Emergency care is in “dire” situation after loss of NHS beds, says royal college
BMJ 2022; 377 doi: https://doi.org/10.1136/bmj.o1376 (Published 31 May 2022) Cite this as: BMJ 2022;377:o1376
The loss of 25 000 staffed hospital beds in the UK since 2010 has created a crisis in urgent and emergency care, a report has warned.
The report from the Royal College of Emergency Medicine says that the reduction in staffed beds was having a negative knock-on impact on emergency department waiting times, ambulance response times, and ambulance handovers.1
Analysis by the college shows that in April 2022 some 24 000 patients in England were delayed by 12 hours or more, from the decision to admit to admission. Elsewhere in the UK waiting times are calculated from the time of arrival to admission. In Scotland 4000 patients faced a 12 hour wait, and 11 000 patients in Wales faced such a wait. In Northern Ireland the figures from March 2022 showed that 8581 patients faced a 12 hour wait.
The Royal College of Emergency Medicine’s vice president, Adrian Boyle, said, “The situation is dire and demands meaningful action. Ultimately, there are widespread staffing shortages leading to a shortage of staffed beds in the system.” He said that 13 000 more staffed NHS beds were required throughout the UK to drive meaningful improvement.
Boyle noted that, since the loss of 25 000 beds in the UK since 2010, bed occupancy and ambulance response times had increased, emergency department waiting times had risen, and more elective care operations had been cancelled. This was “all evidenced by the fall in four hour performance, the increase in 12 hour waits, the increase in delayed ambulance response times, and the rise in ambulance handover delays,” he added.
Missed targets
Since 2015 the NHS as a whole had not met its target for at least 95% of patients attending emergency departments to be admitted, transferred, or discharged within four hours, the report says.
Last year the college reported that at least 4519 excess deaths in England in 2020-21 had occurred as a result of overcrowding and stays of 12 hours or more in emergency departments.2 Among the recommendations in the new report are:
Providing 4500 more beds throughout the UK by next winter and around 8500 more over the next five years,
Increasing the proportion of side rooms in new hospital buildings to restrict the number of beds made unavailable through infection, and
Boosting mental health bed capacity.
The report highlights a 23% fall in mental health beds in England since 2010-11, which it says is “heaping additional pressure not just on the mental health sector, but also the acute sector as patients are forced to seek treatment outside of appropriate care settings.”
It also notes that the UK has the second lowest number of beds per 1000 inhabitants in the EU (2.42 per 1000) and that it saw the third highest decline in Europe in 2000-21 (by 40.7%).
Of the 25 000 beds taken out of active service since 2010, 17 767 were in England, 4227 in Scotland, 1809 in Wales, and 1060 in Northern Ireland, with three quarters removed before the covid pandemic, the report says.
Responding to the report, a Department of Health and Social Care spokesperson said, “We recognise the pressure on urgent and emergency care services, and we have set out our plan to help tackle the covid backlog, backed by record investment.
“The NHS is taking a range of actions—including providing an additional £50m [€58.8m; $63m] of funding to support increased NHS 111 call-taking capacity this year—to help people access urgent care when they need it.”