Latest RCEM Winter Flow data shows Emergency Departments are “at or beyond the limits of their resilience” 

8 February 2019

The latest weekly performance data from over 50 Trusts and Health boards shows that “conditions in our Emergency Departments for both patients and staff are grave indeed”, according to the Chief Executive of The Royal College of Emergency Medicine.

Responding to data from the College’s Winter Flow Project for the week ending 3 February 2019 showing average four-hour performance at just 77.98%, Gordon Miles, RCEM Chief Executive, said: “Regretfully, as has been the case for the duration of this year’s Winter Flow Project full compliance with the NHS Constitution commitment that at least 95% of patients attending A&E should be admitted, transferred or discharged within four hours remains a distant prospect.  

“While reporting poor four-hour performance scores have now become quite routine, this does not change the fact that conditions in our Emergency Departments for both patients and staff are grave indeed. At 77.98% performance is 3.14 percentage points lower than was the case in 2017-18 and is the lowest performance figure we have ever recorded in the first week of February.

“This means that the majority of our contributors remain in the ‘red zone’. In fact, performance is significantly more adverse the 85% threshold where patients and staff are at the highest level of risk. It is perhaps even more concerning that unlike the situation 2016-17 or even 2017-18 at this point, there is almost no sign of performance recovering from the expected low points around the Christmas period. We have reported declines in performance for seven of the last ten weeks. This suggests that while the staff in our departments are striving to keep patients safe, those departments are at or beyond the limits of their resilience.

“The decline in the number of patients subject to Delayed Transfers of Care we have recorded this week (1,928 down from 2,056) can be expected to have gone some way towards improving patient flow but the number of acute beds recorded this week (37,521, down from 37,621) suggests that physical capacity may have plateaued.

“As we have noted in previous weeks the reality of this situation is that large numbers of patients are being cared for in undignified conditions in corridors, at greater risk of hospital acquired infections. The imperative if departments reach this crisis point, is deploy as many clinical staff as possible to prevent patients coming to avoidable harm. What this week’s data shows quite clearly is that the hospitals within the Winter Flow group are doing just that. At 723, the number of temporary doctors and nurses on the shop floor is the highest we have ever recorded and a 16.8% increase in the last four weeks alone, itself a testament to the pressure the system is under.”