The Royal College of Emergency Medicine has responded to the publication of NHS England’s Model Emergency Department document, warning that while the new guidance has some usefulness, it is unlikely to have a “meaningful impact” on the longstanding issues of ED overcrowding and corridor care.
NHS England’s Model ED document sets out a detailed blueprint for the structure and organisation of an Emergency Department, including associated facilities such as Urgent Treatment Centres, Same Day Emergency Care units, and the newly renamed Extended Emergency Medicine Ambulatory Care services.
The RCEM acknowledges that the publication outlines key components of a modern ED and will have some practical utility for NHS organisations. However, it cautions that physical layout and process diagrams alone cannot address the systemic pressures driving overcrowding – particularly rising demand, insufficient bed capacity, delayed discharges and wider workforce shortages.
The College said that without a significant expansion of inpatient and community care capacity, EDs will continue to experience “dangerous” levels of crowding, resulting in patients waiting for hours in corridors or temporary holding areas.
The Model ED document includes:
- An overview of how patients should be assessed upon arrival
- Explanations of pathways through the department
- Descriptions of different clinical areas and what types of patients they support
- Operational expectations for emergency care, urgent care and ambulatory emergency services
RCEM recognised that standardised design principles may help improve consistency across departments, but stresses that ED overcrowding is primarily driven by exit block, not by problems within the ED itself. The College continued to warn that corridor care represents a patient safety risk and is a direct consequence of inadequate hospital flow. It argues that layout guidance does not address the root causes of why EDs are forced to use corridors as overflow spaces.
RCEM says meaningful improvement will require:
- More staffed hospital beds
- Improved social care capacity to reduce delayed discharges
- Investment in emergency care workforce recruitment and retention
- System‑wide action to reduce avoidable attendances and admissions
RCEM President, Dr Ian Higginson, said that:
“There is a lot to unpack in this publication from NHS England, which will have utility in helping organisations adopt a more standardised approach to the provision of emergency care facilities in England. This is a reasonable objective.
“At the same time, there is acceptance within the document that there may be a need for local variation at times, provided there are good reasons and that the quality of care is maintained.
“There is also a welcome acknowledgement around the problem of overcrowding, and that there is a need to adopt a “whole system” approach.
“However, in isolation this document is unlikely to have meaningful impact on reducing overcrowding given that it relates to only one piece of the jigsaw. Other pieces are missing and we look forward to seeing how the whole scene develops. The publication of the NHSE document relating to the first 72 hours is one example of how this picture needs to build up, and is welcome.
“Overcrowding and corridor care is ultimately driven by our inability to find beds for patients who need to be in hospital. This is because hospitals are full. Although it seems logical to start at the front door of hospitals, this is not really where the problem lies – we should be more concerned with how things are expected to look at the back door…”
In his response to the blueprint, Dr Higginson also outlined how the document will provoke a “useful discussion” about how things are done, whilst also helping to add some clarity around key issues. Whilst the RCEM did have significant concerns, Dr Higginson also said that they will be interested to follow how the intent of the document is turned into implementation.
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