The terrible consequences of the lack of front line NHS capacity, in both elective emergency services, is taking a heavy toll according to recent research.
At the end of August a Labour Party analysis showed a massive 120,000 people had died while on the waiting list for NHS treatment last year (2022/23) – double the equivalent number five years earlier. Among the more tragic examples were 3,615 deaths of waiting list patients at London’s Royal Free Hospital, with 2,888 in Morecambe Bay hospitals and 2,039 in Leeds.
The figures, which have been found to be sound by Full Fact are calculated from the results from the 35 trusts which responded to Labour’s survey of 138 acute trusts.
But they have been criticised by NHS England, which argues that the “does not demonstrate a link between waits for elective treatment and deaths, and … the data does not include the cause of death or any further details on the person’s age and medical conditions.”
This objection would be more credible if NHS England itself published data on deaths on waiting lists drawing on a wider if not a full response from acute trusts – and possibly also mental health trusts.
Meanwhile the ill-effects of chronic delays in emergency care also depend upon analysis by another external body, the Royal College of Emergency Medicine.
Earlier this year RCEM published research which revealed there were an estimated 23,000 excess patient deaths in England in 2022 associated with waits of 12 hours or more in A&Es. Using the same methodology, between January and July this year it calculates there have been almost 12,000 excess deaths linked to these 12-hour plus waits.
Responding to the publication of the latest official NHS statistics the RCEM notes record numbers of patients attended A&Es in 2022/23, but despite the increased attendances, fewer patients were admitted.
Yet despite almost 200,000 fewer emergency admissions in 2022/23 compared with the previous year, the lack of capacity and problems with discharging patients to suitable care outside hospital meant that the delays were far worse.
The RCEM points out that shortage of NHS capacity meant that “one in 10 patients (9.2%) who were admitted to hospital from A&E waited 12 hours or more [for a bed] from the clinical decision to admit them.”
This percentage figure understates the shocking four-fold increase in numbers of patients waiting on trolleys for over 12 hours after a decision to admit them, from 98,000 in 2021/22 to 410,092 in 2022/23.
The proportion treated or discharged within 4 hours fell once again to just under 71% in 2022/23 compared with 77% the previous year – and 95.9% ten years earlier.
Perhaps more shocking were the 22 trusts that averaged below 50% of patients treated or discharged within 4 hours, within which three, Derby and Burton (39.5%), West Hertfordshire (37.3%) and Barking Havering and Redbridge (31.7%) were by far the worst.
Other figures show that doctors have been right to argue that there is now little difference between the historic “winter peak” of demand and the lowest level of demand for A&E services: indeed the lowest month for daily attendances in 2022/23 was January, while the second highest was June.
RCEM President Dr Adrian Boyle commented:
“Record attendances met with the significant shortfall of staff and beds meant huge numbers of patients faced severe delays for care that we know are associated with increased harm and even deaths. Despite these record attendances, fewer patients were admitted. However, those that were admitted waited longer than ever before.
“We know that it is the elderly, the sickest and most vulnerable, and those experiencing a mental health crisis that face the longest waits for a bed. We are pleased that the government has committed to regularly publishing 12-hour length of stay data measured from the time arrival, as this is shining a light on this problem. However, since the government published their urgent and emergency care delivery plan in January 2023 we have not seen sufficient progress on reducing long stays for patients who need to be admitted to hospital.”
In August this year alone monthly A&E performance figures show that over 112,000 patients faced a 12 hour wait from their time of arrival, and dangerous levels of bed occupancy.
Just a few days later the RCEM released NHS England data obtained via a Freedom of Information request that revealed the shocking fact that between April 2022 and March 2023, a total of 399,908 people who attended English Emergency Departments faced delays of 24 hours or more.
This was highlighted in the launch of the RCEM’s General Election Manifesto 2023/34 – entitled “Resuscitate Emergency Care”. It notes the need for proper resources and a long term approach:
“Since 2011-12 an average £433 million has been allocated each year to support the NHS to manage seasonal pressures – this funding is often received too late in the year to make an impact and is mostly spent on locums, agency and bank staff or is wasted on initiatives that have not been thoroughly tested.”
It sets out the four priorities political parties must commit to in order to ease the crisis being experienced in Urgent and Emergency Care in the UK.
- End ambulance queues and overcrowded Emergency Departments.
- Provide the UK with enough Emergency Medicine staff to deliver safe and sustainable care
- Resource the NHS to ensure the emergency care system can provide equitable care to all.
- Introduce transparent ways of measuring how hospitals are performing so we know which ones need to improve.
The recommendations are the kind of common sense response ministers have stubbornly rejected for at least the past 13 years:
- Ensure that there are enough hospital beds available that are appropriately staffed, so hospitals have the space and resources available to be able to care for all the patients who need emergency admission. Hospitals should never be more than 85% full.
- Commit to increase funding for the NHS and prioritise high-risk hospitals within the maintenance backlog. This will enable urgent repairs and replacements, ensuring safer conditions and better care for patients and staff.
- Pledge additional resources to support the delivery of safe emergency care across the devolved nations and support all political parties in Northern Ireland to re-establish a Government in Stormont.
- Provide more resources to improve community and social care services, so that when a patient’s medical treatment is complete, they can leave hospital quickly and safely.
- Recruit additional UK Emergency Medicine staff across all professions and ensure that they stay in their jobs, so that there are enough clinicians to take care of patients safely as well as enough to train the workforce for the future.
- Commit to addressing the retention crisis, so the NHS can retain its skilled workforce.
- Increase capacity in mental health hospitals, so that people who need admission to a mental health hospital receive prompt care close to home.
- Align resource allocation for the NHS with local population needs.
- Resource the health and social care system to meet the 95% four-hour standard in the long term.
- Publish hospital-level performance figures to improve transparency and enable comparisons of local health systems.
Launching the manifesto, Dr Boyle said
“None of my colleagues in Emergency Medicine want to work in conditions that create situations like this. This week our members have been sharing the shocking reality of their experiences in their departments via our social media and they have been heartbreaking to read.
“We must never allow this terrible situation to become accepted as normal. It really is the case that 24 Hours in A&E is no longer just a TV show – it is the shameful reality for hundreds of thousands of people – and it must not be allowed to continue.”
The question is whether such clear and focused demands will be taken up by any of the main political parties to offer a genuine alternative to the current chaotic decline in emergency and elective services.
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