Intended for healthcare professionals


Overcrowding and long delays in A&E caused over 4000 deaths last year in England, analysis shows

BMJ 2021; 375 doi: (Published 18 November 2021) Cite this as: BMJ 2021;375:n2835
  1. Gareth Iacobucci
  1. The BMJ

England had at least 4519 excess deaths in England in 2020-21 as a result of overcrowding and stays of 12 hours or longer in emergency departments, an analysis by the Royal College of Emergency Medicine has found.

The findings are given in a new report from the college into the extent of harm that crowding causes.1

The mortality figure was calculated from findings from the NHS’s Getting It Right First Time (GIRFT) programme, which found that one in 67 patients staying in an emergency department for 12 hours came to excess harm, and hospital episode statistics (for 2020-21), which measure numbers of stays of 12 hours from time of arrival.

Adrian Boyle, vice president (policy) of the Royal College of Emergency Medicine, expressed deep alarm at the figures. “To say this figure is shocking is an understatement. Quite simply, crowding kills. For many years we have issued warnings about the harm that dangerous crowding causes, but now we can see the number of excess deaths that have occurred as a result.”

He said October 2021 saw an “unimaginable” 7059 stays of 12 hours from the time of decision to admit, the highest number ever recorded.2

“The number of 12 hour stays has risen drastically for six months and is very likely to rise again in the coming months,” said Boyle. “The picture is more bleak, as hospital episode statistics show that 12 hour stays from time of arrival are 21 times higher than 12 hour DTA [decision to admit] stays.3 We now know that at least one in 67 of these patients are coming to avoidable harm. It is appalling.”

He said that the predicted trajectory was supported by a recent report of the Association of Ambulance Chief Executives,4 which found that as many as 160 000 patients each year may be coming to harm as a result of delayed ambulance handovers.

The college has asked to meet with England’s health and social care secretary, Sajid Javid, to discuss patient safety and the unprecedented pressures facing the urgent and emergency care system. It is also urging NHS trusts to safely expand capacity where possible and to focus on ensuring timely discharge of patients once their treatment was complete.

In the longer term, it urged the government to restore bed capacity to pre-pandemic levels which (would equate to an extra 7170 beds), to increase funding for social care to support patients when leaving hospital and in the community, and to publish a long term workforce plan to tackle shortages of emergency medicine consultants.

“The situation is unacceptable, unsustainable, and unsafe for patients and staff,” Boyle said. “It is up to the government, NHS leaders, and all of us to work together to put a stop to dangerous crowding, avoidable harm, preventable deaths, and ambulance handover harm and to ensure that we keep patients safe and deliver effective urgent and emergency care.”

Commenting on the report, Matthew Taylor, chief executive of the NHS Confederation, said, “Overcrowding in emergency departments is not merely inconveniencing patients during their visits to hospital, it’s costing thousands of lives.

“This report again shows why healthcare leaders are sounding the alarm, with the health service now under critical and unsustainable pressure.”