PEOPLE FIRST: Foreword by Sir Robert Francis, KC

Page last updated: 28 April 2023

No-one can deny that our emergency services are in a critical state, and with bed capacity now overwhelmed in our hospitals, they are constantly failing to meet reasonable expectations for response times, quality of care and safety. The importance we accord to emergency care is demonstrated by the inclusion of standards for response times in the NHS Constitution.

The performance figures against these standards speak for themselves. In August 2022:

  • the England mean average response time for Category C1 [life threatening, such as a cardiac arrest] was 9:08 (standard = 7 minutes), and the 90th centile was 16:20 minutes (standard = 15 minutes).
  • the C2 [such as a chest pain or stroke] mean response time was 43 minutes (standard = 18 minutes), and the 90th centile was a staggering 1 hours 33 minutes (standard = 40 minutes). 
  • of the patients who attended an emergency department (type 1) only 58% had a decision made to admit, discharge or transfer them in four hours.
  • 28,756 patients waited in an emergency department for more than 12 hours after a decision was made to admit them. In August 2021 this was 2,787 patients.

In April 2022, the mean average time from 999 call until arrival at hospital for patients who had a stroke was 1 hour 54 minutes. To that has to be added the 58 minutes to receive thrombolysis and/or the 1 hour 30 minutes to get from arrival at hospital to a CT scan.

Similar if not more alarming figures could be produced for the response after arrival at emergency departments, confirmed by the almost daily reports of alarming ambulance queues.

However, the figures do not address the reality of what this means for patients. That is why Margaret’s story, which has inspired this paper, is so important and should be watched by all who read this. It shows how in one case, but a case clearly representative of so many others, the dysfunction of the system leads to serious deterioration in health and a corresponding increase in the demand on the service as a whole.

This paper rightly describes the situation as a system crisis and alerts us to the danger of gross delays becoming the new normal, while undermining the trust and confidence the public are entitled to have in their NHS and social care services and the already stressed morale and wellbeing of our hard working and dedicated NHS and social care staff.

Fortunately none of the leaders brought together to inform this paper are complacent, and all are committed not just to identifying the systemic issues which combine to cause these awful results, but to describe the actions which could change things for the better. I was privileged to participate in discussions attended by 250 leaders from all points in the system, from frontline services to ICS to national level. It is out of their contributions and their real life experience that the suggestions in this paper have come.

I suggest that all members of ICS Boards and Partnerships should ask themselves how they can implement each and every one of the suggestions, if they have not done so already. It has been clear for a long time that the crisis in emergency care cannot be solved by that part of the service alone. Change is required throughout health and social care services. Patients cannot wait until the gaps in staffing have been addressed when there is not even a national workforce strategy in place. They will not get the safe treatment and care they need unless the staff we now have are given all the support they need. Our hospitals will not regain the capacity they need to cope with increased demands without new ways of working. 

The time to action many of the recommendations in this paper is now. Patients like Margaret are entitled to no less.

Sir Robert Francis, KC

Chair, Healthwatch England

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