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63-527: The Royal College of Emergency Medicine ( RCEM ) is an independent professional association of emergency physicians in the United Kingdom which sets standards of training and administers examinations for emergency medicine . The patron is the Princess Royal . The College in its current form was incorporated by royal charter in 2008. However, the history of its preceding organisations,

126-778: A different approach to some areas of care, such as becoming the first nation in the UK to have a single waiting times target for cancer treatment. The Welsh NHS has broadly under-performed compared to the English NHS, with higher waiting times for both urgent and routine care. However a Full Fact report by the Chief Executive of the Nuffield Trust Nigel Edwards acknowledges that the two nations targets are not directly comparable because "the Welsh population

189-649: A joint programme from the Nuffield Trust and the Health Foundation , tracked 41 million visits to A&E departments in England in order to better understand the pressures leading to increased waiting times and breaches of the four-hour target. Researchers identified a rise in older patients and related increase in long-term conditions as key factors, alongside extremes of temperature (in both summer and winter) and crowding at peak times. They noted that

252-457: A learned occupation who are entrusted with maintaining control or oversight of the legitimate practice of the occupation;" also a body acting "to safeguard the public interest;" organizations which "represent the interest of the professional practitioners," and so "act to maintain their own privileged and powerful position as a controlling body." Professional associations are ill defined although often have commonality in purpose and activities. In

315-491: A limit in terms of what can be achieved within the available resources. The announcement of the reduction of the target from 98% to 95% was immediately followed by a reduction in attainment to the lower level. By December 2014, the number of patients being treated within four hours had fallen to 91.8%. From December 2015, the 95% target over England as a whole was missed every month. From October–December 2016, only 4 out of 139 hospitals with major type 1 A&E departments met

378-478: A mental health inpatient bed to become available. When time was measured from time of arrival in the department to admission to a ward the figures of people waiting more than 12 hours were about six times greater than the nationally published figures which in July reached 29,317. The Welsh NHS sets a measure of patients waiting more than 12 hours to be treated, transferred, and discharged by A&E. In January 2019,

441-611: A possible 12-hour extension. In December 2019 trusts in London were told to set up dedicated spaces to care for three mental health patients in every A&E department. In December 2019 there were 2,347 breaches, compared with 284 recorded in December 2018. In February 2022 there were 16,404 breaches and in March 2022 22,506. The NHS Standard Contract for 2022-23 requires hospitals to count 12-hour waits from time of patients’ arrival in

504-652: A procedure had waited 18 weeks or more. By March 2018 there were 2,647. The largest numbers were at Northern Lincolnshire and Goole Hospitals NHS Foundation Trust , Imperial College Healthcare NHS Trust , King's College Hospital NHS Foundation Trust , Royal Cornwall Hospitals NHS Trust and East Kent Hospitals University NHS Foundation Trust . 2,432 patients had waited longer than a year in November 2018. In January 2019 NHS England announced that in future both providers and commissioners would be fined £2,500 for each such patient. In February 2022 299,478 patients had been on

567-443: A profession or group of professions and protect the use of professional titles" and professional bodies that "are independent membership organisations that oversee the activities of a particular profession and represent the interests of [their] members" and which "may offer registration or certification of unregulated occupations on a voluntary basis." Many professional bodies are involved in accrediting degrees, defining and examining

630-673: A remedy should they be breached. Non-acute crisis response waiting time targets are to be introduced by NHS England for integrated care systems from April 2022. Performance is to be measured on the percentage of services delivered within two hours. Mental health targets are also planned, although no start date has been set, requiring require that urgent referrals to community crisis services should be seen within 24 hours, and “very urgent” referrals should be seen within four hours. Mental health patients referred from emergency departments should be seen face-to-face by liaison teams within one hour. The Patient Rights (Scotland) Act 2011 establishes

693-451: A report saying that the NHS needed at least 5,000 more beds to achieve safe bed occupancy levels and hit the four-hour target in emergency departments . The College sets standards of training and administers examinations for emergency physicians. It also organises annual scientific meetings, as well as continuing professional development meetings for its members. In November 2021 it produced

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756-737: A report showing that pressures from the COVID-19 pandemic in the United Kingdom had produced more than 4,500 excess deaths in 2020-21 as a result of crowding or 12-hour stays in emergency departments. The College sets the qualification awarded by examination that lead to a Certificate of Completion of Training in emergency medicine training in the United Kingdom - the Fellowship of the Royal College of Emergency Medicine (FRCEM). Doctors who complete this training program may sit

819-567: A target at the expense of another. For example, ambulances have been forced to queue up outside a busy emergency departments so that the ambulances might not be able to meet their target in responding to emergency calls, but the hospital can meet its A&E target. Excess emphasis on the targets can mean that other important aspects of care, especially those not easily measured, may be neglected. Some have however praised targets for producing faster reductions in waiting times in England than other UK countries between 1996 and 2006. NHS England under

882-449: A target that, by 2004, at least 98% of patients attending an A&E department must be seen, treated, and admitted or discharged in under four hours. The target was further moved to 95% of patients within four hours in 2010 as a result of the coalition's claims that 98% was not clinically justified. Trusts which failed to meet the target could be fined. In July 2016 NHS trusts were set new "performance improvement trajectories". For 47 of

945-480: Is a group that usually seeks to further a particular profession , the interests of individuals and organisations engaged in that profession, and the public interest . In the United States, such an association is typically a nonprofit business league for tax purposes. In the UK, they may take a variety of legal forms. The roles of professional associations have been variously defined: "A group of people in

1008-638: Is around eight hours. In January 2022 research published in the Emergency Medicine Journal found that there was one extra death For every 82 admitted patients whose time to inpatient bed transfer is delayed more than 6 to 8 hours from time of arrival at the emergency department. In May 2021, after prolonged consultation NHS England announced that the 4 hour target was to be replaced by a new set of 10 metrics. The new “bundle of ten standards” includes In September 2022 Thérèse Coffey said: “I can absolutely say there will be no changes to

1071-422: Is by setting a clear target". 48% of departments said they did not meet the target for the period ending 31 December 2004. Government figures show that in 2005–06, 98.2% of patients were seen, diagnosed and treated within four hours of their arrival at A&E, the first full financial year in which this has happened. The four-hour target triggered the introduction of the acute assessment unit (also known as

1134-526: Is doubtful that a single target (fitting all A&E and related services) is sustainable. Although the four-hour target helped to bring down waiting times when it was first introduced, since September 2012 (after the introduction of the Health and Social Care Act 2012 and top-down reorganisation of the NHS) hospitals in England struggled to stick to it, prompting suggestions that A&E departments may be reaching

1197-544: Is monitored. As of January 2020 25,549 patients (5.5%) had been waiting more than nine months to receive treatment. 445,360 in England had been waiting six months or more by the end of December 2017 - three times more than in 2013. The President of the Royal College of Surgeons said it was “completely shameful” that patients were being forced to resort to paying for operations the NHS should provide as these waiting times led to an increase of 53% between 2012 and 2016 in

1260-627: Is not initially suspected, should be seen by a specialist within two weeks. Only 77.5% of patients referred for breast symptoms between April and June 2019 were seen within 2 weeks. Only 38% of hospitals met the target in 2019 and 22.5% of people waited longer than two months for their first treatment. In February 2022 10.7% of patients treated waited more than 104 days. Over four million patients were waiting for non urgent hospital care as of July 2017. The Royal College of Surgeons together with other medical groups fear patients are waiting longer in anxiety and pain for hospital procedures. The target

1323-656: Is older, sicker and more deprived than the English population—so its NHS has to work harder". A four-hour target in emergency departments was introduced by the Department of Health for National Health Service acute hospitals in England . The original target was set at 100%, but lowered to reflect clinical concerns that there will always be patients who need to spend slightly longer in A&;E, under observation. Setting

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1386-611: Is required, was introduced. In England time was measured from the point a decision to admit is made and not from the moment the patient arrives. Between January and March 2012 only 15 patients in England waited more than 12 hours, but in the same months in 2017 1,597 patients breached the target. In January 2018 1,043 patients waited over 12 hours for a bed, the worst figure ever recorded. 272 were at University Hospitals of North Midlands NHS Trust . Problems at Lancashire Care NHS Foundation Trust led to more than 1,000 cases of patients waiting over 12 hours for admission in 2018–19. This

1449-512: Is the lowest figure since December 2015 and was below the Welsh Government's 95% target. Between January and March 2018 25,475 operations were cancelled at the last minute for non-clinical reasons by NHS providers - 20% more than the first quarter of 2017, and the highest number since records began in 1994–95. This was 1.3% of all elective activity - the highest proportion recorded since 2004–05. The 2019 NHS Long Term Plan proposed

1512-596: The American , Canadian and Australasian colleges. The BAEM was renamed once more in 2004 to the British Association for Emergency Medicine , retaining the same initials. The intercollegiate Faculty of Accident and Emergency Medicine ( FAEM ) was inaugurated on 2 November 1993 with six parent colleges: the Royal College of Surgeons , the Royal College of Physicians , the Royal College of Physicians of Edinburgh , Royal College of Surgeons of Edinburgh ,

1575-563: The Health and Social Care Board and are less demanding than in the rest of the UK. None have been met since 2015, and some for considerably longer. A&E waits when considered using the NHS measure of 4 hours to discharge show that performance in Northern Ireland has dropped 13% between May 2018 and September 2019. According to the BMA the main reasons for not reaching this target are: In 2014, research conducted by QualityWatch ,

1638-487: The NHS in the 1990s – for example, guaranteeing a maximum two-year wait for non-emergency surgery and reducing rates of death from specific diseases. The subsequent Labour government introduced far more targets and managed performance far more aggressively - a management regime sometimes referred to as 'targets and terror'. Targets were blamed for distorting clinical priorities, and in particular for one organisation achieving

1701-712: The Royal College of Physicians and Surgeons of Glasgow , and the Royal College of Anaesthetists . It was tasked with developing academic and training issues, whilst the BAEM had responsibility for professional and clinical matters. In late 2005, FAEM reached agreement with BAEM for the two organizations to merge to form a new medical royal college. The faculty was renamed the College of Emergency Medicine ( CEM ) as of 1 January 2006, becoming independent of its parent colleges. It relocated to Churchill House in London (the headquarters of

1764-521: The UK the Science Council defines a professional body as "an organisation with individual members practicing a profession or occupation in which the organisation maintains an oversight of the knowledge, skills, conduct and practice of that profession or occupation". The Quality Assurance Agency distinguishes between statutory bodies and regulators that "have powers mandated by Parliament to regulate

1827-653: The "Royal" title, as the Membership of the Royal College of Emergency Medicine (MRCEM), and the higher Fellowship of the Royal College of Emergency Medicine (FRCEM). In August 2016 further changes to the curriculum led to the merging of the examinations into a new FRCEM exam, split into three parts: the FRCEM Primary Examination, FRCEM Intermediate Certificate, and the FRCEM Final Examination. Further revisions in July 2021 saw

1890-400: The 140 trusts with "type one" major A&E facilities this meant a target of less than 95% waiting under 4 hours. In January 2017 Jeremy Hunt announced that the target would in future only apply to "urgent health problems". In January 2018 only 77.1% of patients were admitted or discharged within four hours, the worst ever performance for type one A&E departments. In December 2018 it

1953-563: The Conservative governments reduced the number of targets, in particular removing most of those relating to health inequality, and encouraged a system wide approach. However shortage of staff and funding meant that performance against targets nonetheless declined. Guidance published in February 2018 conceded that most of the targets would not be met before April 2019. The hospital care and A&E performance measures for October 2019 were

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2016-532: The Emergency Department to the time they are admitted to a ward. Measured in this way February and March 2022 show around one in five admissions through ED waited more than 12 hours from arriving until being admitted to a ward – equating to around 158,000 cases, 22% of attendances. Problems were particularly severe for people with mental health problems, with many examples of mental health patients waiting up to three days in emergency departments for

2079-658: The FCEM examination, and on completion become a Fellow of the College and may be recommended by the College for a Certificate of Completion of Training in emergency medicine. The first sitting of the College's examination was the Fellowship of the Faculty of Accident and Emergency Medicine (FFAEM) examination, equivalent to the current Final FRCEM, was in October 1996. In 2003 the College introduced an introductory examination, now

2142-660: The Faculty of Accident and Emergency Medicine and the British Association for Emergency Medicine, date back to 1993 and 1967 respectively. Traditionally in British hospital practice, "casualty departments" were staffed and led mainly by non- consultant doctors with surgical backgrounds. The first UK doctor to be designated as a "Consultant Surgeon in Charge of the Casualty Department and Receiving Room"

2205-409: The Royal College of Anaesthetists, where BAEM was also based) on 29 August 2006. CEM and BAEM formally merged in February 2008, with the new organisation continuing under the name of "College of Emergency Medicine", but incorporated by a royal charter giving it its own legal status. In February 2012 the College moved to newly purchased headquarters at 7-9 Bream's Buildings in London. Dr Clifford Mann

2268-577: The United Kingdom. However performance against the target declined almost 10% between May 2018 and September 2019. In March 2022 average waits for an ambulance for stroke and heart attack patients (category 2) reached as long as two hours in some regions. The national target for reaching them is 18 minutes. According to the Association of Ambulance Chief Executives more than 3,000 patients may have suffered “severe harm” from ambulance delays in February 2022. In June 2022 ambulance response times for

2331-599: The Welsh NHS has recorded a record 6,882 patients waiting more than 12 hours in A&E, and Morriston Hospital in Swansea represented 15% of all A&E patients waiting more than 12 hours. The Welsh NHS Confederation responded to the figure by stating its disappointment but acknowledging numbers of patients attending with complex needs were increasing in Wales. Ambulance response times however improved and hit their target for

2394-562: The exams being separated out again; the FRCEM Primary and FRCEM Intermediate qualifications were depreciated and replaced with the MRCEM primary and MRCEM intermediate SBA examinations (which in the interim had continued as a qualification for doctors not in formal training programmes). Professional association A professional association (also called a professional body , professional organization , or professional society )

2457-615: The first UK specialty exam in emergency medicine held in 1983 under the auspices of the CSA. The CSA adopted the British Accident & Emergency Medicine Journal and Archives of Emergency Medicine as its journals in 1985. The CSA changed its name to the British Association for Accident and Emergency Medicine ( BAEM ) in 1990. It helped found the International Federation for Emergency Medicine in 1991 along with

2520-450: The first time since October. All across the UK the target is that patients should be treated within 62 days of an urgent referral, but the way this is measured varies. In Northern Ireland the target has not been met since 2015. The Welsh Government in 2019 became the first nation in the UK to have a single waiting times target for cancer treatment. In England 93% of patients referred for investigation of breast symptoms, even if cancer

2583-453: The four UK nations, a position it has held since September 2015. However like all other UK nations this performance has recently declined. In Scotland this target has dropped 5% between May 2018 and September 2019. In England, the target is also for 95% of A&E patients to be treated, transferred, and discharged within four hours. However performance has fluctuated between 90 and 84% between 2015 and 2019, consistently putting it second in

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2646-470: The list for over 52 weeks. Of those 23,281 had been waiting more than 2 years. In Northern Ireland more than a third of patients, 94,222 people, had waited more than a year for their first appointment in October 2018. According to the Royal College of Surgeons in Ireland the 52-week target had "not been completely achieved in over 11 years". In Wales a year target is not measured but a nine month target

2709-452: The majority of pressure was falling on major A&E units, and proposed that rising demand as a result of ageing and population growth may be pushing already stretched emergency departments beyond maximum capacity. In July 2017 the Royal College of Emergency Medicine produced a report saying that the NHS needed at least 5,000 more beds to achieve safe bed occupancy levels and hit the four-hour target. Even though exceptions are allowed to

2772-459: The medical assessment unit), which works alongside the emergency department but is outside it for statistical purposes in the bed management cycle. It is claimed that though A&E targets have resulted in significant improvements in completion times, the current target would not have been possible without some form of patient re-designation or re-labelling taking place, so true improvements are somewhat less than headline figures might suggest and it

2835-653: The most serious category one incidents, including cardiac arrests, sank to an average of 9 minutes and 6 seconds, half a minute slower than in May. The target time is 7 minutes. Maria Caulfield told the House of Commons on 10 July 2022 that ambulance service response time performance had improved month on month, but in fact it had deteriorated in June. In Wales, the target is also for 95% of A&E patients to be treated, transferred, and discharged within four hours. While higher than

2898-770: The numbers paying personally for private operations. In July 2021 it was reported that there was a 46% increase in patients waiting more than 104 weeks for treatment, from 2,597 to 3,802 from April to May. There were 5.45 million people waiting for hospital treatment in England in JUne 2021 with very large differences in the numbers waiting in different areas, with 25 times more patients waiting for heart operations in Birmingham and Solihull than in West Lancashire. In Wales, as of January 2020 83.5% of patients were waiting less than six months to start hospital treatment. This

2961-510: The performance in Northern Ireland (60%), the Welsh NHS is third in the United Kingdom, putting it 7 percent behind NHS England and 8% behind NHS Scotland. The Nuffield Trust have identified Welsh underperformance as influenced by the Welsh population being older, sicker and having more deprivation than any other UK nation. Performance against the target has like all other UK nations in recent years, having declined by 7.5% between May 2018 and September 2019. Targets in Northern Ireland are set by

3024-465: The preferred route of entry to specialist registrar training, the Membership of the Faculty of A&E Medicine (MFAEM). Both examinations were renamed in 2006, as part of the creation of the College, as Fellowship of the College of Emergency Medicine (FCEM) and Membership of the College of Emergency Medicine (MCEM) respectively. Their titles were further updated in 2015 when the college gained

3087-529: The skills and competencies necessary to practice, and granting professional certifications to indicate that a person is qualified in the subject area. Many professional bodies also act as learned societies for the academic disciplines underlying their professions, such as the American Statistical Association . Four-hour target in emergency departments The Major Conservative government first set public targets for

3150-536: The target and across England the average wait was around 23 weeks. The clinical commissioning group joint committee for mid and south Essex in December 2019 reported that local hospitals were “now working” to a 40-week referral to treatment target. In December 2017 there were 1,750 patients waiting a year or more, the highest total since August 2012. 242 were at Imperial College Healthcare NHS Trust , 156 at Mid Essex Hospital Services NHS Trust and 114 at Royal Cornwall Hospitals NHS Trust . 11.8% of those waiting for

3213-438: The target and missing the point". But they are alluring to politicians. Hunt says the effectiveness of targets is in inverse proportion to their quantity and points out that no other country runs its healthcare system by targets. Goodhart's law applies: "When a measure becomes a target, it ceases to be a good measure". The NHS Constitution for England specifies waiting times in the accompanying Handbook, but does not provide

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3276-499: The target for four-hour waits in A&E.” The Labour government (1997-2010) had identified a requirement to promote improvements in A&E departments, which had suffered under-funding for a number of years. The target, accompanied by extra financial support, was a key plan to achieve the improvements. Prime Minister Blair felt the targets had been successful in achieving their aim. "We feel, and maybe we are wrong, that one way we've managed to do that promote improvements in A&E

3339-700: The target. In November 2018, the British Medical Association reported that performance on emergency admissions, trolley waits for more than four hours and A&E patients seen within four hours in the summer of 2017 was worse than in the winters of 2011–15. Performance against the four-hour wait target in the summer of 2018 was the worst second quarter performance recorded. Only 88.9% of patients were seen within four hours in September. The number of people admitted, transferred or discharged within four hours in emergency departments in September

3402-408: The targets, concerns have been raised that the target has put pressure on A&E staff to compromise patient care. A significant proportion (90%) of A&E consultants welcomed the four hour target in a study but felt that 98% was too high a target. At the same time as the four target was introduced a target that no patient should wait longer than 12 hours before they are admitted to a ward, if that

3465-495: The treatment time guarantee, but also does not specify a remedy should it not be met. Targets in Northern Ireland are set by the Health and Social Care Board and are less demanding than in the rest of the UK. None have been met since 2015, and some for considerably longer. Targets in Wales are set by the Welsh Government and set out in the NHS Wales Delivery Framework. The Welsh Government has taken

3528-498: The worst ever recorded. Sajid Javid called for a ‘proper review of NHS targets’ in September 2021. According to Jeremy Hunt the Stafford Hospital scandal showed that concentrating on national targets led to managers deprioritising the safety and well-being of patients. Targets can benefit patients but they can also lead to bureaucracy, gaming and poor patient care, or as David Nicholson famously put it - "hitting

3591-442: The worst figure since the target was introduced in 2004. In November 2019 not a single A&E department hit the four-hour wait time target. Performance in the first three months of 2019-20 was the worst since records began in 2011. In Scotland, the target is for 95% of A&E patients to be either admitted, transferred or discharged in four hours. It was last met in July 2017. Scotland has performed best on this measure out of

3654-555: Was Maurice Ellis , who was appointed at Leeds General Infirmary in 1952. Another 15 years passed before a distinct professional body came into being; Ellis became the head of the Casualty Surgeons Association ( CSA ) which first met on 12 October 1967 at BMA House (a year before the equivalent American College of Emergency Physicians in the United States). The field developed over the years, with

3717-632: Was about a third of all the 12 hour breaches, which were mostly mental health cases - where admission to a ward is not within the control of the trust running the A&E department. A review found that some patients in Lancashire were “potentially being held against their will without appropriate legal provision”. Some were detained in seclusion rooms for more than a week under section 136 of the Mental Health Act 1983 , which only provides that patients can be lawfully detained for 24 hours, with

3780-516: Was president of the College 2013–2016, and was an outspoken critic of the Coalition government 's Health and Social Care Act 2012 which he blamed both for causing "decision-making paralysis" and leaving the country short of around 375 emergency doctors. The college was granted permission to use the "Royal" title in January 2015, giving rise to its current name. In July 2017 the college produced

3843-409: Was reported that patients with only minor ailments could be excluded from the target and a new target introduced so the most urgent cases should be seen within an hour. The effect of the target can be that patients waiting just below 4 hours get a lot of attention, but once the target is breached there is no further consequence. The average time spent by a patient in A&E who has breached four hours

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3906-423: Was that 90% of patients admitted to hospital for treatment and 95% of those not admitted should receive consultant-led care within 18 weeks unless it is clinically appropriate not to do so, or they choose to wait. The proportion of people waiting more than the six week target for diagnostic tests was at its highest since records began in September 2018. By August 2019 less than 49% of hospital services were achieving

3969-463: Was up more than 3% compared to September 2017 with a 7% rise in emergency admissions said by John Appleby to be astonishing. Attendance at A&E departments has been increasingly steadily for many years, more so at ‘type 3’ departments, like urgent care centres (where waiting times are generally lower). In the first eight months of 2018, an average of 67,000 people attended each day. In January 2019, only 84.4% of patients were seen within four hours,

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