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23,000 Excess Deaths in 2022 Were ‘Linked to A&E Waits’, Says College

NHS waiting lists

Data show 1.65 million patients in England faced 12-hour waits from time of arrival in A&Es in 2022.

A new briefing by the Royal College of Emergency Medicine, RCEM Explains: Long waits and excess deaths, reveals that in 2022 1,656,206 patients waited 12-hours or more from their time of arrival in an Emergency Department. This is equal to over 4,500 12-hour time of arrival waits per day in 2022 and equal to 10.2% of all Type 1 attendances.

In 2022, NHS England reported that 347,703 patients waited 12-hours from decision to admit to admission (DTA), equal to 2.1% of Type 1 attendances. Significantly, the total number of 12-hour time of arrival waits for 2022 is 4.8 times the total number of 12-hour decision to admit (DTA) waits for 2022. This demonstrates how the DTA metric is misleading and only the tip of the iceberg.

Using the total number of 12-hour time of arrival waits for 2022 and the best available scientific research we can calculate that there were an estimated 23,003 excess patient deaths in England in 2022 associated with long waits in the Emergency Department.

A&E 4-hour wait data

Recently Chamber published NHS England data assessed by Vuit, Curia’s population health data partners, ranking all NHS trusts on all A&E patients treated within four hours.

Ranking each trust on their performance highlights that the top 5 trusts include Northumbria, Sheffield, Birmingham, Maidstone and Tunbridge Wells and Alder Hey.

The worst performers include Wye Valley, East Cheshire, Airedale, Queen Elizbeth Kings Lynn, Princess Alexandra Harlow and Mid Cheshire.

Excess Deaths

An extra or excess death is a death that might not have occurred if there were not X amount of delays to admission. If 72 patients did not wait eight- to 12-hours from their time of arrival in Emergency Departments, there would not be an ‘extra’ or excess death.

Commenting on the FOI findings, President of the Royal College of Emergency Medicine, Dr Adrian Boyle said:

“These data, while shocking, are unsurprising. For a long-time we have known that the true scale of long waits in Emergency Departments has been hidden. Long-waiting times are associated with serious patient harm and patient deaths – the scale shown here for 2022 is deeply distressing. The data show how necessary it is to have transparent figures. We are pleased that both the Department of Health and Social Care and NHS England have heeded our calls and will be publishing the 12-hour data from time of arrival in the Emergency Department regularly from April this year. We look forward to seeing this data be published then.

“We believe that being honest with the data will be a service to patients and staff. It will lead to a better understanding of patient flow and to both transformation and change in the emergency care system. However, this transformation and change can only come if we have the staff, beds and resources we need. We urge the government to publish the fully funded long-term NHS workforce plan that they pledged to deliver. This must include measures to retain existing staff who are burned out and may be considering leaving the NHS.

“Alongside the publication of this 12-hour data we must see a renewed focus on the four-hour access standard. We believe the new four-hour target of 76% is unambitious and is too low, it presents the risk that the sickest and most vulnerable patients will continue to face the longest waits. We urge this target to be revised to a more ambitious figure.

“The delays to admission in Emergency Departments are a symptom of a hospital wide problem. We know that 14,000 beds are occupied by patients who should be discharged but are unable to be due to the shortages in social care. We must see sustained and continued investment in social care and a bolstering of the social care workforce. Enabling the timely discharge of patients will help free up beds and in turn help reduce these long-waits in Emergency Departments.”

Increased waiting time in A&E has caused an increase in excess deaths say Royal College of Emergency Medicine
1.65 million patients in England faced 12-hour waits from time of arrival in A&Es in 2022

Final thought

Whilst there are those that will dispute the data, there is no doubt that excess deaths are on the rise. This is partly due to the pandemic, but it is also because of failure within the system.

Let’s be frank, excess deaths were on the rise before the pandemic due to various problems including elongated winter crises.

As the NHS thinks again about long-term acute planning ahead of the next winter, they must confront this data, think through performance and act urgently.

Policy institute Curia will be looking at ways to improve performance in emergency departments as part of the NHS Innovation and Life Sciences Commission.

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