OOne half of Rishi Sunak’s NHS promise to voters has seen some modest progress in recent months. Waiting lists for pre-planned hospital treatments and outpatient appointments in England fell from 7.8 million to 7.6 million between September and December last year. Given the intense pressure on the healthcare system from multiple directions, this improvement is a remarkable achievement by the trusts that delivered it – even if the overall situation remains dire, with waiting lists predicted to continue for longer than before the pandemic, until 2030 at the earliest.
But the Prime Minister’s commitment was not limited to waiting lists. The promise he made in January last year, as one of five priorities he said voters should judge him on, was that “NHS waiting lists will fall and people will get the care they need more quickly”. New calculations from the Royal College of Emergency Medicine (RCEM) show his government is shockingly falling short when it comes to the wider goal of faster treatment.
The RCEM highlights the serious dangers that treatment delays continue to cause. People who need to be hospitalized make up a minority of ER patients. For example, in February this year on average 13,373 people were admitted out of a total of approximately 45,000 seen in emergency departments every day. But based on an analysis of people stuck in A&E for 12 hours or more while waiting for hospital beds, the RCEM estimates that 268 additional deaths are likely to have occurred every week by 2023 – for a total of almost 14,000 unnecessary deaths. deaths. .
These are terrible numbers. People should not die because of a lack of beds – or because of delays in placing people in them caused by a shortage of staff. The NHS lost 25,000 beds across Britain as a whole in the decade to 2022, and emergency specialists have previously highlighted the dangers of a situation where seriously ill or injured people cannot be admitted quickly.
A&E wait time objectives have sometimes been criticized as a poor measure of overall NHS performance. As with all objectives, there is a risk of perverse incentives and inappropriate distortion of what clinical judgments should be. Currently, there are strong arguments for prioritizing new investment in primary care, mental health and social care over hospitals. But attention should also be paid to research showing that risks to life increase due to delays in emergency care. Greater public awareness of the epidemiological concept of “excess deaths” since the pandemic should ensure that emergency physicians’ warning is heeded.
A&E is just one window into the broader health and care system, but it is crucial. In emergency situations, or when GP practices are closed or difficult to access, these departments function more like a front door. The principle underpinning the UK healthcare system – that care is free when it is needed – is being tested every time someone goes through it.
Voters should take Mr Sunak at his word and look beyond the waiting list figures. There are other areas of concern that require attention, including with regard to timeliness. The risks caused by emergency department delays are a frightening prospect, especially for anyone living with a potentially life-threatening condition. Emergency physicians have performed a valuable public service by highlighting the threats to life that can be caused by excessively long waits.