Hospital Dr News

NHS elective care being rationed to prop up deteriorating A&E waiting time performance

A&E performance against the four-hour wait target stands at just 82.45% – 12.55 percentage points lower than the 95% standard, as the NHS enters winter proper.

This performance in the first week of December has been revealed by the Royal College of Emergency Medicine’s annual Winter Flow Project to look at system-wide pressures impacting on the emergency care system over the winter period.

The project sees data collected from over 50 sites across the UK on a weekly basis and measures four-hour performance, acute bed capacity, delayed transfers of care, cancelled elective operations and the number of locums and agency staff sites employ.

At 82.45%, the four-hour standard performance in Type 1 EDs remains slightly better than was the case at the same point last year (81.28%).

Gordon Miles, Chief Executive of the Royal College of Emergency Medicine, said efforts mandated by NHS England to free up acute beds by reducing the number of Delayed Transfers of Care have had a positive impact.

The Winter Flow Project has recorded 1997 DTOCs down from 2643 at the same point last year.

However, he warned that care was being rationed in order to manage the emergency flow.

Miles said: “What these figures make clear is that providers are making determined efforts to lower their bed occupancy levels by cancelling increasing numbers of elective operations. This week the Winter Flow Project contributors recorded 3530 cancellations as compared with 2470 at the same point last year.

“This indicates that to some extent, care is already being rationed. This may turn out to be a false economy not only because clearing the backlog will eventually require large sums of money the NHS currently does not have, but because patients with untreated problems are likely to turn up in Emergency Departments requiring treatment which might otherwise been unnecessary.”

The Winter Flow Project also identifies high usage of locum staff in ED.

Miles said: “There are only 1671 consultants in emergency departments in England, while we recorded 568 locum and agency staff being employed in EDs every week – and that number appears to be increasing.”

Only a third of NHS EDs are included in the data.

Miles says the recommendations outlined in ‘Securing the future workforce of Emergency Departments in England’ must be acted upon, and the additional posts that this strategy outlines must be properly funded.

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