An NHS in crisis: patients are now waiting longer for almost every type of emergency care

There’s no doubt that the NHS is deep in crisis. The NHS is facing spiralling waits for emergency and routine care; waves of national strikes; budgets squeezed by inflation; and endless declarations of critical incidents by trust trying to preserve capacity for their sickest patients.

But what does an ’NHS in crisis’ really mean for patients needing emergency care? The unfortunate reality is that patients are likely to face multiple delays on their journey to treatment. The figure below shows the average patient waiting times across different stages of a patient’s journey, from calling 999 to getting into a hospital bed. The time spent waiting at every stage has elongated between 2019 and 2022, despite the waiting times in 2019 already being far beyond national targets.1

Chart which shows compared to 2019, 2022 had a significant increase in the number of patients waiting for an emergency ambulance to arrive, to be then handed to A&e, then waiting for a treatment decision at A&E and then to be admitted to a bed.

And while this figure does not show the full patient journey and is only a snapshot2 of waiting times in both years, it is indicative of what patients needing emergency care are experiencing. In the time it took for a patient to get a treatment decision in 2019, it’s possible that in a similar timeframe in 2022, a patient would have only just arrived in the A&E department. In aggregate, patients on this pathway could have been waiting three and a half hours longer in 2022 compared to 2019. This includes four times longer waiting for a 999 call to be answered (from 9 to 36 seconds), more than double the time waiting for an emergency (category 2) ambulance (from 22 to 48 minutes) and nearly double the time waiting in A&E for a bed (from 175 to 330 minutes). The data for 2023 so far suggests waiting times this year could go in the same direction.

These delays raise doubts about the quality and safety of care patients are receiving – for example, handover delays could be exposing a significant number of patients to preventable harm. And there are already a number of harrowing stories of people who have lost their lives due to waiting time delays (BBC News 2023; BBC Sounds 2022).

These delays raise doubts about the quality and safety of care patients are receiving

So what’s the reason for these waiting time delays? The primary cause is the breakdown of the flow of patients across the whole emergency and inpatient pathway. Capacity for patients is limited all the way from the ‘front doors’ of A&E to the ‘back doors’ into social care. And without sufficient capacity, it becomes impossible to move patients along the pathway in a timely way. The lack of capacity is further exacerbated by the gradual growth in demand for services. Only made worse by the long-term effects of the Covid-19 pandemic – for example, missed opportunities for preventive care may have increased patient needs.

If the NHS is going to get patient waiting times for emergency care under control, it needs to restore patient flow, by rebalancing demand and capacity for emergency and inpatient services. And there are several ways the government can support the system to do that.

First, the government can help provide short-term additional capacity across the whole pathway. The extra £250 million to support hospital discharges is a good start, albeit introduced too late to support the NHS through this winter. However, there is no one single service to blame here – the whole pathway needs support. Second, the government can commit to long-term solutions to increase service capacity. For example, by committing to a long-term strategic approach to workforce planning that focuses on rebuilding the workforce and increasing retention. Without this long-term workforce planning, extra funding for beds and ambulances will have limited impact. And finally, the government can facilitate a reduction in demand by championing long-term prevention strategies – for example, strategies to prevent cardiovascular disease, a significant cause of mortality and morbidity in England.

Any of these options could help provide reassurance to patients that there is a way out of the current crisis. Because the longer the emergency pathway gets, and the longer the NHS crisis goes on, more and more patients will receive sub-standard care.

1Waiting time targets include 18 minutes for category 2 ambulances and 15 minutes for an A&E handover.
2September is the most recent month where both A&E quality data and London Ambulance Trust data are available.

Comments

All of this rests with the state of social care and how this and all previous governments have ignored social care for many years, perhaps to never having recognising social care to any extent.

Pay in social care has never been good and it has only been allowed to get much worse, but the Employment terms and conditions have been also allowed to be eroded.

While much of social care is in the private sector be it care homes, home care, supported living, respite and hospices and anyothers, is mostly funded by Local Authorities (LAs) and since 2010 they have been sbjected to stringent Austerity cuts and still, are to some extent, so LAs have been severely restricted to fund social care to any extent, but even before 2010 social care was never fully funded. But it is more that social care workers pay, but the employment terms and conditions including travel expenses, sick pay, holiday pay and even recognition of holidays and much more.

The NHS can't survive without social care and social care can't survive without the NHS, so it would make so much more sense for them to be much more intergrated and while that is ongoing in the ICS and ICBs much more is so required.

It should have been done so much earlier but at least it has commenced, well I hope so.

It is my belief that social care and the NHS should have been fully integrated in 1948 when the NHS was created and with so much hindsight it may well have been.

But it needs much alinement to the medical and social models where all care is 'person centred' to the person being in need of care and to a large extent their immediate family, as both are, to much extent, are 'Experts by Experience', as professionals and non-professionals should be seen as working in the same teams with equal recognition by all, whether being paid or not.

Social care workers tend not to work in 'silos' as care needs to be directed to as and what is needed, while the NHS tends to work in 'silos' due to much specialisations, while this iis expected and needed to some extent and more 'holistic approach is reuired in many instances, but not to the extent of ignoring individual choices of the persons in need of care for theor own views and wishes should always of a main consideration. Much more information needs to be disclosed and also with regards to 'best practice' and safeguarding and so much more informed choice, not forgeting capacity to make decisions, where 'full capacity' may not always be there and could change from day to day.

Caring for someone will never be easy and should never be seen as so and needs great understanding, skills in many areas for every carer is skilled in many ways and no one should be looked on as being unskilled. Many social care workers are wrongly look at as being so, for to work correctly, effectively and efficiently everyone has to be skilled and in some ways social care workers are as skilled and in some respects more skilled as others within their own areas.

Lets all work together in every ways possible.

Vaccination is one of the most cost -effective ways to save lives, improve health, keep people of all ages active and reduce pressure on hospitals & primary care.