Emergency care departments heading for 'worst winter on record', says new BMA analysis

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Hospital emergency care departments in England are heading for “the worst winter on record” and will need up to 10,000 more beds to care for patients safely, according to new analysis from the British Medical Association (BMA).

The BMA’s analysis shows that more than 300,000 patients could be left for more than four hours on trolleys in emergency care departments before being admitted.

The new figures follow BMA analysis, released in November, of NHS England data from the last seven years, showing mounting pressure on emergency care departments, with record levels of admissions during the most recent winter. 

Some 200,000 more patients were left on hospital trolleys in emergency care departments than in the same period in 2011, the analysis shows.

Bed occupancy overall and acute beds hit 95.1% in February 2018, despite guidance from the National Audit Office that occupancy should not go beyond 85%, to prevent a negative effect on the quality of care. According to NHS Improvement, when occupancy is above 92%, the decline in emergency care standards begins to speed up. 

Responding to the BMA analysis, Niall Dickson, chief executive of the NHS Confederation, said:

“All the signs are that we are about to face yet another difficult winter and the reality is that the NHS has been unable to meet its performance targets since 2015.

“Our members have been working hard to manage the relentless rise in demand and it seems highly likely that more beds will be needed this winter to help local services cope.

“But of course, beds need to be staffed and we have serious shortages of doctors, nurses and other staff - they cannot be conjured out of thin air.

“Longer term, just putting more resources into hospitals is not the answer if we want to make the service sustainable.

“The NHS has to be supported in developing new services in the community to relieve overstretched hospitals, otherwise this situation will never be tackled. Patients deserve to be treated at the right time and in the right place and that is not happening.”

Key issues raised by the BMA analysis included:

• High bed occupancy has knock-on effects across all hospital departments and is often a key factor in cancelling planned operations. It can also delay patients moving from the emergency department to a ward. 
• To maintain occupancy at this elevated rate, the NHS opened 4,000-5,000 temporary escalation beds from January to March.
• To bring bed occupancy down to 92%, this winter, the NHS in England will need to keep using the 5,000 escalation beds opened at the peak of the winter crisis last year, and will need an extra 5,000 general and acute beds. 
• Without more resources, the BMA has said it believes about 238,000 patients will spend more than four hours waiting to be admitted, 12,000 more than the record from the previous winter; if conditions worsen even further, as many as 305,000 could face long waits on trolleys. 
• The percentage of patients seen, admitted, or discharged within four hours of visiting an emergency department will reach record lows, with compliance falling to between 84.3 per cent and 82.5 per cent, down from the previous low of 85 per cent. The Government target is 95%.

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