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Eliminating crowding in Emergency Departments must be the number one priority of any incoming Government

Royal College of Emergency Medicine

4 min read Partner content

The Royal College of Emergency Medicine (RCEM) is the single authoritative body for Emergency Medicine in the UK. They outline their key asks for the General Election Manifestos.

Emergency Departments are stretched to the limit, with staff increasingly working in crowded hospitals. All political parties must commit to addressing these challenges.

NHS Emergency Departments across the four nations are operating at a dangerous capacity. Eliminating crowding in Emergency Departments must be the number one priority of any incoming Government.

Crowding and corridor care         

Since 2010-11 attendances to Type 1 Emergency Departments in England have increased by 1,748,283 (12.5%) – equivalent to the workload of 22 medium-sized departments. Every year, millions of people turn to our Emergency Departments as increasing numbers are living longer with a complex range of medical needs.

Primary and social care services have not been developed to address this need. Emergency Departments are now the first port of call for many patients.

Alongside the rest of the health and social care system, Emergency Departments are inadequately supported and have not been resourced to meet demand. 

With services not resourced to match demand placed on Emergency Departments, admitting patients into a hospital bed in a timely way has become frequently unachievable. Over 300,000 patients waited more than 12 hours in Emergency Departments in 2018-2019.  This has been exacerbated by the loss of 15,000 staffed beds across England since 2011.

This October we witnessed the worst ever four-hour performance figures since records began. The Royal College of Emergency Medicine continues to take the view that the four-hour standard remains an important indicator of patient flow through a hospital.  The ongoing Clinical Standards Review should only replace the four-hour standard with measures that evidently improve patient flow and crowding in Emergency Departments. 

We recommend increasing the bed capacity in hospitals to maintain flow in Emergency Departments and estimate that at least 4,000 extra staffed beds are needed in England alone this winter to achieve 85% bed occupancy.  

A new Government must also immediately publish a Social Care White Paper, with the view of expanding social care provision to improve patient flow and address delays in transfers of care in Acute Hospitals.  Additional funding must address the £2.3 billion shortfall in social care faced by councils, as advocated by the Local Government Association.

Alternative access 

NHS Emergency Departments are crowded because we are increasingly providing care for patients who have tried to seek alternative care prior to their attendance.

The best and most cost-effective health care systems in the world are based on a strong primary care system, but we know GPs are under incredible pressure. 

To improve this, we need an expansion of the GP workforce and their hours of availability, along with development of round-the-clock support for frail elderly people in care homes.

Government should also consider expanding Same Day Emergency Care and co-locating primary care services with Emergency Departments, to allow patients to be routed to the best place to obtain their care.

Recruitment and retention

Currently our workforce suffers from burnout, attrition, and staff shortages.

Emergency Departments have insufficient resources to meet the minimum number of consultants and senior decision makers required per 100,000 attendances. This is exacerbated by changes in pension taxation.

Nursing staff play a pivotal role in maintaining patient flow in hospitals, the shortage of nursing staff across the four nations must also be urgently addressed.

Government should invest in the workforce to meet RCEM guidelines for safe staffing levels for all staff working in Emergency Departments and ensure the NHS People Plan provides a clear framework for addressing Emergency Medicine staff shortages.


Crowded NHS Emergency Departments can be a frightening experience for people with dementia, or those suffering from a mental health crisis. High demand, inadequate space and poor departmental infrastructure create a volatile environment.

We want Government to work with the College to develop an effective measure for patient experience in Emergency Departments.

Safety and Space

The CQC estimates that over half of Emergency Departments in England are inadequate or require improvement for safety. There are similar concerns about Emergency Departments in the devolved nations. 13% of legal claims against the NHS in England originate in Emergency Medicine, the highest number of any specialty.

Many emergency departments need urgent repairs.


The Royal College of Emergency Medicine’s Policy and Communications team works with politicians and policymakers in England, Scotland, Wales and Northern Ireland.

We are the first port of call for enquiries on all matters relating to health and Emergency Medicine policy.


Telephone: 020 7067 4814

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