Twelve-hour A&E waits average over 400 a day, leak reveals

Internal operational data submitted to NHS England, and seen by HSJ, suggests the number of patients who waited 12 hours or more in an emergency department, from decision to admit to being given a ward bed, increased by around 15 per cent in December, compared to the previous month.

The leaked data is from “situation reports” from NHS trusts, but is unvalidated. It reliably reflects the trend in 12-hour waits, but the final validated figures for December, due on Thursday, are expected to be even higher.

The internal data suggests there were around 10,700 trolley waits of more than 12 hours in December, compared to around 9,300 in November. The December total is around three times higher than that of December 2020, and four times higher than December 2019.

The numbers have risen further in January, with the daily total averaging around 400 up to 9 January. If this rate continued, it would lead to around 12,500 such cases in the full month.

Separate figures from the Royal College of Emergency Medicine, released on Tuesday, also point to a significant increase. RCEM’s figures are based on weekly data from 40 sites and measure a slightly different waiting time (see files below).

Adrian Boyle, vice president of policy at RCEM, told HSJ that one factor behind the long stays in EDs are a lack of inpatient capacity, partly caused by staffing issues.

He said: “From what I’m hearing around the country there is appalling crowding, and people taking an awfully long time to move through departments. It’s very pressurised, it feels very unsustainable and frequently feels very unsafe.

“It’s difficult to see hope at the moment, because there is no clear end to this pressure. What this is going to mean is everything is going to continue to get slower, and patients are going to wait longer and longer.

“Our EDs were generally not overcrowded in 2015. I can remember seven years ago we didn’t have overcrowding at levels we’re getting at the moment. Twelve-hour stays were not a thing 10 years ago.”

A source at one large hospital in the south of England said earlier this week that major problems with flow meant that one in five of its accident and emergency patients were waiting more than 12 hours for admission, and that at one point the department had nearly a dozen patients waiting more than 24 hours at the same time. They said delayed discharges from acute beds were the major cause of the problem. Many NHS leaders have cited major pressures in domiciliary care and care homes — such as absences and outbreaks meaning homes cannot admit patients — in recent days.

Meanwhile, hospital capacity is effectively a lot lower than normal, with many wards having to be reserved for covid-positive patients, and large numbers of contacts of covid-positive patients, who also have to be isolated.

According to NHS England statistics, 90 per cent of patients who last week had been in hospital for three weeks or more, and who no longer met the criteria to reside in hospital, were not being discharged to places such as social care. 

HSJ revealed last week that trusts had fallen far short of an NHS England target to reduce delayed discharges. 

An NHS England spokesman said: ”Omicron means more patients to treat and fewer staff to treat them – around 10,000 more colleagues across the NHS were absent each day in recent weeks compared with the previous seven days, with almost half of all absences down to covid.

“Our staff are stepping up as always, working closely with colleagues in social care to get people out of hospital safely and dealing with an increasing number of ambulance call outs – figures show last November was the second busiest on record for A&E.”

Updated at 10:10am, 12 January, with comment from NHS England.