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Quality in the Emergency Department

The drive for quality - How to achieve safe, sustainable care in our Emergency Departments

Emergency care systems in the UK & Ireland are facing their biggest challenge in well over a decade as they aim to cope with unsustainable workloads and a lack of sufficient numbers of middle grade doctors and Consultants in Emergency Medicine to deliver consistent quality care. Both the Care Quality Commission and NHS England have recognised the scale of the crisis and the need for urgent action.

In this report, the first of its kind, The College calls for fundamental change in the way we design, fund and run our emergency care systems. Ten recommendations are made across 4 domains that must be considered and adopted by national policy makers, commissioners, clinicians and Trust Boards in order to return our systems to stability and help deliver the quality of care that our patients expect when they seek our help in an emergency. The principles within the recommendations apply to all countries within the UK though the commissioning arrangements will be different in each.

The report, based upon the results of a comprehensive survey of 131 Emergency Departments (EDs) in the UK between 2011 and 2012, recommends urgent action in a number of key areas of:

  • system redesign to manage workloads and decongest the ED
  • expansion and sustainable working practices for staff
  • a radical change to the way in which emergency care is funded
  • a better system to measure the success of improvement rather than 4hr system performance alone.

The authors state that all parts of the urgent and emergency care system need to participate and radical overhaul to the way work is recognised and funded is needed. Importantly, the medical workforce challenges facing EDs at present will only be properly addressed by creating safe and sustainable working patterns that meet appropriate standards, allow good training environments to prosper and are attractive to the trainees of the future.

Press release 14 May 2013 - Download

Full Report - Download

Summary - Download

Key Messages - Download

Media Comment on The drive for quality


BBC Breakfast News, 15th May

BBC News at 10, 15th May

Sky News, 15th May

Channel 4 News, 15th May


BBC, 15th May, ‘A&E must change or face collapse, NHS warned’

The Independent, 15th May ‘NHS warned over emergency care: hospital A&E units facing 'collapse'’

The Telegraph, 15th May ' A&E crisis: hospital casualty units under huge pressure, Jeremy Hunt admits,’

The Guardian, 15th May ‘Call for A&E overhaul amid rise in patient numbers – report’


Support for Drive for Quality

NHS Confederation statement on Drive for Quality 15th May 2013

NHS support plan launched to help hospital and A&E departments keep waiting times in check (9 May 2013)

NHS England has announced plans to to strengthen performance in urgent and emergency care are being put in place across the country to help hospital A&E departments meet demand and tackle waiting time pressures.

Read the A&E improvement plan and accompanying letter to staff.

NHS England has joined with the NHS Trust Development Authority (NTDA) and Monitor, which are responsible for provider regulation, to ensure coordinated action to ease the immediate pressures.

At the same time, a review will take place to understand the causes of problems, which differ around the country.