On one half of Rishi Sunak’s NHS pledge to voters, there has been some modest progress in recent months. Waiting lists for pre-planned hospital treatment and outpatient appointments in England fell from 7.8m to 7.6m between September and December last year. Given the intense pressures on the health system from multiple directions, this improvement is a remarkable achievement by the trusts that brought it about – even while the overall situation remains dire, with waiting lists predicted to remain longer than before the pandemic until 2030 at the earliest.
But the prime minister’s commitment was not limited to waiting lists. The pledge he made in January last year, as one of five priorities on which he said voters should judge him, was that “NHS waiting lists will fall and people will get the care they need more quickly”. New calculations by the Royal College of Emergency Medicine (RCEM) show that, with regard to the broader aim of delivering speedier treatment, his government is falling shockingly short.
The RCEM points to the grave dangers that treatment delays continue to cause. People who need to be admitted to hospital are a minority of A&E patients. In February this year, for example, an average of 13,373 people were admitted out of a total of about 45,000 seen daily in A&E departments. But based on analysis of people who are stuck in A&E for 12 hours or more while waiting for hospital beds, the RCEM estimates that 268 excess deaths are likely to have occurred each week in 2023 – adding up to a total of close to 14,000 unnecessary deaths.
These are terrible figures. People should not be dying because of a lack of beds – or because of delays in putting people in them caused by staff shortages. The NHS lost 25,000 beds across the UK 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 quickly admitted.
A&E waiting-time targets have sometimes been criticised as a poor proxy for overall NHS performance. As with any targets, there is a risk of perverse incentives and inappropriate skewing of what ought to be clinical judgments. Currently there is a powerful case for prioritising new investment in primary care, community mental health and social care in preference to hospitals. But research showing that risks to life are increased by A&E delays must also be addressed. Greater public familiarity with the epidemiological concept of “excess deaths” since the pandemic should help to ensure that the emergency doctors’ warning is heeded.
A&E is just one window on the wider health and care system, but it is a crucial one. In emergencies, or when GP surgeries are closed or hard to access, these departments function more like a front door. The principle underpinning the UK’s health system – that care is free at the point of need – is tested every time a person goes through.
Voters should take Mr Sunak at his word and look beyond the headline waiting-list figures. There are other areas of care that require scrutiny, including in relation to timeliness. The risks caused by delays in A&E are a frightening prospect, particularly for anyone living with a potentially life-threatening condition. Emergency doctors have performed a valuable public service in highlighting the threats to life that can be caused by excessively long waits.
