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10th 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

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

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

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

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

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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

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

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.

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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)
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

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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,
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

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