Excess Deaths Linked to Long ED Waits Double in Five Years

The Royal College of Emergency Medicine reports that excess deaths linked to prolonged waits in emergency departments across the United Kingdom have more than doubled over the past five years, with new analysis indicating that delays in care contributed to over 1,000 preventable deaths in Northern Ireland alone during 2024.

According to data released by the Royal College of Emergency Medicine (RCEM), the number of excess deaths associated with extended emergency department (ED) waiting times rose from approximately 400 annually in 2019 to over 1,000 in 2024 across the UK, representing a 150% increase. The college attributes this rise to systemic pressures within the National Health Service, including chronic bed shortages, staffing gaps and delayed access to inpatient care, which result in patients spending excessive time in ED corridors or waiting areas.

Dr. Adrian Boyle, President of the Royal College of Emergency Medicine, stated in a press release accompanying the findings: “Every hour a patient spends waiting in an emergency department increases their risk of harm. We are now seeing clear evidence that prolonged waits are not just causing distress and discomfort — they are contributing to avoidable deaths, particularly among older adults and those with complex health needs.”

The analysis, which drew on hospital performance data, mortality statistics, and academic studies examining the relationship between ED crowding and patient outcomes, found that patients waiting more than six hours for admission to a ward faced significantly higher risks of deterioration, especially those presenting with sepsis, heart failure, or respiratory conditions. Older adults aged 75 and over were disproportionately affected, accounting for nearly 60% of the excess deaths linked to ED delays.

In Northern Ireland, where healthcare performance has been under particular scrutiny due to long-standing funding and infrastructure challenges, the RCEM estimated that over 1,000 excess deaths in 2024 were associated with ED waits exceeding national targets. The region’s average ED waiting time for admission surpassed 12 hours in multiple trusts during winter months, far exceeding the NHS England target of 95% of patients being admitted, transferred, or discharged within four hours.

Public health experts note that while correlation does not automatically imply causation, multiple peer-reviewed studies have established a plausible biological and clinical mechanism linking ED overcrowding to increased mortality. A 2023 study published in The BMJ found that each additional hour of delay in ED admission was associated with a 1% increase in in-hospital mortality, with risks rising sharply after six hours. Similar findings have been replicated in studies from Canada, Australia, and the United States, reinforcing concerns about the global implications of emergency department strain.

The UK’s National Health Service has faced sustained pressure in recent years, with winter 2023–2024 recording some of the highest ED attendance figures on record. According to NHS England, over 24 million people attended emergency departments in England during 2023, a 5% increase from the previous year. Despite government pledges to reduce waiting times, bed occupancy rates in many hospitals regularly exceeded 95%, a threshold widely regarded as unsafe for maintaining timely patient flow.

In response to the RCEM’s findings, the Department of Health and Social Care reiterated its commitment to improving urgent and emergency care through the delivery of new hospital beds, expansion of community-based alternatives to ED attendance, and investment in urgent treatment centres. However, frontline clinicians warn that without meaningful increases in staffing and social care infrastructure, efforts to reduce ED congestion will remain insufficient.

Age UK, a leading charity supporting older adults, echoed these concerns, stating that delays in emergency care often exacerbate underlying conditions in elderly patients, leading to complications such as delirium, dehydration, and loss of mobility that can trigger rapid decline. Caroline Abrahams, Charity Director at Age UK, said: “Older people are not just more likely to attend A&E — they are also more likely to suffer serious harm when they are left waiting without proper monitoring or timely intervention.”

The Royal College of Emergency Medicine continues to advocate for systemic reforms, including real-time hospital capacity monitoring, mandatory escalation protocols when ED waits exceed six hours, and greater integration between emergency, acute, and community care services. As the UK approaches another winter season, health leaders stress that preventing further avoidable deaths will require urgent, coordinated action across the entire healthcare system.