Distancing measures now ‘impossible’ in overcrowded EDs

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Growing pressure on emergency departments continues, according to new figures
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NHS England officials are examining a recent spike in emergency department attendances, with multiple reports that crowded units can no longer meet distancing guidelines.

Data seen by HSJ indicates A&E attendances are now running well above seasonal levels.

In May, there were slightly more attendances at major EDs than in the same month in 2019, making it the second busiest month on record with 1.4 million type 1 attendances, according to published data. Now internal NHS data seen by HSJ, as well as published Public Health England monitoring data (see chart left), show attendances have continued to grow at a similar rate in June — taking them well above normal pre-covid seasonal levels.

June 18 PHE EDs

The up-to-date June figures seen by HSJ indicate that, if the current trend continues, this month could see around 10 per cent more attendances than May, which would make it the busiest month on record. In each of the five years up to 2019, there was a fall in attendances between May and June.

HSJ understands NHS England officials are examining what is behind the rise. Theories put forward by hospital clinicians include difficulties in accessing GPs, health problems delayed during covid now presenting to ED, hotter weather, and the mental health implications of extended lockdown measures.

There have been particularly sharp rises among children (see chart below). HSJ was told this appeared to be mostly due to resurgence of respiratory infections as lockdown restrictions are lifted, but may also reflect some delayed presentations.

Many ED doctors are reporting record attendances.

The Royal College of Emergency Medicine told HSJ that in a snap poll it had carried out, 47 of 50 EDs which responded said they had seen all-time record breaking numbers of daily attendances during June.

EDage

^{Daily number of total attendances recorded, across PHE’s Emergency Department Syndromic Surveillance System, to 13 June}

Adrian Boyle, RCEM vice president, said there were rising numbers of all patient groups, but there was a particular increase in low acuity patients – who have gone to EDs due to a lack of access to primary care and “overwhelmed” GPs. He called on NHS 111 to try to increase the clinical support available to advise low acuity patients.

He added: “Many people have tried very responsibly to get help elsewhere, but when they have not had that care they will go to the one place that is always open. We suspect there are a lot of people sent to us by NHS 111 because there are not viable alternatives.

“I don’t think there are short term fixes. We need a medium and long term plan to increase capacity within the system.

“We are always concerned about crowding [in EDs] and the effect it has on the care we give to patients and the effect on staff. We know working in a crowded environment for a long time increases burnout and makes it difficult to keep well trained staff.”

The chief executive of a London hospital told HSJ some sites were breaking ED attendances records. The person said: “Lots of people can’t get into primary care. We [have] had lots of sunburn and hayfever. It [means] people wait a long time [to be seen] but also maintain distancing is impossible.”

NHS England was approached for comment.

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