The Royal College of Emergency Medicine is celebrating a breakthrough in its fight to fully reveal the extent of delays in hospital emergency departments affecting those in most serious clinical need.

Until now NHS England has insisted on reporting only 12 hour-plus delays after the decision has been taken to admit a patient – by which time they could already have been in the hospital for many hours. Now the NHS Standard Contract 2022/23 will measure data from point of arrival in A&E to discharge, admission or transfer, rather than from the decision to admit.

The RCEM now expects NHS England to publish this data in full on a monthly basis from the start of the new financial year. The information is already collected by trusts, but until now it has not been made public in the same way as the four-hour target data, and the current figures on 12-hour “trolley waits” for a bed after decision to admit.

The change will lead to a significant increase in the number of reported waits over 12 hours – although the actual number of incidents will remain the same, with the smokescreen of the less accurate measure removed. The new contract also better reflects reality by changing NHS England’s stance from ‘zero tolerance’ for 12-hour waits to seeking to cap numbers, at a maximum of 2 per cent of patients, although it seems even this lesser target is out of reach.

RCEM Dr Katherine Henderson said: “We know that long stays in Emergency Departments harm patients and long stays (usually due to lack of an available bed) have consequences for other patients; ambulances cannot transfer patients into the department, and then cannot go back into the community, thereby putting further lives at risk.

“When published, together with NHS England and the Department of Health and Social Care, we will be able to assess in full the state of Urgent and Emergency Care and both bring about and implement the changes that staff and patients urgently need.”

In the most recent RCEM Winter Flow survey, which covers a sample of 50 hospitals across the UK, 12-hour stays from arrival in A&E exceeded 6,000 in every single week of February, and between January and February, 12-hour stays increased to over 9% of attendances. With five weeks still left to run 12-hour stays in winter 2021/22 (121,003) exceeded the total set during the whole of Winter Flow 2019/20 (119,281).

Twelve hour waits from decision to admit have become increasingly common: House of Commons Library figures show between 2011-2014 there were a total of 915 12-hour waits: but in January 2022 there were an average of 534 per DAY (16,558 in the month).

Four hour waits have also increased from an average of 5.2% of patients attending a major hospital (Type 1) A&E in 2011/12 to 24.7% in 2019/20. In January 2015 8.7% of patients waited over 4 hours: in January 2022 it was a staggering 37.7%.

Delays arise from shortage of beds: an RCEM survey last November showed over half of Emergency Departments had provided care to patients in non-designated areas such as corridors every day in the previous week, heightening safety risks.


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