The History of Casualty Watch Project
​Casualty Watch was the first example of co-ordinated, data-collection and analysis to assess service quality in the history of CHCs.

Casualty Watch began in King's College Hospital (London) in 1990, and was initiated by Camberwell (later Southwark) CHC's Acute Group.  This followed a decision by King's College Hospital to close hundreds of beds in August 1989; a decision which immediately led to the widely publicised 'warehousing' of seriously ill people on trolleys - a practice that has since spread widely to other hospitals.
​What was Casualty Watch?

A representative from the CHC - often a member - visited the local A&E Department at 4.30pm on the last Monday of each month and saw a Nurse or Consultant-in-Charge to check details about patients waiting in A&E.  For each patient, data is collected on:
  • Age
  • Gender
  • Postcode (only the first letters in order to preserve the patient's confidentiality)
  • Arrival time
  • Time of decision to admit (if applicable)
  • The provisional diagnosis
  • The treatment plan for the patients
  • Whether the patients were sitting on a chair, lying on a trolley or a bed
  • How long the patients had been waiting.

Collecting the data, particular if the groundwork has been done, should have taken no longer than 30 minutes. The patients' name is never recorded, and neither are the patients interviewed.
​Why do Casualty Watch?

Casualty Watch was used because it was a quick, highly effective and non-labour intensive method of data collection.  Collecting Casualty Watch data enabled Southwark CHC to monitor its local Casualty Department every month for several years, and to relate the data to other service changes.  

Casualty Watch became a powerful tool in discussions with providers and commissioners, and enabled the CHC to press for better services, more beds and humane treatment for seriously ill people. It also gave the CHC an opportunity to press the case for more resources with central Government, and was successful campaigning tool in persuading the old Regional Health Authority to provide capital to re-develop King's College Hospital's Casualty Department.
​Co-ordinated Casualty Watches

Fears about widespread hospital bed and Casualty closures, following the Tomlinson Report on London's health services, led to an agreement between London CHCs to co-ordinate 'Casualty Watch' visits, and to collate the results to demonstrate waiting times across London at a fixed point in time.

At 4.30pm on 28 March 1994, Lambeth, City & Hackney and Southwark CHCs took pat in a trial run.  This showed that 26 patients were waiting on trolleys in excess of 4 hours.  Five patients in excess of 20 hours , with the worst case being a man of 84 waiting over 87 hours on a trolley at St. Bartholomew's Hospital.

The first multi-site co-ordinated simultaneous Casualty Watch took place on 25 April 1994.  On this occasion, CHCs monitored Casualty Departments at:

King's College Hospital                        The Royal London Hospital                           Greenwich General Hospital
Guy's Hospital                                       Homerton Hospital                                         Queen Mary's Hospital, Sidcup
St. Thomas' Hospital                            St. Bartholomew's Hospital                           Bromley Hospital
New ham General Hospital                 The Brook Hospital                                         Tunbridge Wells Hospital
Brighton Hospital

The co-ordinated, multi-site Casualty Watch continued to take place on a monthly basis, and included many hospitals from London, Kent, Sussex, Surrey, Hertfordshire, Birmingham, Liverpool and Newcastle.
​Why 4.30pm?

This was a frequently asked question.  Many people that that Casualty Watch would be more effective if it were carried out on a Friday or Saturday evening - when A&E Departments are traditionally known to be busy.

Reasons for not doing Casualty Watch on a Friday or Saturday evening, included:
  • CHC representative are less likely to want to be in the Departments at these, often distressing times
  • A&E staff are less likely to have time to help with the collection of data
  • Casualty Watch would cause no disruption to an A&E Department

Reasons for doing Casualty Watch on a Monday, included:
  • Longs waits had been recorded in A&E Departments on Mondays, because patients had not been discharged from the hospital Wards over the previous weekend.  This could lead to a shortage of beds when admissions to hospital from the A&E Departments was necessary.  
  • Research published in 1995** found that 'while there was consistency in overall numbers attending across most days of the week, markedly higher volumes of patients attended on the Monday during the day (2.00pm - 10.00pm), and at night on the Friday and Saturday'.
  • CHC representatives would feel more comfortable visiting the A&E Department early on a Monday evening, than they would on a Friday or Saturday evening.
Nationwide Casualty Watch

In 1997, ACHCEW became involved with Casualty Watch, and it was agreed to attempt a Nationwide Casualty Watch to see if London's problems were replicated elsewhere.

Following a trial run in November 1997, the first Nationwide Casualty Watch took place in January 1998.  CHCs from England, Wales and Northern Ireland took part and the project proved successful in detailing the scale of the problem.
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**  Information & Statistics Division National Health Service in Scotland (1995), Treated in time - Survey of waiting times at Accident & Emergency Departments in Scotland. Edinburgh.