Emergency medicine: Government’s plan won’t avert crisis this winter, leader warns

Hospitals could see ambulances queuing outside emergency departments and patients lined up in beds in the corridors again this winter, despite the government’s pre-emptive plan to try to avert a crisis, the president of the Royal College of Emergency Medicine has warned.

Last winter dozens of NHS trusts and ambulance services across England declared critical incidents, as the health service struggled to meet the huge demand caused by flu and covid, as well as the care backlog. The situation was exacerbated by ongoing workforce shortages and discharge delays, as social care also struggled to cope.1

In July the government launched a package of measures to prepare services in England for this winter, including so called “care traffic control” centres to aid hospital discharge.2 This followed a two year recovery plan for urgent and emergency care,3 published in January 2023, that promised £1bn of investment to fund 5000 new beds (boosting capacity by 5%) and 800 new ambulances for winter 2023.

But Adrian Boyle has said more needed to be done. “We have supported the recovery plan in good faith, but we are concerned that the key element of this, around the increase in the bed numbers and progress against that, has not been sufficient,” he told The BMJ ahead of his address at the royal college’s annual scientific conference in Glasgow on 26 September.

“The NHS, compared with international peers, is underbedded. We’re short somewhere around 10 000 beds across the NHS in England. We’re still seeing these very long waits in emergency departments. I am convinced we’re going to see exactly the same problem this winter.”

Boyle said that the government’s focus on 76% of patients being admitted, transferred, or discharged within four hours was creating a “perverse incentive,” with managers focusing on getting the people who can be sent home out of emergency departments rather than caring for the patients who need to be there. “The problem with this is that the people who need to be admitted are being neglected operationally,” Boyle said. “We’re anxious. We know that last winter was extremely difficult. It was visibly tough, and working in an environment like that is not sustainable.”

Figures from NHS Digital showed that a record number of more than 400 000 patients waited more than 12 hours in emergency departments before being transferred, admitted, or discharged in the last year—an increase of 80% on 2021-22.4

Boyle has called for all political parties to commit to five priorities to ease the crisis in urgent and emergency care, in a manifesto launched on 25 September.5 These include an end to ambulance queues outside emergency departments, enough emergency medicine staff to deliver safe and sustainable care, equitable care for all, and transparent ways to measure hospitals’ performance.