First reported 15 Apr 2014•Latest report 17 Dec 2025
Definition
What this concern includes
Includes recurring deficiencies in the number, availability, deployment, cover or resilience of doctors, nurses and other staff needed to care for, monitor and manage Emergency Department patients, including shortages during busy periods and staffing levels insufficient for demand.
Excludes agency-staff use, fatigue, competence or retention concerns unless they directly establish insufficient emergency-department staffing capacity for safe patient care.
Excludes emergency-department space, overcrowding, bed-flow and general operational-pressure deficiencies where staffing capacity is not the shared unsafe condition.
Excludes one-off staff absences or isolated clinical omissions where no continuing emergency-department staffing-capacity problem is asserted.
Reports
18
Distinct published reports
Individual concerns
20
A report can raise multiple concerns
Date range
2014–2025
First to latest report issue date
Stated actions
64
Described in published responses
Reports over time
Reports over time
Reports about this concern issued each year.
* 2026 is projected from reports observed to 7 Sep 2026.
Most frequent recipients
Most frequent recipients
Reports about this concern sent to each recipient.
Department of Health and Social Care7
Betsi Cadwaladr University LHB4
NHS England4
Sherwood Forest Hospitals NHS Foundation Trust2
Aneurin Bevan University LHB1
Chelsea and Westminster Hospital NHS Foundation Trust1
Conwy County Borough Council1
Denbighshire County Council1
Flintshire County Council1
Greater Manchester Health and Social Care Partnership1
Milton Keynes University Hospital1
Royal College of Emergency Medicine1
Royal College of Paediatrics and Child Health1
Royal Free Hospital1
Royal Stoke University Hospital1
Ministerial department7
NHS trust6
Local health board5
Executive non-departmental public body4
Healthcare site4
Devolved government1
Devolved legislature1
Health professional body1
Health-system partnership1
Professional body1
Welsh county borough council1
Welsh county council1
Concerns and responses across reports
Only concerns grouped under this recurring concern are included. Select any concern, action or position to view the source wording.
Inner West London
Concerns raised1
Insufficient A&E staffing to manage demand during busy periods
This report raised 3 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.4
Action
Invest £250 million to expand same-day and urgent care services and support faster diagnosis, treatment and discharge.
Stated by Department of Health and Social CareStated in progressThe respondent said that this action was in progress when they made their response on 19 December 2025.
Action
Increase urgent care delivered in primary, community and mental health settings.
Stated by Department of Health and Social CareStated in progressThe respondent said that this action was in progress when they made their response on 19 December 2025.
Action
Increase urgent care capacity outside hospitals through new neighbourhood health services.
Stated by Department of Health and Social CareStated plannedThe respondent said that this action was planned when they made their response on 19 December 2025.
Action
Improve hospital flow by reducing waits exceeding 12 hours and progressing towards eliminating corridor care.
Stated by Department of Health and Social CareStated plannedThe respondent said that this action was planned when they made their response on 19 December 2025.
Inner North London
Concerns raised1
Understaffing of the emergency department, including insufficient staff to take basic observations
This report raised 5 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.6
Action
Maintain augmented paediatric consultant cover from 09:00 to 23:00 on weekdays.
Stated by Royal Free London NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 17 March 2025.
Action
Provide augmented medical and nursing staffing, including a 24/7 Emergency Department Assistant, using bank and agency cover pending establishment approval.
Stated by Royal Free London NHS Foundation TrustStated in progressThe respondent said that this action was in progress when they made their response on 17 March 2025.
Action
Review the business case for a Clinical Practice Educator, Emergency Department Assistant and additional paediatric emergency-department nursing establishment.
Stated by Royal Free London NHS Foundation TrustStated in progressThe respondent said that this action was in progress when they made their response on 17 March 2025.
Action
Review day and night emergency-department staffing skill mix.
Stated by Royal Free London NHS Foundation TrustStated plannedThe respondent said that this action was planned when they made their response on 17 March 2025.
Action
Conducted work to identify where paediatric rota gaps most significantly affect services.
Stated by Royal College of Paediatrics and Child HealthStated completedThe respondent said that this action was complete when they made their response on 17 March 2025.
Action
Continue advocating locally and nationally for active reduction of paediatric rota gaps.
Stated by Royal College of Paediatrics and Child HealthStated in progressThe respondent said that this action was in progress when they made their response on 17 March 2025.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.2
Position
Nursing staffing was in line with safe establishment levels, apart from one registered-nurse rota gap before Billie’s attendance.
Stated by Royal Free London NHS Foundation TrustDisputes the concernThe respondent disagreed with part of the concern or the basis for it.
Position
The response cannot comment on the hospital emergency department’s staffing model, staffing numbers or skill mix.
Stated by Royal College of Emergency MedicineUnable to actThe respondent said that a constraint prevented them from taking the relevant action.
Staffordshire and Stoke-on-Trent
Concerns raised1
Failure to provide 1:1 registered nurse staffing in the Emergency Department resuscitation area
This report raised 1 other concern. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
Action
Reinstate a named-nurse model in the resuscitation area and audit it through internal and ICB review processes.
Stated by University Hospitals of North Midlands NHS TrustStated plannedThe respondent said that this action was planned when they made their response on 21 February 2025.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.4
Position
Flexible nursing allocation is preferred to fixed one-to-one resuscitation staffing because it prioritises staff according to acuity, surge and skill.
Stated by University Hospitals of North Midlands NHS TrustExisting arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
Position
A team approach, supported by flexible staffing and specialist support, is considered more effective than assigning a Named Nurse in the resuscitation area.
Stated by NHS EnglandExisting arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
Position
The Trust does not consider that insufficient nursing staff caused the failure to recognise Philip’s deterioration.
Stated by NHS EnglandDisputes the concernThe respondent disagreed with part of the concern or the basis for it.
Position
The Trust is responsible for providing further comments and information on actions taken since the inquest concerning the Coroner’s concerns.
Stated by NHS EnglandRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
West Sussex, Brighton and Hove
Concerns raised1
Failure to include corridor patient care areas in the Emergency Department nursing staffing template
This report raised 1 other concern. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
Action
Publish principles for providing safe, good-quality care in temporary escalation spaces when demand exceeds capacity.
Stated by NHS EnglandStated completedThe respondent said that this action was complete when they made their response on 15 October 2024.
Birmingham and Solihull
Concerns raised1
Insufficient emergency department staffing to care for, monitor and manage patients
This report raised 3 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.5
Action
Reduce reliance on external agency nursing staff through improved Emergency Department recruitment and withdraw agency requests.
Stated by University Hospitals Birmingham NHS Foundation TrustStated in progressThe respondent said that this action was in progress when they made their response on 15 April 2024.
Action
Reduce the Emergency Department Ambulatory Area to minor injuries and on-site urgent-care GP referrals, concentrating staff in the main department.
Stated by University Hospitals Birmingham NHS Foundation TrustStated plannedThe respondent said that this action was planned when they made their response on 15 April 2024.
Action
Publish the delivery plan for recovering urgent and emergency care services.
Stated by Department of Health and Social CareStated completedThe respondent said that this action was complete when they made their response on 15 April 2024.
Action
Deliver 5,000 additional staffed, permanent hospital beds to increase emergency care capacity.
Stated by Department of Health and Social CareStated completedThe respondent said that this action was complete when they made their response on 15 April 2024.
Action
Make £1.6 billion available over two years to support timely hospital discharge and reduce emergency department overcrowding.
Stated by Department of Health and Social CareStated completedThe respondent said that this action was complete when they made their response on 15 April 2024.
Nottinghamshire
Concerns raised1
Insufficient paediatric nursing capacity and senior nurse support in the Emergency Department
This report raised 6 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.9
Action
Roster registered children’s nurses during identified peak emergency-department attendance periods.
Stated by Sherwood Forest Hospitals NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 15 April 2024.
Action
Require adult nurses caring for children to complete specified paediatric experience, training, study days, e-learning and supervised shadowing.
Stated by Sherwood Forest Hospitals NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 15 April 2024.
Action
Record paediatric nursing staffing as a significant risk and review it monthly through specialty and Trust risk committees.
Stated by Sherwood Forest Hospitals NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 15 April 2024.
Action
Develop a rotational pathway for registered children’s nurses through continuous Emergency Department and paediatric collaboration.
Stated by Sherwood Forest Hospitals NHS Foundation TrustStated plannedThe respondent said that this action was planned when they made their response on 15 April 2024.
Action
Train an Emergency Department adult nurse as a paediatric nurse, increasing staffing by one whole-time equivalent.
Stated by Sherwood Forest Hospitals NHS Foundation TrustStated in progressThe respondent said that this action was in progress when they made their response on 15 April 2024.
Action
Provide newly qualified registered children’s nurses with discipline-specific preceptors, supernumerary practice and Emergency Department induction.
Stated by Sherwood Forest Hospitals NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 15 April 2024.
Action
Review Emergency Department escalation processes for proactively identifying and escalating nursing staffing concerns.
Stated by Sherwood Forest Hospitals NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 15 April 2024.
Action
Add a peak-time Band 5 registered-nurse shift and improve Healthroster displays to identify children’s-area registered children’s nurse cover gaps.
Stated by Sherwood Forest Hospitals NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 15 April 2024.
Action
Implement a supervisory Band 7 Nurse in Charge role providing visible senior nursing support across the Emergency Department, with supernumerary deployment from July 2024.
Stated by Sherwood Forest Hospitals NHS Foundation TrustStated plannedThe respondent said that this action was planned when they made their response on 15 April 2024.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Position
Recruitment challenges mean the Trust is unable to meet RCPCH paediatric nursing workforce standards despite active recruitment.
Stated by Sherwood Forest Hospitals NHS Foundation TrustUnable to actThe respondent said that a constraint prevented them from taking the relevant action.
Nottinghamshire
Concerns raised1
Insufficient trained paediatric nursing capacity in the Emergency Department
This report raised 5 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.7
Action
Use attendance data to roster registered children’s nurses during peak paediatric attendance periods.
Stated by Sherwood Forest Hospitals NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 15 April 2024.
Action
Require adult nurses caring for children to complete defined paediatric experience, training, study-day and supervised-shadowing competencies.
Stated by Sherwood Forest Hospitals NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 15 April 2024.
Action
Record registered children’s nurse staffing as a significant risk and review it monthly through specialty and Trust risk governance.
Stated by Sherwood Forest Hospitals NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 15 April 2024.
Action
Develop a rotational registered children’s nurse pathway jointly between Emergency Department and Women and Children services.
Stated by Sherwood Forest Hospitals NHS Foundation TrustStated plannedThe respondent said that this action was planned when they made their response on 15 April 2024.
Action
Train an Emergency Department adult nurse in paediatric nursing to increase staffing by one whole-time equivalent.
Stated by Sherwood Forest Hospitals NHS Foundation TrustStated in progressThe respondent said that this action was in progress when they made their response on 15 April 2024.
Action
Use Healthroster improvements and additional evening registered-nurse shifts to identify paediatric staffing gaps and support peak attendance.
Stated by Sherwood Forest Hospitals NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 15 April 2024.
Action
Provide a 24-hour supervisory Band 7 Nurse in Charge role responsible for staffing allocation and escalation of workforce concerns.
Stated by Sherwood Forest Hospitals NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 15 April 2024.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Position
Recruitment challenges mean the hospital is unable to meet national Registered Children’s Nurse workforce standards despite active recruitment.
Stated by Sherwood Forest Hospitals NHS Foundation TrustUnable to actThe respondent said that a constraint prevented them from taking the relevant action.
North Wales (East and Central)
Concerns raised1
Insufficient doctors and nurses for Emergency Department patient demand
This report raised 11 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.3
Action
Continue expanding consultant staffing in the Emergency Department, now providing 8.6 whole-time-equivalent consultants plus one locum.
Stated by Betsi Cadwaladr University LHBStated completedThe respondent said that this action was complete when they made their response on 28 December 2023.
Action
Map the Emergency Department resource required to meet demand and national recommendations.
Stated by Betsi Cadwaladr University LHBStated in progressThe respondent said that this action was in progress when they made their response on 28 December 2023.
Action
Review and increase the Emergency Department nurse staffing roster template through the annual staffing review.
Stated by Betsi Cadwaladr University LHBStated in progressThe respondent said that this action was in progress when they made their response on 28 December 2023.
North Wales (East and Central)
Concerns raised1
Unsustainable pressure on emergency department clinicians and other staff
This report raised 1 other concern. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.13
Action
Establish a dedicated project team to develop and deliver urgent and emergency care improvements.
Stated by Betsi Cadwaladr University LHBStated completedThe respondent said that this action was complete when they made their response on 18 October 2023.
Action
Implement the 8 Steps Project to improve emergency department patient flow and monitor performance through daily huddles and dashboards.
Stated by Betsi Cadwaladr University LHBStated in progressThe respondent said that this action was in progress when they made their response on 18 October 2023.
Action
Develop the YGC acute medical model, including its rota and working patterns, to provide timely senior decision-making and appropriate specialty care.
Stated by Betsi Cadwaladr University LHBStated in progressThe respondent said that this action was in progress when they made their response on 18 October 2023.
Action
Improve the information technology systems used for same-day emergency care.
Stated by Betsi Cadwaladr University LHBStated in progressThe respondent said that this action was in progress when they made their response on 18 October 2023.
Action
Introduce telephony systems to support additional GP and ambulance-service referrals to same-day emergency care.
Stated by Betsi Cadwaladr University LHBStated in progressThe respondent said that this action was in progress when they made their response on 18 October 2023.
Action
Develop a more efficient board-round system to expedite discharge and improve patient flow.
Stated by Betsi Cadwaladr University LHBStated in progressThe respondent said that this action was in progress when they made their response on 18 October 2023.
Action
Return the GP Out of Hours Service to Ysbyty Glan Clwyd and co-locate it with emergency services.
Stated by Betsi Cadwaladr University LHBStated in progressThe respondent said that this action was in progress when they made their response on 18 October 2023.
Action
Re-establish fortnightly strategic meetings with the Welsh Ambulance Service to review demand, conveyances and demand-reduction actions.
Stated by Betsi Cadwaladr University LHBStated completedThe respondent said that this action was complete when they made their response on 18 October 2023.
Action
Present ambulance performance data at emergency department governance meetings to review required actions and support zero-tolerance handover performance.
Stated by Betsi Cadwaladr University LHBStated completedThe respondent said that this action was complete when they made their response on 18 October 2023.
Action
Review the emergency department rota and skill mix to address identified doctor shortages.
Stated by Betsi Cadwaladr University LHBStated plannedThe respondent said that this action was planned when they made their response on 18 October 2023.
Action
Undertake a Monday-to-Friday daytime see-and-treat test to support staff learning and evaluate its effect on emergency department performance.
Stated by Betsi Cadwaladr University LHBStated plannedThe respondent said that this action was planned when they made their response on 18 October 2023.
Action
Scrutinise emergency department improvement plans and performance and provide executive support for their delivery.
Stated by Betsi Cadwaladr University LHBStated in progressThe respondent said that this action was in progress when they made their response on 18 October 2023.
Action
Support delivery of emergency department improvement plans responding to Healthcare Inspectorate Wales inspections.
Stated by Betsi Cadwaladr University LHBStated completedThe respondent said that this action was complete when they made their response on 18 October 2023.
North West Wales
Concerns raised1
Insufficient staffing levels to meet demand and safely care for patients
This report raised 1 other concern. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
No linked response statements
No respondent-stated action or position is linked to these concerns in the published data.
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Includes recurring deficiencies in the number, availability, deployment, cover or resilience of doctors, nurses and other staff needed to care for, monitor and manage Emergency Department patients, including shortages during busy periods and staffing levels insufficient for demand.
