Urgent & Emergency Care — NUH (RX1)

Phase 4: the A&E 4-hour standard (a flow standard, like cancer — each month's attendances scored on timeliness), 12-hour decision-to-admit waits, and the emergency bed base — where UEC meets the elective spine: average occupied emergency beds = daily admissions × length of stay (Little's Law a third time), and the elective recovery's bed requirement stacks on the same adult G&A pool.

Seeded from the published Monthly A&E (MSitAE) provider CSVs (April 2024/25/26) and UEC Daily SitRep winter timeseries (2023-24 → 2025-26). From Apr-26 the co-located UTC activity reports under RX1's code — all-types performance jumps for reporting reasons; type-1 is the comparable ED series. Growth is calibrated from the latest pair (the earliest is contaminated by the UTC split — the reverse of the RTT/DM01 EPR situation). Emergency flows run 7 days a week, so growth pairs compare CALENDAR months — all three Aprils have 30 days and 22 weekdays — and no working-day adjustment applies (unlike the elective modules). 4-hour milestones (82% Apr-27 per the Medium Term Planning Framework objective → 88% Apr-28 → 95% Apr-29) and the 12-hour-to-zero date are documented modelling assumptions; the glide is also derived for type-1, since the all-types metric is UTC-flattered. Ambulance handover is seeded from the NHSE Ambulance Handover Times by Acute Trust collection (monthly timeseries from Oct-2023 + April snapshots).

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UEC position & trajectory

Where do these numbers come from?

A&E 4-hour performance — required glide path (all types; constitutional 95%)

Timely attendances per month (required vs at today's rate)

12-hour DTA waits per month (assumed path to zero)

The shared bed pool — where UEC meets the elective recovery

Emergency occupied beds follow Little's Law (daily admissions × LOS, with LOS derived from winter occupancy net of the elective share so the decomposition doesn't double-count); open beds needed add the occupancy-target headroom. The elective spine's bed requirement (phase 1) stacks on top — both press on one adult G&A pool of ~1,600 beds.

Adult G&A beds — required vs available (emergency + elective vs winter average open)

WinterAdult G&A openOccupiedOccupancy Long-stay 7+ d14+ d21+ d21+ share of occ Critical care occ/open

The long-stay columns are the discharge-delay proxy: beds held by patients in hospital over 7/14/21 days. Winter 2025-26 is the tightest of the three years — occupancy 95.4% against the 92% planning norm, with a quarter of occupied beds held by 21+ day stayers. Releasing long-stay beds is the biggest single lever on the pool.

Discharge delays (Discharge Ready Date, April months)

MonthDischarges% delayed Bed-days lost≈ beds occupied by delay 1 day2-34-6 7-1314-2021+

The recoverable beds (one chart, three tables' argument)

Occupancy (95.4%), long-stay patients (a quarter of the pool) and discharge delay (≈179 beds) are the same story told three ways: the bed gap is largely a discharge problem. Decomposing the winter-average occupied pool:

Bed base by specialty (KH03, occupied overnight)

SpecialtyOccupied overnightShare

Occupied overnight beds — long run (June snapshots)

The emergency-dominated bed base is concentrated in geriatric medicine, respiratory and general internal medicine — the same wards the long-stay and discharge-delay beds sit in. The elective recovery competes for what remains.

Levers

Ambulance handover (handovers at NUH, all types)

Mean handover time by month (standard: 15 minutes; hours lost counted beyond 30)

MonthHandoversMean >15 min>30 min>60 min Crew hours lost (>30 min)

Handover delay is queueing at the front door for the same beds the long-stay, discharge-delay and elective columns are competing for. The Jan-2024 peak (mean 85 minutes) has more than halved, but the mean still sits at twice the 15-minute standard — and April 2026's 747 crew-hours lost ≈ an ambulance crew permanently parked outside ED.