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More than a million older people faced waits of 12 hours or more in A&Es in England last year – and shockingly, the older a person is, the more likely they are to experience a long stay in the emergency department – new data from the Royal College of Emergency Medicine (RCEM) reveals.It comes as the College publishes a new report looking at the care older people receive in emergency departments.The research, titled ‘Care of Older People 2023-24’, is part of the College’s clinical Quality Improvement Programme which aims to improve the care of patients attending Emergency Departments. This interim report reflects the findings of the second year of the three-year programme. Across the UK, 149 Emergency Departments submitted 24, 865 patient cases from 4 October 2023 – 3 October 2024. A key finding was that among patients over the age of 75, there was insufficient screening for three common conditions which primarily affect this age group: Only 16% of patients were screened for delirium – a reversible condition which can be associated with mortality, characterised by a sudden change in mental function.On average less than half (48%) had screening to assess the risk of falling.An average of 56% underwent screening for general frailty – which if detected can trigger early intervention and support in hospital and in the community.Despite a year-on-year improvement from 2023, these patients are enduring the longest waits in A&Es and are bearing the brunt of an Urgent and Emergency Care system in crisis. Older people are often more likely to suffer with complicated or multiple health issues. This, combined with the wider issues related to a shortage of in-patient beds, mean they can often end up enduring extreme long waits in A&E – often on trolleys in corridors.

This King's Fund article sets out how prioritising non-clinical support for people who frequently attend A&E can contribute to the government’s ambition to deliver three major shifts in health and care.

The health service in England has endured a punishing winter. Stark warnings about a potential ‘quad-demic’, the ‘busiest year on record’ for A&E and ambulance services, and ’jampacked’ hospitals prompted comparisons with the COVID-19 pandemic.  But how bad was winter 2024/25? The Health Foundation present analysis of routinely collected and publicly available data on health service performance and the possible contributing factors.  Key points: This winter saw the NHS in distress. Only 73% of A&E patients were treated within 4 hours, similar to the last two winters, and far below the 95% constitutional standard. The number of people experiencing 12-hour waits before admission reached a new record high. Numbers of A&E diverts and ambulance handover delays were worse than over previous winters. Looking at operational performance, winter pressures and other factors, the analysis explores the extent to which disruptions to urgent and emergency care were caused by higher than usual levels of winter illnesses and/or systemic weaknesses within the NHS. Levels of flu and diarrhoea and vomiting were higher than usual. Hospital admissions for flu reached a similar peak to winter 2022/23 but took longer to fall, leading to a 50% higher total number of flu bed days. However, hospital admissions for RSV were similar to previous winters, while admissions for COVID-19 remained low. Winter A&E attendances have risen steadily each year. However, slightly fewer patients attended major A&E departments in winter 2024/25 than in 2023/24, and emergency hospital admissions fell slightly. This suggests the NHS struggled to cope with a small increase in demand from patients needing emergency hospitalisation, while also expanding elective activity in line with government commitments to improve elective performance. Bed occupancy during winter has been rising for the last 15 years, exceeding the NHS 92% threshold for the first time in winter 2017/18, highlighting a system at its limits. Since COVID-19, a substantial increase in delayed discharges is likely to have obstructed the flow of patients out of hospitals, worsening bottlenecks upstream in the care pathway from A&E into wards and from ambulances into A&E. Overall, the conditions this winter, while severe, were similar to those in recent years and not far above what the NHS can normally expect. Attributing operational problems to external factors such as winter illnesses and higher demand risks offering false comfort about the resilience of the health service. The shows the health service performing far worse than before the pandemic and reporting record or near-record levels of operational problems across urgent and emergency care. Ahead of the government’s forthcoming Urgent and Emergency Care Plan, this raises key questions about what might be behind some of the underlying issues contributing to what has now become an annual winter crisis.

Patient safety is being put at risk in Emergency Departments due to missed doses of vital prescription medicines. This is one of the findings of a study being carried out by the Royal College of Emergency Medicine (RCEM) which revealed that many patients who rely on prescription medication to manage chronic conditions such as diabetes and Parkinson’s, aren’t always getting these vital drugs when in A&E. These types of drugs are known as ‘time critical medication’ (TCM) and, as the name suggests, it is important they are taken at specific times. If a dose is delayed or missed, it can cause a person’s health to worsen. And if this delay is prolonged, the consequences can be severe. The RCEM’s new report – Time Critical Medication QIP 2023-24 is part of the College’s clinical Quality Improvement Programme  (QIP), which aims to improve the care of patients attending Emergency Departments. The three-year QIP examines how time critical medications are dealt with in practice when patients come to the Emergency Department and how clinical methods and patient safety can be improved. This report reflects the findings of the first year of the programme. Across the UK, 136 Emergency Departments collated and analysed data for people living with diabetes and Parkinson’s, who take certain medication such as insulin injections and a drug called levodopa, taken as tablets or capsules. Supported by Parkinson’s UK and Diabetes UK, the QIP found more than half of eligible patients (53.4%) taking TCM weren’t identified within 30 minutes of their arrival in ED. Meanwhile, around 68% of eligible patients’ doses weren’t administered within 30 minutes of the expected time. In response to the findings, the QIP team made the following recommendations: Patients on TCM need to be identified early to start the process of getting all doses whilst in the ED. Systems need to be in place that will facilitate the timely administration of TCM, including self-administration. Local EDs must have a clear governance structure in place to determine who is responsible for the prescribing and administering of TCM in the ED from when the patient arrives, to when they are admitted to the ward or discharged from the ED. Further reading on the hub: Time-critical Parkinson’s medication: the human cost of delays and mistakes HSSIB investigation report: Medication not given: administration of time critical medication in the emergency department Parkinson's UK: Time critical medication guides for health professionals Improving safety for diabetic inpatients: 4 key steps D1abasics: Equipping staff to care safely for inpatients with diabetes

The Nuffield Trust and The King’s Fund join forces each year to analyse and present findings from the gold-standard survey of public attitudes and opinions towards the NHS and social care, as surveyed by NatCen. The 2024 survey results show that the British public are deeply unhappy with the way the NHS runs – just 1 in 5 people said they were satisfied. Key findings Satisfaction with the NHS In 2024, just one in five British adults (21%) were ‘very’ or ‘quite’ satisfied with the way in which the NHS runs. This is the lowest level of satisfaction recorded since the survey began in 1983 and shows a steep decline of 39 percentage points since 2019. Only 2% of respondents were ‘very’ satisfied with the NHS, down from 4% in 2023. The percentage of people who were ‘very’ or ‘quite’ dissatisfied with the NHS rose to 59% in 2024, from 52% in 2023. This represents a statistically significant 7-percentage-point increase from the year before, which already had the highest dissatisfaction seen in 40 years of the British Social Attitudes survey. A higher proportion of people in Wales (72%) were dissatisfied with the NHS compared to the survey average and compared to people in England (59%). Supporters of the Reform party were less likely to be satisfied (13%) than the survey average and this was significant after controlling for other variables like age and income. There is a divide between generations, with satisfaction lower and falling in younger age groups. While the proportion of people who were satisfied rose slightly for those aged 65 and over, from 25% to 27%, among those under 65 it fell significantly, from 24% to 19%. Satisfaction with social care In 2024, only 13% of respondents said they were ‘very’ or ‘quite’ satisfied with social care (the same figure as 2023). 53% of respondents were ‘very’ or ‘quite’ dissatisfied. Respondents in Wales (69%) were again significantly more likely to be dissatisfied than the survey average. Satisfaction with different NHS services Public satisfaction with A&E services has fallen sharply, from 31% to just 19%, and dissatisfaction has risen from 37% to 52%. These are the worst figures on record by a large margin and make A&E the service with lowest satisfaction levels for the first time. Satisfaction with NHS dentistry has continued to collapse. As recently as 2019 this was at 60%, but it has now fallen to a record low of 20%. Dissatisfaction levels (55%) are the highest for any specific NHS service asked about. Satisfaction with GP services continued to fall, mirroring the trend over the last few years. 31% of respondents said they were satisfied with GP services, compared with 34% in 2023. Inpatient and outpatient hospital care is the part of the NHS with the highest levels of satisfaction, with 32% saying they were satisfied and only 28% dissatisfied. Attitudes to standards of care, staffing and efficiency The majority of the public (51%) said they were satisfied with the quality of NHS care. People aged 65 and over were more likely to be satisfied (68%) with the quality of NHS care than those under 65 (47%). Dissatisfaction with waiting times and the ability to get an appointment is widespread, and is consistent across respondents from all ages and UK countries: 62% of all respondents were dissatisfied with the time it takes to get a GP appointment. 23% were satisfied. 65% of respondents said they were dissatisfied with the length of time it takes to get hospital care. 14% said they were satisfied. Dissatisfaction levels are highest regarding the length of time it takes to be seen in A&E. 69% of respondents said they were dissatisfied, while just 12% said they were satisfied. Only 11% agreed that ‘there are enough staff in the NHS these days’. 72% disagreed. NHS funding, principles and priorities 8% of respondents said that the government spent too much or far too much money on the NHS; 21% said that it spent about the right amount, and 69% said that it spent too little or far too little. When asked about government choices on tax and spending on the NHS, the public would narrowly choose increasing taxes and raising NHS spend (46%) over keeping them the same (41%). Only 8% would prefer tax reductions and lower NHS spending. Only 14% of respondents agreed that ‘the NHS spends the money it has efficiently’. 51% disagreed with this statement. Respondents felt the most important priorities for the NHS should be making it easier to get a GP appointment (51%) and improving A&E waiting times (49%), with increases in staff (48%) and better hospital waiting times close behind (also 48%). A&E has now slightly overtaken staffing as a priority, reflecting the sharp fall in satisfaction described above. People under 65 were more likely to prioritise improving mental health services (34%) than those aged 65 and over (21%). As in previous years, a strong majority of respondents agreed that the founding principles of the NHS should ‘definitely’ or ‘probably’ apply in 2024: that the NHS should be free of charge when you need to use it (90%); the NHS should primarily be funded through taxes (80%); and the NHS should be available to everyone (77%). The percentage of people saying that the NHS should ‘definitely’ be available to everyone decreased from 67% in 2023 to 56% in 2024. This is the only statistically significant change year-on-year across all three principles. Supporters of the Reform party (20%) were significantly less likely to say that the NHS should ‘definitely’ be available to everyone than the survey average.