Official measures ‘hide the true scale’ of 12 hour hospital waits Royal College of Emergency Medicine finds huge discrepancy in way patient arrivals are recorded in England compared to rest of the UK

The head of the Royal College of Emergency Medicine has accused NHS England of covering up the true number of patients waiting over 12 hours in hospital.

Dr Katherine Henderson said RCEM data shows that in the first week of December more than 5,000 patients waited for longer than half a day in the Emergency Departments of 50 Trusts and Boards across the UK. The sample is equivalent to a third of the acute bed base in England.

From the beginning of October 2019 alone, more than 38,000 patients have waited longer than 12 hours for a bed at the sampled sites across the UK – yet official NHS England reports that in England a total of only 13,025 patients experienced waits over 12 hours since 2011-12.

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Dr Henderson said the massive discrepancy in the data is the way in which it is reported.

Waiting time measurements

The RCEM’s data measures the number of patients waiting over 12 hours from the moment they arrive at A&E, whereas NHS England, unlike the NHS in Wales, Scotland and Northern Ireland, start the clock at the point at which a decision to admit is made – meaning that a patient could already have been waiting hours before this.

Dr Henderson said: “In a nine-week period, at only a third of trusts across the UK, we’ve seen nearly three times the number of 12 hour waits than has been officially reported in eight years in England. This must be fixed.

“The way in which it has historically been reported does our patients a disservice and hides the true scale of the problem of corridor care. These figures are truly shocking and are terrible for patients and staff alike. Many patients are now getting often life changing news while stranded on a trolley in a corridor. This cannot be right, and we must strive to put an end to ‘corridor care’. But we can only do that if we acknowledge the true scale of the problem.”

Dr Henderson said NHS England must change the way in which 12-hour waits are measured to be in-line with how the devolved nations report it. “This is such a vital measurement and indicator of safety that whatever else comes out of the review process, a true measurement of how many patients are being kept waiting for over half a day is essential,” she said.

Worst performance

Data from the RCEM’s 2019-20 Winter Flow report also shows that just 68.79 per cent of patients were seen within four hours at the reporting sites – the worst performance in the five-year history of the project.

Dr Henderson said: “We are clearly in the worst state we’ve ever been in as we enter the true winter season. Norovirus and the ongoing pensions taxation issue will not have helped, but this decline has been long in the making.

“We are deeply concerned that one of the areas of the health service most valued by patients – the Emergency Departments – are, year on year, struggling to cope and increasingly difficult places for staff to deliver the standard of care they want to. Emergency Departments are the NHS safety net and the safety net is buckling.

“The number one priority for the incoming Government must be to address this and we welcome any opportunity to speak to the next Secretary of State for Health and Social Care, to help remedy the situation.”

Niall Dickson, chief executive of the NHS Confederation, said: “The way we measure performance is not right. Two in three health leaders say the current measures are not ‘fit for purpose’.”

NHS England declined to answer directly the accusation whether it was covering up the true scale of waiting times or whether it would change its methodology of data collection in light of the RCEM’s findings. The way the data is collected pre-dates NHS England’s existence.

‘Pulling out all stops’

NHS England is currently working with the RCEM on a clinical review of standards, led by NHSE national medical director Professor Stephen Powis, which includes looking at how official waiting times data is collected. An interim report published in March found a “high degree of variation” in the proportion of patients waiting more than 12 hours in A&E, with some departments having more than 8 per cent of patients waiting more than 12 hours.

A NHS spokesperson said: “Our doctors, nurses and other staff are pulling out all the stops to look after more and more people, and a particular increase in patients who are older and have more complex illnesses.

“While hospitals will continue to open more beds as needed over the coming weeks, the public also have a role to play going into winter, and can help NHS staff by getting their flu jab if they’re eligible, talking to a pharmacist for expert advice about winter bugs before they get worse, or using the NHS 111 phone or online service if they need medical help fast but aren’t sure what to do.”

NHSE has pointed out that the measurement criteria in the article have always been in use, and that there was no intention on their part to cover up. NHS England is currently working with the RCEM on a clinical review of standards, led by NHSE national medical director Professor Stephen Powis, which includes looking at how official waiting times data is collected. An interim report published in March found a “high degree of variation” in the proportion of patients waiting more than 12 hours in A&E, with some departments having more than 8 per cent of patients waiting more than 12 hours.

This report has been updated on 18th December 2019.