The Royal College of Emergency Medicine (RCEM) has issued a stark warning to Members of the Senedd, describing the lack of hospital capacity to move patients out of emergency departments as a 'silent killer'. Dr Rob Perry, Vice President (Wales) of RCEM, has written an open letter to all Senedd members, calling for urgent action to address the crisis.
What is Exit Block?
Exit block occurs when a patient's emergency treatment is complete but they cannot leave the ED because no hospital bed is available. This causes overcrowding, with patients treated in corridors and ambulances queuing outside. Dr Perry said: 'Exit block is dreadful and dehumanising for patients – robbing them of privacy, dignity, and often sleep. It causes moral injury to the staff looking after them... but even worse than that, it leads to avoidable deaths.'
Excess Deaths and Rising Waits
Research shows that mortality rises after five hours in the ED. RCEM estimates 965 excess deaths in Wales in 2025 due to waits of 12 hours or more, up from 934 in 2024. The number of patients waiting over 12 hours has increased five-fold since 2015 and more than doubled in the last five years. A recent RCEM survey found Welsh EDs operating at 176% capacity on average.
Call for Systemic Change
Dr Perry argues the focus must shift from managing demand at the 'front door' to improving patient flow out of hospitals. Key recommendations include: a national commitment to end overcrowding, ensuring patients are never treated in non-designated areas, treating overcrowding as equivalent to other causes of mortality, and prioritizing whole-system patient flow. He also calls for routine reporting on care in non-designated areas and adequate staffing levels.
'This silent killer in our midst can only be stopped by refusing to accept exit block as inevitable, or to tolerate it,' Dr Perry wrote, urging the Senedd to act decisively.
