Four-hour performance at the lowest point so far in RCEM’s Winter Flow Project 2018/19

18 January 2019

Four-hour performance was 78.17% on average across the 50 Trusts and Health Boards monitored in the Royal College of Emergency Medicine’s Winter Flow Project in the week ending 13 January 2019.


Gordon Miles, Chief Executive of the Royal College of Emergency Medicine said: “Although full compliance with the four-hour standard has been, and remains, a distant prospect,  for a number of weeks we have been able to report comparably positive four-hour standard performance compared with previous years. This week unfortunately, this is no longer the case. 

“At 78.17% performance is 1.27 percentage points lower than was the case in 2017-18 and in is in fact the lowest performance figure we have ever recorded in the second week on January. In 2015-16 at this point performance was 81.99%. This means that the majority of our contributors are in the ‘red zone’  below 85% performance where patients and staff are at the highest level of risk.

“You can however see clear evidence of our Winter Flow contributors trying to do something about it. For example, the number of locum and agency doctors and nurses working in EDs within the Winter Flow group has gone up by 90 in a week (17.57%). Although the number of temporary staff is not yet back to the level we saw in late December, in this regard we are back to where we were at our starting point in October.

“Similarly, the number of acute beds in service has continued to rise relatively sharply and has gone up by (1.8%) since last week of December. It is also fair to point out that in some ways this week has been particularly challenging. The Winter Sitrep data published this week by NHS England shows the highest number of beds closed as a result of norovirus that they have recorded so far this year (4,318). 

“However, it would be a mistake to think that a rise in the incidence of norovirus has done anything other than made a bad situation worse rather than merely blighting an otherwise satisfactory state of affairs. The Winter Strip data for this week also shows that bed occupancy reached 94.7%. This is well above the 85% occupancy that is considered safe and speaks of widespread crisis management in Emergency Departments.

“And it is worth pausing a moment to consider the reality of what this means for patients and the staff who are working to keep them safe. It means patients languishing for extended periods in corridors with little or no privacy and at greater risk of avoidable harm. While this may indeed have become widespread, this should never be considered acceptable. The NHS needs to take substantive steps to provide sufficient capacity to prevent this from happening.”