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10 th January 2018

Dear Prime Minister,

We are writing to you as Consultants in Emergency Medicine, Fellows of the Royal College of Emergency Medicine and as Clinical Leads (Consultants in charge) of our Emergency Departments, representing 68 Acute Hospitals across England and Wales.

We note your recent apology to patients and thanks for how hard we and other NHS staff are working.

We feel compelled to speak out in support of our hardworking and dedicated nursing, medical and allied health professional colleagues and for the very serious concerns we have for the safety of our patients.

This current level of safety compromise is at times intolerable, despite the best efforts of staff.

It has been stated that the NHS was better prepared for this winter than ever before. There is no question that a huge amount of effort and energy has been spent both locally and nationally on drawing up plans for coping with NHS winter pressures. Our experience at the front line is that these plans have failed to deliver anywhere near what was needed.

We acknowledge that our Trusts and local CCGs are doing everything they can to create capacity and more beds in the short term, and we are grateful to them for their continued assistance in such a time of crisis. We also acknowledge the help and support given to the Emergency Departments by our colleagues in other specialties and disciplines across our hospitals.

The facts remain however that the NHS is severely and chronically underfunded. We have insufficient hospital and community beds and staff of all disciplines especially at the front door to cope with our ageing population’s health needs.

As you will know a number of scientific publications have shown that crowded Emergency Departments are dangerous for patients. The longer that the patients stay in ED after their treatment has been completed, the greater is their morbidity and associated mortality.

Recent media coverage has reported numerous anecdotal accounts of how appalling the situation in an increasing number of our Emergency Departments has become. These departments are not outliers. Many of the trusts we work in are in similar positions.

Last week’s 4 hour performance target was between 45 and 75%. Thousands of patients are waiting in ambulances for hours as the hospitals lack adequate space.

Some of our own personal experiences range from

Over 120 patients a day managed in corridors, some dying prematurely

An average of 10-12 hours from decision to admit a patient until they are transferred to a bed

Over 50 patients at a time waiting beds in the Emergency Department

Patients sleeping in clinics as makeshift wards

We have known for a number of years that recruitment of staff to Emergency Departments has been challenging. The recent collaboration between the Royal College of Emergency Medicine and NHS England, Health Education England and NHS Improvement will provide a medium term solution to grow our clinical workforce as well as decrease the attrition rate.

So as a matter of urgency we ask that you consider supporting strategies that will reduce crowding in our Emergency Departments. These include;

1. A significant increase in Social Care Funding to allow patients who are fit to be discharged from acute beds to be cared for in the community.

2. A review of the number of hospital beds that are available for acute care. A number of independent organisations have confirmed that the UK has an inadequate acute bed base to meet the needs of its population.

3. Prioritisation to implement the workforce strategy that has been agreed between the Royal College and the relevant arms length bodies.

In the meantime we would like to apologise to our patients for being unable to fulfil our pledge for a safe efficient service and acknowledge the hard work and dedication of the staff.

You will understand with the public interest in this matter that we have released this letter to the press also.

We remain hopeful and committed to improving the care of patients in Emergency Departments throughout the UK.

“The NHS belongs to the people….it touches our lives at times of basic human need when care and compassion are what matter most” The NHS Constitution, 1948.

Note: we sign this on behalf of ourselves and our departments but this does not necessarily represent the views of our individual Trusts.

Shaz Afzal – County Durham and Darlington NHS Foundation Trust Shariq Ahmed- Wrightington, Wigan and Leigh NHS Foundation Trust Vazeer Ahmed – Cambridge University Hospitals NHS Foundation Trust Abosede Ajayi, Charing Cross, ICHNT Andy Ashton – St Helens and Knowsley Teaching Hospitals NHS Trust Ravi Ayya- West Suffolk Hospital Ahmad Aziz – Mid Essex Hospital Services NHS Trust, Broomfield Hospital Bill Bailey – Chesterfield Royal Hospital Tom Blyth – Heart of England NHS Foundation Trust (Solihull) Birmingham Dan Boden – Derby Teaching Hospitals NHS Foundation Trust David Clarke – Royal Berkshire NHS Foundation Trust Jonathan Costello – Royal Free, London Jim Crawfurd – James Paget University Hospital, NHSFT Susan Dorrian – Heart of England NHS Foundation Trust (Heartlands) Birmingham Ola Erinfolami – Heart of England NHS Foundation Trust, Birmingham Jane Evans – Norfolk and Norwich University Hospitals NHS Foundation Trust Shindo Francis – Milton Keynes University Hospital James Gagg – Musgrove Park Hospital, Taunton & Somerset NHSFT Steve Haig - Great Western Hospitals NHS Foundation Trust, Swindon Elaine Harding – Lewisham and Greenwich NHS Trust Miriam Harris – London North West Hospitals NHS Trust Ed Hartley – University Hospitals Coventry and Warwickshire NHS Trust Katherine Henderson – Guy’s and St Thomas’ NHS Foundation Trust Chris Hetherington – South Warwickshire NHS Foundation Trust Caroline Howard – Southend University Hospital NHS Foundation Trust Ann Hicks – Plymouth Hospitals NHS Trust Hywel Hughes – Betsi Cadwaladr University Health Board, Wrexham Maelor Hospital Nickie Jakeman Ruchi Joshi – Walsall Healthcare NHS Trust Meg Kelly – United Lincolnshire Hospitals NHS Trust Tarek Kherbeck, The Norfolk & Norwich University Hospital Liam Kevern – Northern Devon Healthcare NHS Trust Milena Kostic - The HillingdonHospitals NHS Trust Subramanian Kumaran – Shrewsbury and Telford Hospitals NHS Trust Nick Laundy – Countess of Chester Hospital NHS Foundation Trust Stuart Lloyd – Bedford Hospital NHS Trust Stephen Lord, York Hospital, York Teaching Hospitals NHS Foundation Trust Andres Martin – North Middlesex University Hospital David Matthews – Mid Cheshire Hospitals Foundation Trust Nick Mathieu – Torbay and South Devon NHS Foundation Trust Ann-Marie Morris – University Hospitals of North Midlands Rachel McColm – Wye Valley NHS Trust Lisa Niklaus – Barts Health NHS Trust Julie Norton – University Hospitals of North Midlands Tom O’Driscoll – Betsi Cadwaladr University Health Board, Glan Clywd

Nick Payne –Frimley Health NHS Foundation Trust Rob Perry – Betsi Cadwaladr University Health Board, Ysbyty Gwynedd (Gwynedd Hospital), Bangor, North Wales Shewli Rahman – Burton Hospitals NHS Foundation Trust Junaid Rathore – Royal Liverpool and Broadgreen University Hospitals Trust David Raven – Heart of England NHS Foundation Trust, Birmingham Ben Rayner – Hull and East Yorkshire Hospitals NHS Trust Tim Rogerson – Aneurin Bevan University Healthboard, Royal Gwent Hospital, Newport Emma Rowland Mustafa Sajeel – Heart of England NHS Foundation Trust, Good Hope, Birmingham Ramy Saker – Frimley Health NHS Foundation Trust, Wexham Park Ravi Sant – United Lincolnshire Hospitals NHS Trust, Pilgrim Hospital, Boston Matt Shepherd – Harrogate and District NHS Foundation Trust Toby Slade – Royal Cornwall Hospitals NHS Trust Dave Snow – Southport and Ormskirk Hospital NHS Trust Lisa Somers – Whipps Cross University Hospital, Barts Health NHS Trust Sarah Spencer – Abertawe Bro Morgannwg University Health Board, Princess of Wales Hospital, Bridgend Jo Taylor – The Dudley Group NHS Foundation Trust Nam Tong – The Queen Elizabeth Hospital, Kings Lynn NHS Foundation Trust Will Townend – Hull and East Yorkshire Hospitals NHS Trust Malcolm Tunnicliff – Kings College Hospital NHS Foundation Trust James Williamson – Warrington and Halton NHS Foundation Trust Libby Wilson – University Hospitals Aintree NHS Foundation Trust Athar Yasin – North West Anglia Hospital NHS Foundation Trust, Peterborough City Hospital