The Royal College of Emergency Medicine has warned the number of clinicians working in the NHS in Wales is almost half what is needed. A landmark survey of emergency medicine staff in Wales has found "there are just too few staff" as delays in A&E reach record levels.
The ‘Wales’ Emergency Medicine Workforce Census 2023’ is an in-depth analysis of the state of the emergency medicine workforce, providing an insight into the working patterns of clinicians and allowing a forecast to be made around the future. It found there is one consultant for every 7,784 patient attendances at A&E, nearly twice as many as the recommended one consultant for every 4,000 patient attendances.
But it said there were simply not enough staff at all levels to cope with the demands and warned that junior doctors are being "overstretched". The number of urgent life-threatening 999 calls that take too long to reach rises dramatically.
The census had responses from all 12 major emergency departments in Wales and found there were 90 gaps in the consultant rota, 33 in the middle grade rota and eight in the junior rota.
Concerns were also raised about what will happen in the future with 19 out of 101 consultants planning to retire in the next six years - a fifth of the consultant workforce. The report also found that there needed to be an increase of 75% consultants and 120% increase in the workforce.
Dr Suresh Pillai, vice president of the Royal College of Emergency Medicine Wales, said: “The findings of this vital census are stark and really shows why Emergency Care in Wales is broken; we simply have too few staff.
“We are way off the RCEM recommended ratio of one WTE Consultant per 4000 attendances. This means existing consultants are stretched extremely thinly in Emergency Departments. We need more consultants for the safe supervision of trainees and junior staff.
“It’s no wonder that many are exhausted, burnt out and looking to leave. Exhorting staff to work harder and ‘find efficiencies’ to improve care just won’t wash – they are already at their limits, doing their very best. Any service that is not properly resourced will eventually collapse, and this survey makes it abundantly clear that the crisis emergency care finds itself is down to having too few staff, attempting to deliver too much. That’s not the fault of patients or because there is ‘too much demand’, it’s the result of a failure to plug the significant gaps in staffing and address retention issues.
“We need sustainable long-term workforce planning to ensure there is a pipeline of doctors coming through. We are way behind where we need to be in terms of staffing and things will only get worse in the years to come if this isn’t addressed. Nearly one fifth of the consultant workforce plan to retire in the next six years, but departments are saying they need at least 75 more right now.
He added: "We’re keen to work with the First Minister, Mark Drakeford, to discuss the Emergency Care crisis and need for long-term workforce planning; the Welsh government must provide the funding to increase the EM consultant workforce by an additional 100 consultants as a matter of urgency, and to facilitate this we must see an expansion to the number of EM training places offered by 15 and maintained year on year.”
Dr Pillai also said that the report found that junior doctors are being "asked to do too much" and called for an expansion in training places as soon as possible, "to spread the load and help fewer feel the need to drop out of training".
In response to the latest ambulance waiting time figures, the Welsh Government has said it acknowledged "emergency care performance is not where we expect it to be" but said it had implemented a number of new measures including extending same-day emergency care services to open seven days a week, improving management of 999 patients on the phone, and recruiting more staff.
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