RCEM CARES

RCEM CARES is our campaign to help mend Emergency Medicine and focusses on five key areas:


C
rowding
Access
Retention
Experience
Safety 

Click on the tabs below to find out why each is important and what needs to be done.

RCEM Cares

Crowding

What is happening?

Crowding, also known as ‘overcrowding’ results in patients being cared for in corridors. This is undignified and inhumane, but also bad for patients. Crowding also creates an unpleasant and error prone working environment for staff. 

Why does this matter?

This is the situation where the number of patients occupying the emergency department is beyond the capacity for which the emergency department is designed and resourced to manage at any one time. This results in an inability to provide safe, timely and efficient care to those patients, and any subsequent patients who attend the department. 

Crowding is consistently associated with less good quality care for patients and increased mortality. The patients who are most affected by crowding are the elderly and the vulnerable. Ambulances are unable to offload, meaning longer waits for subsequent patients. Patients admitted through crowded emergency departments are more likely to end up on the wrong sort of ward and have a longer hospital stay as a result. 

Who should take action and what do they need to do?

Policy Makers

  • Increase the bed capacity in hospitals to maintain flow in Emergency Departments. We estimate that at least 4,000 extra staffed beds are needed in England alone this winter to achieve 85% bed occupancy.
  • Immediately publish a Social Care White Paper, with the view of expanding social care provision to improve patient flow and address delays in transfers of care in Acute Hospitals. Additional funding must address the £2.3 billion shortfall in social care faced by councils, as advocated by the Local Government Association.

System administrators

  • Improve clinician involvement with NHS 111 and call handling services. Referral rates drop if there is ready access to an experienced clinician to provide advice
  • Understand local patterns of demand and configure services to match demand

Trust Boards

  • Crowding is minimised in hospitals where Boards are engaged.
  • Performance standards should be seen as a hospital wide priority.
  • Internal Professional Standards should be negotiated and delivered.
  • Ensure patients can be discharged promptly from inpatient wards.

EM Clinical Leads

  • Ensure there is a robust escalation plans
  • Ensure there are systems that ensure safety during times of crowding.

Supporting Resources


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Election Manifesto 2019

Designed by jannoon028 / Freepik

In reaction to the 2019 General Election we set out what we believe should be done to fix and deliver safer, quality emergency care. Below is our guide for parliamentary candidates and their parties to the problems facing emergency medicine and what we need - and what they can help do - to solve them.

NHS Emergency Departments across the four nations are operating at a dangerous capacity. Since 2010-11 attendances to Type 1 Emergency Departments in England have increased by 1,748,283 (12.5%) – equivalent to the workload of 22 medium-sized departments. Every year, millions of people turn to our Emergency Departments as increasing numbers are living longer with a complex range of medical needs. Primary and social care services have not been developed to address this need. Emergency Departments are now the first port of call for many patients. Alongside the rest of the health and social care system, Emergency Departments are inadequately supported and have not been resourced to meet demand. This means our Emergency Departments are stretched to the limit and staff are increasingly working in crowded departments, delivering care in corridors. 

Based on RCEM CARES our manifesto sets out our plan for better Emergency Medicine:

  • RCEM Election Manifesto 2019 [PDF]