The Royal College of Emergency Medicine

A Message from Lord Pickles and Lord Blunkett, followed by The Royal College of Emergency Medicine's best practice article

The ability to listen and learn from one another has always been vital in parliament, in business and in most aspects of daily life. But at this particular moment in time, as national and global events continue to reiterate, it is uncommonly crucial that we forge new channels of communication and reinforce existing ones. The following article from The Royal College of Emergency Medicine is an attempt to do just that. We would welcome your thoughts on this or any other Parliamentary Review article.

Blunkett signature Rt Hon The Lord David Blunkett
Pickles signature Rt Hon The Lord Eric Pickles

Chief Executive Gordon Miles
The emergency department’s role
is to stabilise patients quickly and
transfer them to wards
The Royal College of Emergency Medicine is the single
authoritative body that speaks for the medical specialty
of emergency medicine in the UK and around the world.
It works to ensure high-quality care for patients by setting
and monitoring standards of care in emergency departments,
as well as providing expert guidance and advice on policy to
relevant bodies on matters relating to emergency medicine. Chief
Executive Gordon Miles explains the formation of the college
and their belief in the importance of the four-hour standard for
emergency care.
Headquartered in London, we aim to advance education and research in
emergency medicine. We are responsible for setting standards for training and
administering examinations for the award of fellowship and membership of our
college, as well as recommending trainees to the General Medical Council for their
Certificate of Completion of Training in Emergency Medicine.
Established in 2008 by Royal Charter, we were granted the title “Royal” in February
2015, having previously beingknown as The College of Emergency Medicine. We
are a relative newcomer in the medical college field and have grown rapidly in the
past 10 years. We now number over 7,500 fellows and members working in the UK
and internationally. We work to represent both the medical specialty of emergency
medicine and the interests of patients.
»Chief Executive: Gordon Miles
»President: Dr Taj Hassan
»Established in 2008
»Based in London
»Services: Expert advice,
guidance, examinations and
standard-setting in emergency
»No. of employees: 44
»No. of members and fellows:
The Royal College of
Emergency Medicine
Highlighting best practice
What is emergency medicine?
Emergency medicine is defined by the
International Federation for Emergency
Medicine as “a field of practice based on
the knowledge and skills required for the
prevention, diagnosis and management
of acute and urgent aspects of illness
and injury, affecting patients of all
age groups with a full spectrum of
undifferentiated physical and behavioural
disorders. It further encompasses an
understanding of the development of
pre-hospital and in-hospital emergency
medical systems and the skills
necessary for this development.”
This specialty was formed just over
50 years ago in the UK, when nine
emergency physicians formed our
predecessor organisation. From these
humble beginnings in Leeds in 1967,
this medical specialty has flourished
around the world.
Increasing pressure on NHS
emergency departments
The field is fast-growing and dynamic.
The pressures faced by NHS emergency
departments are significant, and
demand has risen over time. Despite
this growth, a similar percentage
of the population are visiting
emergency departments each year
as they always have. In essence, the
pressures are twofold: a growing and
ageing population. This latter aspect
affects the type of patient arriving at
emergency departments, as treating
the frail elderly, who often have
complex co-morbidities, is a significant
part of the work.
Readers will be no strangers to
headlines about NHS emergency
departments struggling to see, treat or
discharge patients within four hours of
their arrival. Over time, performance
has reduced, reflecting the pressures
experienced. Given this, it is natural for
policymakers to look for alternatives,
and great efforts are often made
to find ways of preventing patients
coming in. This is often misguided
and tries to tackle the wrong end of
Hospitals are operating at
close to full capacity
Patients come to emergency
departments because they need
treatment or are worried that they
have symptoms that may need urgent
attention. Signposting alternatives
for those who have minor conditions
is one thing, but the real demand
and pressure come from those with
complex medical needs. Dealing
with patients with trivial complaints
relatively quickly is not the issue; it
is those who are very ill or injured
and need hospital beds who are the
This is one of the key challenges.
The emergency department’s role
Patients come because
they need treatment or
are worried they have
symptoms that need
urgent attention
Emergency medicine
focuses on the diagnosis
and management of
acute and urgent illness
and injury
From these
beginnings in
Leeds in 1967,
this medical
specialty has
around the
is to stabilise patients quickly and
then transfer them into the hospital
wards. Due to the fact that hospitals
are operating at close to full capacity,
whereas guidance from the National
Audit Office states that 85 per cent
bed capacity is the maximum, queues
form and emergency departments
often have to hold patients on trolleys,
providing “corridor medicine”. This
is known as “exit block”, where the
exit from the emergency department
is blocked due to inadequate hospital
bed capacity. There is pressure across
the system, and insufficient social care
capacity slows down the release of
patients from hospital, which only adds
to this pressure.
To try to combat this, we are
working with the NHS to expand
the workforce. It takes time to train
emergency physicians and advanced
care practitioners, but that work is
underway. It will actually be paid for by
savings from the spending on locum
or temporary staffing. The pressure
will remain while that training takes
place, but the funding settlement on
the NHS will start to help in 2019.
To make further progress to improve
patient flow through the system, we
are calling for an increase in acute
beds by 5,000 and more resources for
social care.
Protecting the four-hour
We are concerned that the relentless
pressure on the system might
cause some to question whether to
abandon the four-hour standard.
Our view is clear: patient care must
be maintained, and the system must
focus on the quality of that care.
Emergency physicians remember the
very difficult situation that preceded
the introduction of this standard, when
public opinion was of the view that
the queues of patients in emergency
departments were unacceptable. We
do not want to see a return to that.
There are opportunities to do more to
develop ambulatory care, create more
medical assessment units and help
patients to better understand where
best to attend. In recent years, the
development of major trauma centres
has had a beneficial effect.
My views chime with those set out in
our document
Making the Case for
the Four-Hour Standard
, which argues:
“The Royal College of Emergency
Medicine takes the view that it would
be a mistake to conclude that a high
degree of compliance with the four-
hour standard is not possible. On
the contrary, the available evidence
suggests that with the right level
of investment, these targets remain
valid practical objectives that improve
patient care”.
I trust that in the search to be let off
the hook, decision-makers at the top
of the NHS and government don’t give
up on a measure that studies have
shown reduces patient mortality.
Our view is
clear: patient
care must be
maintained, and
the system must
focus on the
quality of that
Those who are seriously
ill or injured and need
hospital beds are the
main concern

This article was sponsored by The Royal College of Emergency Medicine. The Parliamentary Review is wholly funded by the representatives who write for it. The publication in which this article originally appeared contained the following foreword from The Rt Hon Theresa May MP.

The Rt Hon Theresa May MP's Foreword For The Parliamentary Review

By The Rt Hon Theresa May MP

This foreword from the then Prime Minister appeared in the 2018/19 Parliamentary Review.

British politics provides ample material for analysis in the pages of The Parliamentary Review. For Her Majesty’s Government, our task in the year ahead is clear: to achieve the best Brexit deal for Britain and to carry on our work to build a more prosperous and united country – one that truly works for everyone. 

The right Brexit deal will not be sufficient on its own to secure a more prosperous future for Britain. We also need to ensure that our economy is ready for what tomorrow will bring. Our Modern Industrial Strategy is our plan to do that. It means Government stepping up to secure the foundations of our productivity: providing an education system that delivers the skills our economy needs, improving school standards and transforming technical education; delivering infrastructure for growth; ensuring people have the homes they need in the places they want to live. It is all about taking action for the long-term that will pay dividends in the future.

But it also goes beyond that. Government, the private sector and academia working together as strategic partners achieve far more than we could separately. That is why we have set an ambitious goal of lifting UK public and private research and development investment to 2.4 per cent of GDP by 2027. It is why we are developing four Grand Challenges, the big drivers of social and economic change in the world today: harnessing artificial intelligence and the data revolution; leading in changes to the future of mobility; meeting the challenges of our ageing society; and driving ahead the revolution in clean growth. By focusing our efforts on making the most of these areas of enormous potential, we can develop new exports, grow new industries and create more good jobs in every part of our country.

Years of hard work and sacrifice from the British people have got our deficit down by over three quarters. We are building on this success by taking a balanced approach to public spending. We are continuing to deal with our debts, so that our economy can remain strong and we can protect people’s jobs, and at the same time we are investing in vital public services, like our NHS. We have set out plans to increase NHS funding annually by an average by 3.4 percent in real terms: that is £394 million a week more. In return, the NHS will produce a ten-year plan, led by doctors and nurses, to eliminate waste and improve patient care.

I believe that Britain can look to the future with confidence. We are leaving the EU and setting a new course for prosperity as a global trading nation. We have a Modern Industrial Strategy that is strengthening the foundations of our economy and helping us to seize the opportunities of the future. We are investing in the public services we all rely on and helping them to grow and improve. Building on our country’s great strengths – our world-class universities and researchers, our excellent services sector, our cutting edge manufacturers, our vibrant creative industries, our dedicated public servants – we can look towards a new decade that is ripe with possibility. The government I lead is doing all it can to make that brighter future a reality for everyone in our country. 

British politics provides ample material for analysis in the pages of The Parliamentary Review 
The Rt Hon Theresa May MP
Prime Minister