Thousands waiting 24hrs in A&E with mental illness

For the first time, NHS England has published data on long waits for mental health patients in A&Es.

NHSE labelled the data as “experimental”, because no quality checks were performed after it was received. However, they are the first official figures on the size of this long-standing problem. HSJ has previously reported on internal data.

In total, 173 acute hospital sites with a major type 1 or specialist type 2 A&E recorded attendances of mental health patients, and 118 of these recorded stays of 24 hours.

There were 4,008 24-hour stays nationally in October. HSJ’s analysis reveals this constitutes 9 per cent of patients with mental health issues presenting to A&Es. At 19 hospitals, this was more than one in five (20 per cent).

Around a third of mental health patients at A&Es stayed there for more than 24 hours at Royal Blackburn Hospital, Epsom Hospital, St Helier Hospital and Royal Sussex County Hospital, the data reveals. See the table below.

Mental health patients experiencing long stays are a small proportion of all A&E attendances (0.3 per cent nationally). However, these patients face disproportionately longer A&E stays compared to patients with physical health problems. This is often due to waits for specialist mental health care such as inpatient beds which are provided outside of acute hospitals.

Many patients with mental health issues also present with physical complaints - which means they are among the most complex patients A&Es care for. Demand for mental health services generally has also been rising, with some specialties facing long waits.

HSJ approached the 10 hospitals with the highest proportion of 24-hour mental health stays. Those that responded cited increasing demand for mental health patients attending A&E, and difficulties in accessing onward specialist care.

Epsom and St Helier University Hospital Group added it has trained mental health support workers to support patients in A&E experiencing a mental health crisis. Surrey and Sussex Healthcare Trust said it is introducing new processes and expanding senior leadership of mental health care. .

Lancashire and South Cumbria ICB, for the Royal Blackburn Hospital, said it is reviewing its community crisis services. Barts Health Trust said it’s working with local partners to expand mental health bed capacity and community services. UH Sussex also said it’s working with partners to improve the situation.The other trusts were yet to respond.

NHS England said the long waits were “totally unacceptable”. It added more specialist ‘mental health A&Es’ are being opened, while every A&E now has a 24/7 psychiatric liaison team and NHS111 has access to round-the-clock mental health crisis support.

Urgent and emergency care performance more generally worsened in October. Four hours performance for all patients dropped from 75.1 per cent in September to 74.1 per cent last month. Meanwhile, 12-hour waits rose from 9.8 per cent of attendances in September to 10.8 per cent in October.

Ambulance response times slumped in October, with the crucial category 2 figure at 32m 37s – well above the government’s 30-minute target for this year and the actual target of 18 minutes. The year-to-date average is now 29m 11s, making it likely the NHS will miss the overall target.

East Midlands Ambulance Service Trust was a notable poor performer, with the longest average waits in all categories, with category 2 at 46m 55s. It has been asked for comment. EMAS said it had seen increasing numbers of hours lost to handover delays at hospitals and a 9 per cent increase in 999 calls compared with September.

Electives, cancer and diagnostics

Performance against the 18-week elective standard rose from 61 per cent to 61.8 per cent between August and September. This returned the system to broadly where it was in May, before three consecutive months of decline over summer.

NHSE CEO Jim Mackey said at the NHS Providers conference that system leaders had not “given up on” hitting the 65 per cent target by March.

He admitted they were behind the required rate but insisted they were only behind by “one working day’s worth of clock stops”. HSJ understands this is based on there being around 72,000 clock stops per day.

The waiting list size stayed broadly the same, with NHSE reporting a modest fall of around 16,000 cases, to hit 7.39 million cases.

Year-plus breaches fell from 2.6 per cent to 2.4 per cent of the total list, which is around 180,000. The target for March is that no more than 1 per cent of the list should be breaching 52 weeks.

For cancer, 67.9 per cent of patients received treatment within 62 days of a referral in September - down from 69.1 per cent in the previous month. NHSE has set a target of 80 per cent by March 2027.

The number of patients that waited longer than six weeks for a diagnostic test following referral was 22.5 per cent in September - down from 24 per cent in August. Nationally, no more than 14 per cent of patients should wait more than six weeks for a diagnostic test by March 2027.

Updated at 1.45pm, 14 November, to include additional comments