Only one in six emergency departments in England say they can handle a major incident

Overcrowded accident and emergency departments mean only 15% of department heads are confident they can tackle a major incident such as a terror attack or rail disaster, new research shows.

A survey of clinical directors and consultants in 71 emergency departments in England found that emergency departments were overcrowded, with more than 70% saying patients had to wait in corridors or ambulances at least half of the time. Only eleven of them were confident they were “adequately prepared” to respond to a major incident.

The results, published last week in the Journal of Emergency Medicinecame from a study carried out in March last year by academics from Derriford Hospital in Plymouth and the Royal Center for Defense Medicine in Birmingham.

Since then, doctors believe conditions in emergency departments have deteriorated and last week NHS England said 2024 was the busiest year on record for emergency departments and ambulances.

An average of 5,407 patients were treated for flu every day last week, NHS England said, three and a half times as many as the same time last year.

Ambulances queued outside the emergency room because there were no beds for their patients. In the wards within, 12,591 patients were well enough to leave, but their discharge from hospital was postponed because they had nowhere to go. According to the Royal College of Emergency Medicine (RCEM), a shortage of social care placements caused 70.6% of patients to be delayed in hospital.

“It would be wrong to think this is all about winter respiratory viruses,” said Dr Adrian Boyle, chair of the RCEM. ‘These are the straws that break the camel’s back. The problem is that there is not enough capacity – beds and workload – to admit patients. The system has been in crisis all year.”

Boyle said RCEM was “extremely concerned” about the investigation into major incidents. “This is consistent with what many clinical directors tell me, that almost every department currently has one to two wards of patients waiting to be admitted, in corridors or, worse, waiting outside in ambulances.”

The latest NHS winter crisis has led to more than twenty hospital trusts announcing they have been hit by a critical incident, allowing them to postpone appointments for elective procedures to redeploy staff to assist in emergency care.

Major incidents are serious events, from bus or train accidents to disasters such as the Grenfell Tower fire or the Manchester Arena bombing.

Hospitals in England must submit a major incident plan to NHS England every year, usually in collaboration with police and fire services. Most plans include finding a way to free up their A&E to accommodate mass casualty events.

Prof Lucy Easthope, disaster management consultant and author of When the dust has settledsaid most emergency departments would likely be able to respond to a “major incident without notice.”

“But I’m afraid to think what that would do to the existing problem in the hospital,” she said. “Many of our no-notice plans (effectively) sacrifice those not involved in the incident.

“Planners are concerned. Very bluntly: we are late, something like a transport accident. And none of the consultants or doctors get any downtime, so they don’t undergo training for a major incident.”

Easthope said that while people often assume that other patients will accept that disaster victims are given priority, she had seen “huge levels of anger” when there were crowds. And she added that if emergency rooms remain busy, emergency response teams may need to consider how to treat people at the scene of a major accident rather than in hospital.

A spokesperson for NHS England said: “We know the NHS is under significant pressure this winter, but there is a huge amount of planning, practice and assurance taking place for major incidents – and plans to support NHS organizations can be implemented quickly, including providing mutual aid from neighboring hospitals and the voluntary sector.

“Individual NHS organizations are responsible for putting robust major incident plans in place to meet their local needs and we will continue to work with them to ensure this is the case.”