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Latest waiting time figures for emergency departments in England are worst on record

BMJ 2018; 361 doi: https://doi.org/10.1136/bmj.k1658 (Published 12 April 2018) Cite this as: BMJ 2018;361:k1658
  1. Ingrid Torjesen
  1. London

More patients are waiting more than four hours in emergency departments in England than ever before, the latest official waiting time figures from NHS England show.

The figures for both March this year and for the whole of 2017-18 represent new performance lows. Just 84.6% of patients were seen within four hours in March—well below the 95% target.

The previous records for poor performance were in February, when 85% of patients were seen within four hours, and in December 2017, when 85.1% of patients were seen, equalling the previous low of January 2017.

Looking at performance at only major (type 1) emergency departments, the figures for March are even worse, with only 76.4% of patients treated, admitted, or sent home within four hours.

Performance for emergency departments usually improves in March as the NHS comes out of the winter, but continued cold weather, including heavy snow, and high rates of flu and norovirus meant the service continued to struggle.

Publication of the March figures completes the 2017-18 performance data, showing that just 88.4% of patients were seen within four hours across the year and 82.4% in major emergency departments, compared with 89.1% and 83.7%, respectively, in 2016-17. This is the worst performance since the target was introduced in 2004.

There were 23.9 million emergency department attendances in 2017-18, around 515 000 more than in 2016-17 and 4.8 million more than in 2007-08, showing that demand for services is continuing to rise. There were more emergency admissions in March 2018 than any month on record, with the number up 3.3% to 526 398, compared with 476 792 in February.

The pressure on emergency departments has had serious knock-on effects for elective services. The number of patients waiting more than one year for treatment has surpassed 2000 for the first time since August 2012, and the 18 week target for planned treatment has not been met in two years.

Phillippa Hentsch, head of analysis at NHS Providers, said that the figures reflect the continued severe winter pressures seen in March, “but they also highlight the fundamental lack of capacity—in terms of beds and staff—to meet the standards expected of the NHS, and that trusts and frontline staff want to deliver.”

Ian Eardley, senior vice president of the Royal College of Surgeons and a consultant urological surgeon, said that some hospitals were continuing to cancel planned operations so that they could prioritise patients needing emergency care, which in some areas included cancelling cancer surgery.

“Cancelling cancer operations is utterly unacceptable,” he said. “To avoid such a situation arising again, planning for next winter must start now. There also needs to be a concrete plan for dealing with the backlog that has grown over this winter.”

Taj Hassan, president of the Royal College of Emergency Medicine, said that the figures should be a “final wake-up call” for decision makers and ministers: “Recent comments from the government about an increase in funding are very welcome, yet it is disappointing that we have had to get to this point for any meaningful action to even be considered.”

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