whereas NHS England (unlike Wales, Scotland and Northern Ireland) start the clock at the point at which a decision to admit is made – meaning that a patient could already have been waiting hours before this,” she said.

“The way in which it has historically been reported does our patients a disservice and hides the true scale of the problem of corridor care,” she insisted, adding: “These figures are truly shocking and are terrible for patients and staff alike.

“Many patients are now getting often life changing news while stranded on a trolley in a corridor. This cannot be right, and we must strive to put an end to ‘corridor care’.”

But she added: “We can only do that if we acknowledge the true scale of the problem.

“We understand NHSE/I [NHS England and NHS Improvement] accept the need to monitor corridor care. The Clinical Review of Standards absolutely must change the way in which 12-hour waits are measured to be in-line with how the devolved nations report it. This is such a vital measurement and indicator of safety that whatever else comes out of the review process, a true measurement of how many patients are being kept waiting for over half a day is essential.”

The first Winter Flow report of 2019-20 also shows that just under 69% of patients were seen within four hours at the reporting sites – the worst performance in the five-year history of the Project.

Dr Henderson continued: “We are clearly in the worst state we’ve ever been in as we enter the true winter season. Norovirus and the ongoing pensions taxation issue will not have helped, but this decline has been long in the making. 

“We are deeply concerned that one of the areas of the health service most valued by patients - the Emergency Departments - are, year on year, struggling to cope and increasingly difficult places for staff to deliver the standard of care they want to. Emergency Departments are the NHS safety net and the safety net is buckling.”

Niall Dickson, chief executive of the NHS Confederation, commented: "We have to find ways of reducing the demand on our emergency departments – this survey is further evidence of the colossal pressures on staff and the real suffering of thousands of patients. It is small wonder that most leaders say this will be the worst winter ever.

"And the way we measure performance is not right either. Two in three health leaders say the current measures are not ‘fit for purpose’.”

He concluded: "If we want a health service that can cope, we need new services in the community that will relieve the pressure on hospitals as well as action on staffing, social care, and capital investment.”

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