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A&E four-hour performance in the first half of winter worse than last year

Royal College of Emergency Medicine

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The data for the 2018-19 Winter Flow Project at its half way point presents a portrait of conditions in Emergency Departments that continue to become increasingly challenging, says Gordon Miles, RCEM Chief Executive.


Average four-hour emergency care performance was an average of just 82.41% between October and the end of December 2019, according to data from the Royal College of Emergency Medicine’s Winter Flow Project.

Gordon Miles, RCEM Chief Executive, said: “The data for the 2018-19 Winter Flow Project at its half way point presents a portrait of conditions in Emergency Departments that continue to become increasingly challenging. There will have been some relief that we did not see the by now customary drop off in four-hour standard performance at the end of December. However when taken as a whole, the 13-week period saw overall performance at 82.41% which is a drop of 1 percentage point on the position we reached at the same point last year (83.41%).

“It is at this point in our Winter Flow reporting that we usually signpost the connection between improved four-hour standard performance and the ability of Providers to flex (adjust) their bed stock. The idea being that in previous years we have been able to show that those hospitals that have been able to provide additional beds in response to demand have seen better four-hour standard performance.

“This year however, we cannot report this because for the three months to the end of December this has not been the case. Part of the reason for this is that for the first time in our four years of reporting there has been no overall increase in the total bed stock of Winter Flow contributors between the beginning of October and the end of December. This speaks of profound financial pressure and a system with no capacity to respond.

“Wider data from NHS England presents a similarly challenging picture. If we compare quarter 3 of 2018-19 with the same quarter of 2017-19 attendances at Type 1 departments rose 0.73% and admissions rose by 6.15%. Yet despite this entirely predictable increase in demand, the NHS is still failing to plan for these increases in a way which means providing more resources with which to treat the patients.

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