The end of a long wait – why NHSE’s pledge to tackle 12hr+ ED stays really is welcome 

Following the publication of NHS England’s updated Urgent and Emergency Recovery Plan, President of The Royal College of Emergency Medicine, Dr Adrian Boyle explains why it must be considered a positive step 

NHS England has published details of the second year of its two-year Urgent and Emergency Recovery Plan.
The first iteration was published at the end of January 2023 and came off the back of the worst A&E crisis ever experienced.  

News bulletins and front pages were filled with images of queues of ambulances backed up in hospital car parks.  

I am sure you don’t need reminding. 
Now we as a College are often accused of being critical by the powers that be.  
But our ‘criticism’ is never just for the sake of being negative – we always aim to be a truly ‘critical friend’.  
That is why our response yesterday was perhaps more welcoming than some may have expected.  

Let’s be clear. Any attempt to improve UEC must be welcomed. 
Many of the causal factors are beyond the remit or control of the NHS. 
They are so much bigger.  

They fall to the government, and ultimately to us as a society. We must decide what we want our health and social care system to provide and how it will operate.  
And the most difficult question of all, how it is going to be paid for. 
It is a huge elephant in the room.  

An issue so big it gets kicked on and on, popped in the ministerial red box marked ‘too difficult’.  
And it is not likely to be addressed with anything more than lip service anytime soon as politicians shift into full-on pre-election mode.   It is not a snappy, catchy, sexy, ‘new’ vote-enticing policy initiative.  
It is a huge, and hugely expensive, issue to even begin to tackle.  

And while all this pre-election chatter and political posturing continues – our Emergency Departments remain beyond full.  

BBC Newsnight’s piece about looking at Continuous Flow Models as a way of easing ED crowding aired this week.  It included secretly filmed footage from one ED.  

Despite my job(s), and being more than aware of the issues, it still hits me hard to see so many people – all needing care and support, many elderly and fragile – on trollies shoved up against corridor walls.  

No secret filming is advisable. But this gave the public a rare opportunity to see, in not so glorious technicolour, the reality that our members – and of course our poor patients – are experiencing every single day up and down the country.  The old adage a picture paints a thousand words has never been more true. I called it a national shame.  It is. 

Which is why we, as a College, will keep talking about it, keep lobbying politicians and policy makers, keep using the data to evidence the risk and the harms, keep engaging with the media, keep providing ideas and solutions to the NHS about how we can improve things.  

We know the problems we all have to deal with every day can be fixed – but fixing them won’t be easy and it probably won’t be quick.  But a big step toward solving a problem is acknowledging it.  

Earlier this year the college successfully lobbied the Government to publish data on 12-hour A&E waits.  
The fact that that this data exists, and includes thousands of people each month (131,440 people waited 12 hours or more in April 2024), is a damning indictment of the crisis our specialty is facing.  Now we have a clear indisputable picture of the scale of the problem.  The next step is fixing it. 

RCEM has been raising this as an issue, publicly and in private meetings, at every opportunity.  
And our message is being heard – and heeded.  

For the first time in this updated UEC plan. NHSE has specifically referenced the issue of extremely long ED waits and has detailed its plan to reduce them.  Its chosen option is financial incentivisation – now this is not without the risk of unintended consequences – as we have seen from similar schemes targeting the four-hour standard.  And we keenly await the detail.  

But it is a win in the sense that at least ‘something’ is being done. 
Which is why we welcomed the plan. 

So we will see how this plays out, and we will keep monitoring the situation and keep (helpfully?!) offering ideas, solutions and feedback.  After all, we are all on the same side really. We all want to see this issue tackled and long waits ended.  

For the good of our clinicians, for our patients and for society as a whole.