Thousands of patients enduring 12-hour A&E waits every day

About 4,000 patients a day are spending more than 12 hours in A&E as the emergency care system “collapses”, Britain’s top accident and emergency doctor has said.

The head of the Royal College of Emergency Medicine (RCEM) issued the warning as nurses prepare for their first national strike in history, with two days of action planned before Christmas.

Hospitals are already under unprecedented pressure, with record numbers at A&E departments and a quarter of ambulance time lost to delays caused by queuing.

Dr Adrian Boyle, the president of the RCEM, said he was “very worried” about the numbers dying for want of prompt care, with hospitals increasingly too overcrowded to cope with the amount of people coming in.

Regulators have warned of “gridlock” across the system, meaning that many of those in need of emergency treatment are waiting far too long.

Data gathered by the RCEM suggest the number of patients stuck on trolleys for more than 12 hours has risen by 50 per cent in a year. Struggles to access emergency care may now be responsible for about 2,000 deaths a month, analysis suggests.

Dr Boyle called for urgent action to tackle the mounting crisis and warned of a “really, really tough” winter ahead.

“We are very worried about what I would call British exceptionalism,” he said. “There is avoidable mortality that is occurring pretty much only in Britain – which is related to the collapse of the emergency care system.”

It comes as nurses prepare to strike on December 15 and 20, leaving hospitals stripped back to just emergency and urgent care services.

On Saturday night, Steve Barclay, the Health Secretary, accused the Royal College of Nursing of risking patient safety by refusing to attend a meeting to decide which services will be exempt from strike action.

In an exchange of furious letters, Pat Cullen, the union’s general secretary, said members were open to pay negotiations “or nothing”, after Mr Barclay urged the union to return for talks about working conditions.

Mr Barclay said the strikes would “unnecessarily increase the level of uncertainty that patients will have [about] their care and treatment”.

Chemotherapy sessions, cancer tests and transplant services are likely to be affected, while up to 30,000 operations and hundreds of thousands of appointments could be postponed.

Nurses working at NHS 111 centres are among those striking, adding to concerns that extra pressure will be heaped on A&E units.

A ballot of up to 350,000 paramedics, porters and cleaners represented by Unison is expected to report soon, while a vote by the union Unite is due to close later in the week.

NHS officials are particularly concerned by the threat of co-ordinated action between unions, which could push services to breaking point.

NHS data for England show that in 2021/22 almost a million people endured waits of at least 12 hours in A&E – three times higher than three years earlier.

Analysis by the RCEM, which was based on Freedom of Information disclosures, suggests the figure could reach 1.5 million this year, with a 50 per cent rise in cases in a year.

NHS targets say A&E patients should be treated, admitted or discharged within four hours – but the current performance of 71 per cent is the lowest on record. The target has not been met since 2015.

Every month, NHS England publishes statistics showing the number of A&E patients forced to wait more than 12 hours after a decision has been taken to admit them to hospital.

But the RCEM points out that these are the tip of the iceberg, as they do not count any time spent waiting before that decision is taken.

Latest published data showed 43,792 people waited longer than 12 hours in October, up 34 per cent from 32,776 in September and 19,053 in May.

The figure is the highest number in records going back to August 2010.

Increase in mortality from preventable illness

But data collected by NHS Digital, and revealed under FOI disclosures, show the number of patients facing total waits of at least 12 hours after arriving in A&E is about three times as high.

The monthly statistics show 979,488 such cases in the first eight months of the year. This would suggest an annual figure of around 1.47 million this year – even without any deterioration in performance this winter – compared with a figure of 976,264 for the whole of 2021/22.

Meanwhile, estimates suggest that recent increases in mortality – from preventable illnesses, such as heart attacks and strokes – are causing at least 500 deaths a week.

The Care Quality Commission watchdog last month warned that the health and care system was “gridlocked”.

The situation has fuelled ambulance delays, with average waits of an hour for heart attack victims, and vehicles stuck queueing outside A&E departments.

Data from the Association of Ambulance Chief Executives show 23 per cent of ambulance capacity in November was lost to such delays, leaving far fewer ambulances to respond to calls. Before the pandemic, the figure was 7 per cent.

A Department of Health and Social Care spokesman said: “No one should have to wait longer than necessary to access urgent and emergency care, which is why we are working with the NHS to take action to ease pressures across the system and prepare more extensively for winter than ever before.”

An NHS spokesman said: “Urgent and emergency care services are facing considerable demand with record levels of attendances at major A&E departments last year, significant levels of Covid and the highest ever number of the most serious ambulance callouts this summer – that’s in addition to difficulties discharging thousands of patients who are medically fit for discharge.”