RCEM review of winter finds worst ever four-hour performance at emergency departments despite record number of cancelled operations

1 June 2018 

The Royal College of Emergency today publishes its Winter Flow Report for 2017/18, which shows the extent of the struggles faced by emergency departments over the winter period, and the efforts providers took in order to keep afloat.


The report confirms that, despite some improvements, winter of 2017/18 was one of the worst for emergency care system performance in the history of the NHS.

Data was collected from 56 sites across the UK on a weekly basis from October to March and measured four-hour performance, acute bed capacity, delayed transfers of care, cancelled elective operations and the number of locums and agency staff sites employ. 

The results show:

  • average four-hour performance through the winter was 81.21% - the worst since the project began
  • from January to March average performance was just 79.02%
  • average performance reached a record low of 74.7% in the week ending 5 January 2018
  • individual provider performance ranged from 49.13% to 99.47%
  • a project record of 3,410 operations cancelled on average each week.
President of the Royal College of Emergency Medicine, Dr Taj Hassan said: “This report bears out what we’ve seen elsewhere and reflects what our members have been telling us: this was the worst winter we’ve ever experienced. 

“NHS providers have tried to accommodate an ever-larger number of needy patients with an ever-diminishing bed base. The predictable result has been bed occupancy at record levels and thousands of patients stranded on trollies for more than 12 hours. It is clear that support and extra resources cannot come quick enough.

“Unsurprisingly, those providers who were able to deploy more beds at times of peak demand performed best against the four-hour standard. The need for more beds system wide cannot be any clearer.

“More positively, a determined drive to reduce the numbers of patients subject to Delayed Transfers of Care appears to have yielded results; albeit without reaching the 3.5% of bed stock mandated by the Secretary of State for Health and Social Care.

“But this appears to have come at a cost: the cancellation of unprecedented numbers of elective operations. While this may have helped to improve bed availability in a time of crisis, it is surely neither desirable or sustainable to support the standards of treatment for one group of patients directly at the expense of another group of patients. Particularly so because by denying those patients their planned elective treatment, you make it more likely – not less – that those same patients will arrive in an ED department in need of more urgent medical help.”

The report calls on the government to address the under-resourcing of trusts as a matter of urgency, but also suggests practical actions that trusts can take to help mitigate pressure next winter. 
Dr Hassan said: “While we look forward to the government’s announcement about funding to mark the NHS’s 70th anniversary in July, providers cannot afford to be complacent and must continue to do all they can to prepare for winter. 

“For next winter, the major efforts will need to focus on ways in which to create and maintain flow by better planning and engagement of all parts of the hospital and community social support systems. Adequate additional funding for these will be essential. 

“Urgent and emergency care is everyone’s problem to engage and help solve. If we all take responsibility we will mitigate some of the incredible risks that our staff had to manage so heroically this last winter. Having enough staff and acute beds both in hospital and in the community will be the key to safety for our patients.”