Emergency Department (ED) performance figures for England published today by NHS England show emergency admissions at Type 1 EDs was the highest it has been since the start of the pandemic and since January 2020.

The data also show that attendances at Type 1 EDs have increased significantly from 903,644 in February 2021 to 1,159,938 in March 2021. An increase of nearly 30%. This is the highest attendances have been since October 2020.

Despite this, the number of patients staying in an Emergency Department for 12 hours or more dropped by one third, from 1,038 in February 2021 to 688 in March 2021.

Four-hour performance in Type 1 EDs in March 2021 reached its highest since September 2020, at 80%. However, one in five patients were still delayed by four hours or more before being admitted.

Q4 data for the period January 2021 – March 2021 also published today by NHS England show the second lowest quarterly attendances ever at Type 1 EDs with 3,004,733 attendances.

The data for Q4 also show the number of 12-hour delays was the third highest ever with 5,535 patients staying in the Emergency Department for 12 hours of more before being admitted.

The two sets of data paint a complicated picture. The beginning of the year no doubt saw a high number of patients in a complex or severe condition leading to lengthy stays, together with capacity issues and these high acuity patients staying longer in hospital it is likely this contributed towards the high number of 12-hour delays that were seen in January and February 2021.

The data for March 2021, however, show the beginning of a return of patients from the community with a one-third increase in attendances and a reduced number of 12-hour stays, perhaps indicating that these patients are not as high acuity.

However, as the number of attendances increase so do pressures throughout the system. As the NHS recovers from the pandemic and begins to tackle the backlog of elective care, it is vital to ensure Emergency Departments are resourced and have the capacity to meet patient and community demand.

Responding to the data, Dr Katherine Henderson, President of the Royal College of Emergency Medicine, said:

“As the data show the first quarter of this year has been a real challenge, mentally and physically for staff and overall, for Emergency Departments and hospitals. We have faced seriously intense pressures from the pandemic and a high number of high acuity patients with complex conditions.

“The data for March show that we are beginning to see a return of our community patients and a demand for urgent and emergency care services. This is evident by the high number of emergency admissions. The emergency admissions for March 2021 have been the highest since the pandemic began and the highest since January 2020.

“Before the pandemic, our Emergency Departments were crowded, patients were having care administered to them in corridors, and exit block was a serious problem. Looking at the sheer number of emergency admissions, we have concerns that we are beginning to head in that direction again and we will soon see a return of these terrible practices. We must not let things go back to how they were before. It is unconscionable. And the pandemic has highlighted the safety issues and the risks that crowding in our hospitals present.

“As we recover from the pandemic, we have an opportunity to assess and address capacity and the way we deliver care. The pandemic required us to adapt and ensure that patient safety was at the forefront of our minds and we changed the way we deliver care. We should hold onto that as we return to ‘normal’ services.

“As public life slowly returns to normal over the summer, there is widespread fear among health professionals of an Autumn wave of covid, followed by another brutal winter bringing seasonal flu and influenza, all while the NHS is trying to recover and tackle the backlog of elective care.

“Our fear is that without extensive preparation, the NHS could once again be brought to a breaking point, nearly unable to cope and nearly unable to provide care for everyone who needs it.

“We must focus on maximising the potential of alternative care services and working with the relevant bodies to improve it. We must also look at how we can increase capacity throughout the system. If we fail to do that, crowding and corridor care will quickly return inevitably leading to exit block and ambulance handover delays – all of which present a serious risk to patient safety.

“The walls of Emergency Departments are not elastic, and the problem cannot be fixed there alone. This is a system-wide issue, so we are eager to collaborate across hospital departments and with stakeholders to formulate and implement tangible solutions.

“We must not let staff down, neither hospitals nor Emergency Departments, by being underprepared and under-resourced for what could come in the coming months. We cannot once again let Emergency Departments become the safety-net of the system. This summer we have the time to make these changes, we have the time for transformation, if we miss this opportunity, we could quickly return to how things were before.”