'Seek care, but expect delays': Top doctor's warning as figures show 250 people a week die needlessly in A&E
1 April 2024, 10:30 | Updated: 1 April 2024, 10:32
A top doctor has warned British people to expect delays at A&E, after it emerged that 250 people may have died needlessly each week while waiting for emergency care last year.
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Calculations by the Royal College of Emergency Medicine (RCEM) suggest patients are coming to harm due to spending hours in A&E, particularly after a decision has been made to admit them.
Dr Adrian Boyle, the head of the RCEM, said: "People should seek care, but at the same time, they should also expect a delay."
Dr Boyle told LBC's Matthew Wright on Monday that the problem was due to the number of beds available.
"We are perhaps unique within European countries," he said. "Fundamentally the reason why we’re in this situation is that we have a lack of capacity within our healthcare system.
"And I know that people say that we spend a lot on the NHS, but we have less beds per head of population than almost any other country in Europe.
"We haven’t reformed social care so even though we’ve got less beds, we’re not able to use them as efficiently as we should. There are 13,000 people in hospital today waiting for discharge. And they’re not in discharge because there are problems with social care.
Dr Boyle said that the government should be credited for increasing number of beds by 5,000, but that this did not go far enough.
"We think they are about 11,000 beds short of where they should be."
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The NHS recovery plan set a target of March for 76% of patients attending A&E to be admitted, transferred or discharged within four hours.
But data for March shows just 70.9% of patients were seen within that time frame.
In February, the number of people waiting more than 12 hours in A&E departments from a decision to admit to actually being admitted stood at 44,417.
For its new excess death estimates, the RCEM used a very large study of more than five million NHS patients published in the Emergency Medicine Journal (EMJ) in 2021.
This found there was one excess death for every 72 patients that spent eight to 12 hours in an A&E department.
The risk of death started to increase after five hours and got worse with longer waiting times.
In 2022, the RCEM said it believed 300 to 500 excess deaths were likely to have occurred in England each week using this calculation, but it has since carried out a Freedom of Information audit of NHS trusts to refine this figure.
This found that 65% of people waiting 12 hours or more in A&E are patients waiting for a hospital bed.
NHS data for England shows more than 1.5 million patients waited 12 hours or more in major emergency departments in 2023, meaning over a million of those were waiting for a bed.
The RCEM has calculated that, when looking solely at patients awaiting admission, an average of 268 excess deaths are likely to have occurred each week in 2023, which is "only 17 fewer than 2022 when applying the same method".
The college added that patients delayed in the back of ambulances, "of which there are thousands", are not included in the figures but are also at risk of harm.
It said the overall estimates are likely to be conservative.
Dr Boyle said in a statement: "Excessively long waits continue to put patients at risk of serious harm.
"Small improvements in four-hour access standard performance are not meaningful when there are so many people staying more than 12 hours.
"Effort and money should go where the harm is greatest.
"In 2023, more than 1.5 million patients waited 12 hours or more in major emergency departments, with 65% of those awaiting admission.
"Lack of hospital capacity means that patients are staying in longer than necessary and continue to be cared for by emergency department staff, often in clinically inappropriate areas such as corridors or ambulances.
"The direct correlation between delays and mortality rates is clear. Patients are being subjected to avoidable harm.
"Urgent intervention is needed to put people first. Patients and staff should not bear the consequences of insufficient funding and under-resourcing.
"We cannot continue to face inequalities in care, avoidable delays and death."
NHS England has been contacted for comment.
