Reports & Briefings

Find below the Royal College of Emergency Medicine's Reports & Briefings. 

Our latest briefing (September 2018) looks at patient safety and the importance of the four-hour standard.

In 2018, the College’s Northern Ireland Board designed a questionnaire for RCEM’s Fellows in Northern Ireland to better understand the pressures facing NHS staff on the frontline. The survey’s overarching aim was to highlight the difficulties facing emergency care within the context of insufficient resources. The Board also wanted to give a voice to Emergency Department (ED) consultants to hear about what it feels like to work in Emergency Medicine when faced with overwhelming pressures. The results of the survey can be found in the below document.

In 2018, RCEM Scotland looked at the makeup of the emergency medicine workforce in Scotland in light of demand and performance challenges seen in Emergency Departments across the UK. The National Board considered how to ensure that NHS Scotland’s workforce feels supported and valued so that a long-term career in health and social care is a viable option.

In 2017 the College looked at current and predicted future levels of demand, along with calculations on staffing and the possible impact that leaving the European Union will have on both.

In 2014 the Royal College of Emergency Medicine launched the STEP campaign in England, to address the significant challenges faced by A&Es. The College felt that despite some progress in previous years, more work was needed to provide a safe and efficient service for patients. The strategy provided an effective platform and simple messaging to enable the College to engage with Government, politicians and NHS leaders; encouraging them to work together to take the four steps needed to rebuild emergency care.   

In England, to rebuild the Emergency Medicine service the College called for four clear, specific steps to be taken:

STEP 1: Safe and sustainable staffing levels must be achieved
ariffs and funding must be fair and effective
Exit block and overcrowding must be tackled
rimary care facilities must be co-located with A&E services

 These steps are set out in more detail in the below documents.

The Royal College of Emergency Medicine has been campaigning since June 2013 to improve emergency care in the A&E departments of the UK. Key to this has been our STEP campaign – highlighting the need for sustainable staffing, tariff reform and terms that support a work-life balance, the eradication of exit block and primary care co-location. The rationale for the campaign is predicated on three key determinants of system performance – patient demand, hospital capacity and the rate at which patients progress through A&E. So we focus on demand, capacity and flow.

Why does winter in A&E get worse every year? gives an overview of some of the key data behind the College’s arguments as seen through the lens of winter.
Safer, Faster, Better (2015) is designed to help frontline providers and commissioners deliver safer, faster and better urgent and emergency care to patients of all ages, collaborating in UECNs to deliver best practice. It sets out design principles drawn from good practice, which have been tried, tested and delivered successfully by the NHS in local areas across England.

However, the guide should not be taken as a list of instructions or new mandatory requirements. Implementation should be prioritised taking into account financial implications and local context.

The document has been prepared by NHS England in conjunction with the Emergency Care Intensive Support Team (ECIST). Contributions have been sought from the review’s delivery group (comprising a wide range of experts in urgent and emergency care services, as well as patient representatives).
The Royal College of Emergency Medicine in Scotland has published in conjunction with the Scottish Department 'Emergency Department Capacity Management Guidance'.

As identified in the College's STEP Campaign the College is committed wholly to eradicating exit block from Emergency Departments. This guidance proposes the development of a standard operating procedure to avoid crowding by proactively managing capacity in the Emergency Department within the Scottish Governments context of the 6 Essential Actions to Improving Unscheduled Care.

The guidance also includes escalation steps that can be taken when crowding occurs.
The Royal College of Emergency Medicine and the Patients Association have published a joint report 'Time to Act - Urgent Care and A&E: the patient perspective' which highlights new research that we have carried out into the choices, decisions and experiences of patients who have accessed A&E services.
'Ignoring the prescription?' is based on a survey of 142 clinical leaders in Emergency Medicine across the UK carried out in response to the unprecedented pressures over the 2014/15 winter period and reveals just how much needs to be done to address the profound challenges facing Emergency Departments (A&Es).

The report highlights the extent to which the recommendations set out in Acute and emergency care - prescribing the remedy have been implemented. In addition to this, 'ignoring the prescription?' reports that a staggering one percent of the £700 million allocated by the government in England over this winter period was spent on staff or other resources in emergency departments.
'Sentinel Sites: Better Data Better Planning' is the Royal College of Emergency Medicine's initial attempt to gather high quality data from its own ‘sentinel sites’ rather than relying on more comprehensive national data of dubious quality. Such information is essential to inform and guide the planning of urgent and emergency care services in the future.
Unscheduled and Emergency Care services in Northern Ireland are facing profound challenges to deliver safe, efficient and effective patient care as demand continues to rise. In April and June 2014 the RCEM convened two emergency summits that brought together key stakeholders including policy makers, regulators and leaders in acute healthcare in order to develop solutions to the challenges in Northern Ireland's A&E departments.

'Recommendations for Unscheduled and Emergency Care in Northern Ireland' sets out 18 recommendations to address the current challenges, the purpose of which is to maximise the effectiveness of these services whilst improving patient and staff experience.

The reports recommendations are supported by the Chief Medical Officer and the Chief Nursing Officer of Northern Ireland. The aim of these recommendations is to identify best practice strategies on which to build greater capacity and resilience across the system.
We are all too aware that the urgent and emergency care system has been under pressure for some time with increasing emergency admissions, rising levels of acuity and a lack of effective alternatives to the emergency department.

This growing pressure is not sustainable and there is a risk that the quality of patient care will be compromised. Significant measures are needed to avoid an annual crisis and to build a resilient system which is fit for purpose. Given the continuing challenges experienced by patients and those working in acute and emergency care services the Royal College of Emergency Medicine convened an emergency summit with the Royal College of Paediatrics and Child Health, the Royal College of Physicians, the Royal College of Surgeons and the NHS Confederation.

On 4th March 2014 key policy makers, opinion formers and leaders in acute healthcare were brought together to develop solutions to the challenges and to strengthen the system for future service demands. 'Acute and Emergency Care - Prescribing the Remedy' contains the consensus recommendations of this summit. The consensus nature of the proposals reflecting, the needs of patients whether ill or injured, the elderly and children is unique.

This report co-authored by the Royal College of Emergency Medicine, Royal College of Paediatrics and Child Health, Royal College of Physicians and Royal College of Surgeons sets out 13 recommendations for Government, national bodies, commissioners, providers, professional bodies and clinicians, to take forward at local and national levels. Implementing these measures will help build an urgent and emergency care system that is sustainable and resilient to cope with future service demands.

This report is accompanied by a recommendations statement specifically referenced to the health and social care systems of England, Northern Ireland, Scotland and Wales. These statements allocate accountable bodies to each recommendation. Please note that these documents are endorsed solely by the Royal College of Emergency Medicine. Download the report here

Emergency care systems in the UK and Ireland continue to face tremendous challenges as clinical staff, managers and policy makers seek to ensure safe delivery of healthcare to patients. This report, the first of its kind, describes the working practices of consultants and other senior decision makers in the Emergency Department (ED), the pressures they face and the impact on their working lives.

The results are stark and worthy of urgent attention by employers and commissioners. Overall 62% report that their current job plans are unsustainable, whilst 94% of respondents regularly work in excess of their planned activities. Combined with the very serious workforce challenges facing emergency care systems in the UK at present, there is an urgent need for action.

The report 'Stretched to the Limit', based upon the results of a comprehensive survey of 1077 Emergency Medicine Consultants over the winter of 2012 recommends urgent action in three key areas:
-adherence to good job planning for consultants and other senior decision makers
-an urgent review by the BMA and NHS Employers to consider ways in which safe and sustainable working practices for senior decision makers can be appropriately recognised
-a clear focus to address and improve urgent and emergency care system design

Media comment on Stretched to the limit


BBC News, 8th October 2013


BBC News, 8th October 2013, 'A & E doctors say pressure is threat to patient safety'

BBC News, 8th October 2013, 'A & E consultants: Why we left the NHS to work abroad'

The Guardian, 8th October 2013, 'A&E departments face crisis as staff burn out and consultants move abroad'

The Independent, 8th October 2013, 'A&E doctors say they are under 'intolerable pressures' in emergency departments'

The Telegraph, 8th October 2013, 'Nine in ten emergency doctors "working overtime"'

RCEM Press Release

Emergency care systems in the UK & Ireland are facing their biggest challenge in well over a decade as they aim to cope with unsustainable workloads and a lack of sufficient numbers of middle grade doctors and Consultants in Emergency Medicine to deliver consistent quality care.

Both the Care Quality Commission and NHS England have recognised the scale of the crisis and the need for urgent action. In The drive for quality - how to achieve safe, sustainable care in our Emergency Departments, the first report of its kind, The College calls for fundamental change in the way we design, fund and run our emergency care systems.

Ten recommendations are made across 4 domains that must be considered and adopted by national policy makers, commissioners, clinicians and Trust Boards in order to return our systems to stability and help deliver the quality of care that our patients expect when they seek our help in an emergency.

The principles within the recommendations apply to all countries within the UK though the commissioning arrangements will be different in each. The report, based upon the results of a comprehensive survey of 131 Emergency Departments (EDs) in the UK between 2011 and 2012, recommends urgent action in a number of key areas of:
-system redesign to manage workloads and decongest the ED
-expansion and sustainable working practices for staff
-a radical change to the way in which emergency care is funded
-a better system to measure the success of improvement rather than 4hr system performance alone.

The authors state that all parts of the urgent and emergency care system need to participate and radical overhaul to the way work is recognised and funded is needed. Importantly, the medical workforce challenges facing EDs at present will only be properly addressed by creating safe and sustainable working patterns that meet appropriate standards, allow good training environments to prosper and are attractive to the trainees of the future.

RCEM Press Release 
Key Messages
This guidance is for clinicians, managers and commissioners involved in the delivery of Emergency Medicine in the UK and the Republic of Ireland. The public may also find the document of interest. It replaces the previous guidance we issued known as ‘The Way Ahead’ in December 2008.

As the pace of change is brisk we will continually refresh this guidance as the service develops. If you identify any content of this document that you feel should be revisited, please email so that your comments and suggestions can be considered when developing the next iteration of this Handbook. When new versions are issued we will indicate what has been amended in the Amendment History at the beginning of the document and advise Members and Fellows accordingly.

Download the report here