A&E wait times linked to 23,000 excess deaths, college claims

Long A&E wait times could have contributed to some 23,000 "excess patient deaths" last year, a medical college has claimed.

The Royal College of Emergency Medicine (RCEM) said that in 2022 some 1.66 million people in England waited for more than 12 hours in A&E from the moment they arrived in the emergency department.

It warned that long waiting times can have “catastrophic consequences for patient safety and mortality”.

A new briefing paper by the College examined long waits and excess deaths.

It sent a freedom of information request to NHS Digital to discover the number of patients who waited for more than 12 hours from their time of arrival in A&E.

This information is currently only published annually, although officials have committed to publishing monthly data starting later this year.

The RCEM found that in 2022 some 1,656,206 patients in England waited 12 hours or more from their time of arrival in an emergency department until they were admitted, transferred or discharged.

It then calculated the standardised mortality ratio linked to the long waits.

A standardised mortality ratio describes whether a specific population are more, less or equally as likely to die compared with the general population.

The RCEM performed this analysis by using data from a previous study, published in the Emergency Medicine Journal in 2021, which linked excess deaths to long emergency department waits in England between 2016 and 2018.

The study concluded that there was one extra death for every 72 patients that spend eight to 12 hours in the emergency department.

Using the standardised mortality ratio from the study and the 12-hour wait figure from NHS Digital, the RCEM estimated that 23,003 excess patient deaths in 2022 in England were associated with long stays in emergency departments.

But it is worth noting that the study analysed data from 2016-18 so the figures may not be comparable with A&E waits in 2022.

NHS England said that the figures were “very unlikely to give a full or certain picture” on excess deaths.

Dr Adrian Boyle, president of the Royal College of Emergency Medicine, said: “These data, while shocking, are unsurprising.

“Long waiting times are associated with serious patient harm and patient deaths – the scale shown here for 2022 is deeply distressing.

“The data show how necessary it is to have transparent figures."

The Department of Health and Social Care and NHS England will be publishing 12-hour data from time of arrival in the emergency department regularly from April this year.

An NHS England spokesman said: “The cause of excess deaths is down to a number of different factors and so attributing deaths to one exact thing as the figures quoted by the RCEM attempt to do, is very unlikely to give a full or certain picture – it therefore would not be appropriate for NHSE to recognise these as fact and it is right that the experts at the ONS – as the executive branch of the statistics authority – continue to analyse excess deaths.

“The data highlighted looks at time in A&E rather than waits and covers a year when the NHS experienced four record-breaking months for attendances in A&E.

“The NHS is focused on improving patient flow through emergency departments and increasing the number of patients being discharged when they are medically ready.

“The recently published UEC Recovery Plan sets out targets to achieve a four-hour performance of 76% by March 2024, and publish accurate 12-hour waits from time of arrival.”

A Department of Health and Social Care spokesman said: “There are a wide variety of factors contributing to excess deaths and it is important not to ascribe them to one cause.

“However, no-one should have to wait longer than necessary to access urgent and emergency care and it’s encouraging to see significant improvements in performance last month including across all ambulance response times categories and in A&E departments.

“We’ve published a comprehensive urgent and emergency care recovery plan, which was welcomed by the Royal College of Emergency Medicine, which will allow people to be seen quicker by scaling up community teams, expanding virtual wards, and getting 800 new ambulances on the road.

“This is on top of £750 million this winter to speed up hospital discharge and free up beds.

“At the same time we are continuing to grow the NHS workforce and have commissioned NHS England to publish a workforce plan which will set out plans to help recruit and retain more NHS staff.”

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