A report from the Royal College of Emergency Medicine describes the current situation in urgent and emergency care as ‘unsustainable’, and stresses that it will have knock-on effects on elective surgical care for years to come

WaveBreakMediaMicro emergency a&e running busy

The Royal College of Emergency Medicine (RCEM) has released the first data from its annual Winter Flow Project 2021/22, giving a stark warning of what the future may hold for patients needing elective surgical care.

The findings, which make for grim reading, show that:

  • almost 7000 elective care operations were cancelled in both October and November this year
  • 12-hour stays were twice as high as the same time last year
  • long hospital stays have increased by 13% since the beginning of October.

The target for people being seen in A&E within 4 hours is 95%; however, as Dr Adrian Boyle, Vice President of the RCEM, said: ‘Data show 4-hour performance remains incredibly low, averaging at 62% in November.’

He emphasised that urgent and emergency care is ‘verging on [a] crisis’ that is ‘impacting and derailing elective care, meaning that surgery for patients with serious conditions is delayed’.

A recent report from the National Audit Office cautioned that NHS elective care waiting lists will be longer in March 2025, highlighting that ‘if 50% of missing referrals return to the NHS and activity grows only in line with pre-pandemic plans, the waiting list would reach 12 million by March 2025. If 50% of missing referrals return and the NHS can increase activity by 10% more than was planned, the waiting list will still be 7 million in March 2025.’

Currently an estimated 5.8 million people are waiting for treatment.

Dr Boyle described how the current situation is ‘unsustainable’ and emphasised that there must be a willingness to address the crises currently faced by the NHS. He highlighted that ‘the core of the issue is poor patient flow throughout the hospital and exit block caused by difficulties in discharging patients’, adding that the knock-on effects of these blockages are ambulance handover delays, crowding, and patients receiving their care in corridors.

The Winter Flow project has been run annually by the RCEM since 2015, and is now in its seventh year. It will run from October 2021 to March 2022 and will collect anonymised data from forty sites across the UK, publishing them on a weekly basis. Trusts are asked to submit data weekly on:

  • the number of acute beds in service
  • 4-hour performance
  • the number of unplanned attendances at emergency departments
  • the number of patients spending more than 12 hours in an emergency department from arrival to departure
  • the number of patients spending greater than 7 days in hospital from admission
  • the number of cancelled elective operations
  • ambulance handover delays and hours lost.

In the first week of reporting this year, the data for November 2021 also showed:

  • there were 275,596 attendances
  • 20,169 patients spent 12 hours or more in an emergency department from time of arrival; this is equal to 7.3% of attendances
  • 48,154 patients spent 7 days or more in hospital from admission.

Professor Neil Mortensen, President of the Royal College of Surgeons, raised concerns for patients who were being left waiting ‘in limbo’ for their treatment after preparing themselves for vital operations: ‘It is very alarming that more than 13,000 planned operations were cancelled in the past 2 months alone.’

He explained how the Winter Flow report shows there simply are not enough hospital beds to meet the huge demands being seen in the wake of the pandemic, adding: ‘The NHS is staffed by world-leading doctors and nurses. NHS staff are working flat out. They cannot care for patients properly with a bed base the size of a postage stamp.’

Dr Boyle warned that ‘capacity must be expanded to avoid a hard-hitting impact on elective care. While it is crucial that social care is resourced to enable a timely and supported discharge of patients, in the long term restoring bed capacity to pre-pandemic levels and publishing a long-term workforce plan are vital for ensuring no parts of the system are compromised or derailed, promoting good flow throughout the system, and keeping patients safe.’

This article was originally published on Medscape, part of the Medscape Professional Network.

 

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