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England A&E wait times led to needless deaths of up to 14,000, data suggests


Almost 14,000 people died needlessly last year in England while waiting in A&E for up to 12 hours a new estimate suggests.

Calculations by the Royal College of Emergency Medicine (RCEM) based on a large study of excess deaths and waiting times show that 268 people are likely to have died each week in 2023 because of excessive waits in emergency departments.

The estimate used a study of more than five million NHS patients published in the Emergency Medicine Journal in 2021, which found one excess death for every 72 patients who spent eight to 12 hours in an A&E department.

The risk of death started to increase after five hours and got worse with longer waiting times, the study found.

The RCEM previously said it believed 300 to 500 excess deaths were likely to have occurred in England each week in 2022, based on this calculation, but it has since carried out a freedom of information audit of NHS trusts to refine its figures.

This found that 65% of people waiting 12 hours or more in A&E were patients waiting for a hospital bed.

NHS data for England shows more than 1.5m patients waited 12 hours or more in major emergency departments in 2023, meaning more than a million of those were waiting for a bed.

The RCEM calculated that when looking only at patients awaiting admission, an average of 268 excess deaths are likely to have occurred each week in 2023, or 13,919. It said this was 17 fewer each week than in 2022, when a severe flu outbreak and Covid cases overwhelmed the NHS.

The RCEM said its 2023 estimates were likely to be conservative. It said thousands of patients delayed in the back of ambulances, were not included in the figures but were also at risk of harm.

President of the RCEM, Dr Adrian Boyle, said: “Excessively long waits continue to put patients at risk of serious harm. Small improvements in four-hour access standard performance are not meaningful when there are so many people staying more than 12 hours. Effort and money should go where the harm is greatest.”

The NHS recovery plan set a target of March for 76% of patients attending A&E to be admitted, transferred, or discharged within four hours. But data for March shows that only 70.9% of patients were seen within that time.

In February, the number of people waiting more than 12 hours in A&E departments, from a decision to admit to being admitted, stood at 44,417.

Dr Boyle added: “In 2023 more than 1.5m patients waited 12 hours or more in major emergency departments, with 65% of those awaiting admission. Lack of hospital capacity means that patients are staying in longer than necessary and continue to be cared for by emergency department staff, often in clinically inappropriate areas such as corridors or ambulances.

“The direct correlation between delays and mortality rates is clear. Patients are being subjected to avoidable harm. Urgent intervention is needed to put people first. Patients and staff should not bear the consequences of insufficient funding and under-resourcing. We cannot continue to face inequalities in care, avoidable delays, and death.”

An NHS spokesperson said: “We have seen significant increases in demand for A&E services, with attendances in February up 8.6% on last year and emergency admissions up 7.7%.

“The latest published data shows our urgent and emergency care recovery plan, backed by extra funding with more beds, capacity, and greater use of measures like same-day emergency care, is delivering improvements, alongside work with our colleagues in community and social care to discharge patients when they are medically fit to go home, freeing up beds for others.

“The cause of excess deaths is down to several different factors and so it is right that the experts at the ONS – as the executive branch of the stats authority – continue to analyse these causes.