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SAM president warns hospital pressures ‘won’t relent for weeks’

Commenting on today’s release of weekly NHS performance data, Dr Nick Scriven, president of the Society for Acute Medicine, said:

“We are seeing a sustained period of exceptionally high demand on a service that is only being kept safe by dedicated staff going beyond all normal limits.

“This is sustainable only for a week or two and we are now entering the third week of this crisis which will not relent for weeks yet even if admission rates reduce such is the crowding in our hospitals.

“The NHS and individual trusts must now give thoughts on how they can help their staff cope and not succumb themselves to illness brought on by exhaustion, which is now a real danger.

“As a specialty which receives the majority of patients admitted from A&Es, I would again call on the government – as I have been for weeks – to agree to talk to our society for our perspective on what is happening on the ground.”

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Choice of flu vaccine ‘has increased risk of admissions’ – SAM president

Comments from Dr Nick Scriven, president of the Society for Acute Medicine, on the use of the trivalent flu vaccine over the quadrivalent in parts of England feature in today’s media.

He said: “Not using the quadrivalent vaccine has increased the risk of flu admissions this year.

“Half of the flu cases we are getting are the A strain, half are the B.

“It is probably about half the cases that are coming into hospital that may have been prevented.”

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NHS data shows ‘struggle to provide safe and compassionate care’ – SAM President

Following the release of NHS performance data for December which showed only 77.3% of patients were treated in emergency departments with four hours, Dr Nick Scriven, president of the Society for Acute Medicine, said:

“These figures support the messages we have been getting from our members about conditions across the NHS and the struggle they are facing to provide safe and compassionate care in exceedingly difficult conditions.

“They also predate the influenza spread and escalation in England and, combined with the additional numbers of people in corridors on trolleys or as extra capacity, do not tell the extent of this crisis.

“NHS Providers is right when it says we are at a watershed moment in the health service and the government must recognise this – it has had long enough and been warned of this dangers enough times in the last two years alone.

“The data hides the misery and lack of dignity some people are being treated with and it is a potentially worrying side note that the Care Quality Commission is postponing inspections during ‘winter’.

“We would like to reiterate our call to the health secretary to meet and talk to us and establish a meaningful two-way dialogue – so far we have been met by a wall of silence which is an affront to patients and clinicians providing acute medical care.

“I would like to personally thank all staff working in our acute medical units across the nation whatever their job or seniority who are helping to hold everything together, as well as those of any discipline who have answered the calls for help and have come to help us at the sharp end.”

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SAM president urges health secretary to ‘engage with frontline’

Dr Nick Scriven, president of the Society for Acute Medicine, said:

“Despite our disappointment at this failure from the Prime Minister to take a fresh approach to the NHS, we now urge Mr Hunt to take this chance to invite us to his table.

“His time in office, particularly recently, has been tainted with an all too familiar dismissal of the views of frontline staff.

“The handling of preparations for the current build up of winter pressures engulfing the system and his management of it typifies this.

“We want to see much better engagement with clinicians and we would be happy to meet with Mr Hunt at any time to discuss the key issues.”

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More illness and more hospital attendances to come – SAM president

By Dr Nick Scriven, president of the Society for Acute Medicine

This week’s release of NHS statistics for the week between Christmas and the New Year have shown a system under great stress. This is of no surprise to those working in acute hospitals over this period.

However, this was a time of relative calm before the real crisis developed from New Year’s Eve onwards. There has been debate as to what constitutes a crisis but to all those working at the front door the last four days has definitely been at that level.

The National Emergency Pressures Panel (NEPP) has updated its guidance but it must be noted that this is offered entirely as advice and not as a diktat. There is concern that it is being implemented in a piecemeal manner across the country and on a day-to-day timeframe which negates any good for patients cancelled as they are not getting the notice health secretary Jeremy Hunt is taking as a positive.

Without doubt the figures for the next week will show the true magnitude of the system crisis that has engulfed the NHS. It must be emphasised that it is a whole system problem that is hitting all sectors of the NHS and not just the emergency department where the targets are measured and this is despite the heroic efforts of health care staff of all disciplines and grades.

However, we must point out that this was predicted. The Society for Acute Medicine published press releases and statements in October, November and December 2017 warning exactly of this scenario.

When we warned the NHS could break far worse this winter and that it seemed there was nothing new in terms of preparations than crossed fingers, the health secretary disagreed and stated more preparations had been made this winter than ever before.

At the time, we anticipated elective – non-urgent – work would almost certainly cease for several months and, by December, a recommendation was made advising trusts to cancel elective activity until the end of January and, now, beyond that.

When our perspective was reiterated again in November, with particular focus on the potential winter chaos ahead and a lack of direction from the Secretary of State, we were criticised by NHS England for making “claims” that carried “distinctly political overtones”.

However, the fact is the social care crisis, reduction in bed numbers and recruitment issues along with the subsequent intensity of pressure in January demonstrates we were right to raise these concerns and they should have been met with genuine interest, not hot air and rhetoric that is out of touch with activity on the ground and views from the frontline.

The temperature is set to drop again and looks like it will be below the 5° mark which statistics show means more illness and more hospital attendances to come.

While some of the statements from medical professionals have been overzealous and hyperbolic, particularly comparing our multi-million pound hospitals to third world care, the government and healthcare bodies would benefit from listening to the concerns and potential solutions being raised by clinicians and taking appropriate action.

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NHS position ‘as bad as I’ve ever known’ – SAM president

Commenting on the current pressures being faced by hospitals across the country, Dr Nick Scriven, president of the Society for Acute Medicine, said:

“The position at the moment is as bad as I’ve ever known.

“Pre-Christmas 43 trusts were more than 98% full despite 3,000 extra beds in use – I expect this to be at least doubled, maybe trebled today.

“We are starting to report Australasian flu is beginning to appear which is worrying – we are seeing a lot of flu like symptoms but as yet do not know if it is ‘normal’ or the Australasian strain.

“Big issues are currently nurse staffing levels with extra beds being opened around hospitals to cope with winter surge and not enough nurses to go round.

“This is same for doctors and therapists and diagnostic facilities in hopsitals will be swamped – a vicious circle of increased need causing longer delays in whole system.”

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Leading doctor ‘fears for hospitals’ as new year dawns

A leading doctor has said he “fears for hospitals” with pressures on the NHS “escalating rapidly” over the festive period.

Dr Nick Scriven, president of the Society for Acute Medicine, said many trusts reported more than 99% capacity in the week before Christmas which “in my view is not compatible with running a safe acute service”.

“Since the bank holiday things have escalated rapidly and we are on the cusp of a major issue at least as bad as last year when it was described by the Red Cross as a humanitarian crisis,” he said.

“There is an awful lot of respiratory illness causing a lot of severe symptoms in the old and young and 10 to 12-hour delays in emergency departments are now not uncommon – along with patients being placed on inappropriate wards.”

Dr Scriven said staff were “working themselves into the ground” at the front door and needed the support of colleagues to “challenge every discharge decision”.

“I fear for acute trusts this next week,” he explained. “Hopefully the weather will stay mild, but there are also some steps trusts can take to try to alleviate pressure that will cause their hospitals to break.

“I would urge trusts to plan for having extra capacity needed for the next fortnight and plan to staff these consistently, as well as boost diagnostic capacity and therapy services for the next two weeks.

“This will enable them to try to catch up with the backlog caused by effectively having seven to 10 days at what were probably ‘bank holiday’ levels.”

Dr Scriven said it was not known how many trusts had taken advice issued by the NHS National Emergency Pressures Panel to cancel elective – non-urgent – surgery in the first two weeks of January, but he suggested this advice should be extended at least until the end of January and possibly to the end of February.

“To be at this point now – with reports of some hospitals even diverting patients between Christmas and New Year when there is traditionally a lull – suggests we may be in desperate times,” he said.

“With us yet to experience any significant infection outbreaks, my belief is that trusts may be wise to consider cancelling some elective surgery until at least the end of January and maybe into February.”

Acute medicine, also known as acute internal medicine, deals with the immediate and early treatment of adult patients with a variety of medical conditions who present to hospital as emergencies.

The specialty receives the majority of patients admitted from A&E and plays a vital role in maintaining the flow of patients through emergency departments to avoid exit block, the term used when patients cannot be moved into a hospital bed.

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Former SAM president receives OBE in New Year honours

Professor Derek Bell, a past president of the Society for Acute Medicine, has received an OBE in the New Year Honours list.

His award is in recognition of his services to unscheduled care and quality improvement in healthcare.

Prof Bell, who is currently president of the Royal College of Physicians of Edinburgh, was elected the inaugural president of SAM at its inception in 1999 and was appointed the UK’s first professor of acute internal medicine and Imperial College London.

“We are delighted Prof Bell has received an OBE for his work in healthcare, particularly his role in defining and establishing the speciality of acute medicine,” said Dr Nick Scriven, president of SAM.

“We would like to send him our congratulations and hope that the continuous growth and development of SAM as a representative body is a reflection of the successful foundations he laid as inaugural president.”

Elaine Tait, chief executive of the RCPE, added: “We are thrilled that our current president, Prof Derek Bell, has been recognised for his outstanding commitment to improving unscheduled care and his focus on quality improvement in healthcare.”

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SAM president warns cancelled operations stance ‘could last until February’

Following the National Emergency Pressures Panel’s (NEPP) advice for hospitals to defer non-urgent elective care until January, Dr Nick Scriven, president of the Society for Acute Medicine, said:

“The positive of this is action to relieve pressure on the system – the bad news is that it has happened already without much actual unexpected stress on the system.

“We have not yet seen anything out of the ordinary weather or infection-wise so my belief is that this stance will need to be extended until at least the end of February.”

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SAM PRESIDENT WARNS ‘SYSTEM ON A KNIFE-EDGE’

Following the release on the latest NHS performance data today, Dr Nick Scriven, president of the Society for Acute Medicine, said:

“When we talk about the NHS at the moment, all we can say and see is pressure, pressure and more pressure – the system is on a knife-edge.

“This week alone frontline staff from across the UK are reporting theirs hospitals are ‘imploding’, there is’ carnage on the ground’ and they are run off their feet.

“Some hospitals are already cancelling planned surgery and that is something patients will face increasingly over the winter months.”

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Doctor warns hospitals could be ‘jammed full’ this week

A leading doctor has warned hospitals across the NHS could be “jammed full” as early as tomorrow (Tuesday) afternoon.

Dr Nick Scriven, president of the Society for Acute Medicine, said colder weather and snow forecast across the country alongside increasingly high bed occupancy was “deeply concerning”.

“Last week we saw bed occupancy figures published showing that the NHS is short of more than 1,400 beds it needs for winter, with some units reporting more than 95% bed occupancy,” he said.

“One major hospital in the north was on 97%, with the traditionally accepted figure for a safe and efficient service being less than 87%.

“This shows the strain the system is under running into winter and more specifically the challenge the first real cold snap will cause.”

Dr Scriven said as rates of referral increase across all areas during cold weather, most hospitals could be operating at full capacity this week.

“We know in cold weather the rates of referral to hospital with many conditions rises – I think figures show it starts with a mean daytime temperature of four degrees,” he explained.

“This is across all areas, heart attacks, strokes, chest infections and pneumonia, as well as the perhaps expected falls, slips and broken bones.

“If the forecast for colder weather and snow is correct – as we saw over the weekend – I would predict most hospitals will be jammed full by tomorrow afternoon.”

He said frontline staff were going “above and beyond” to get to work despite bad weather and stay late in some parts of the country to help hospitals meet the demand already being faced.

“Frontline staff already pushed to their maximum are still going above and beyond to help their hospitals run as safely and effectively as possible.

“Members of the public can do their bit by following the advice that is out there from the NHS including using the range of alternative options for minor illness rather than adding pressure to emergency departments.”

Acute medicine, also known as acute internal medicine, deals with the immediate and early treatment of adult patients with a variety of medical conditions who present to hospital as emergencies.

The specialty receives the majority of patients admitted from A&E and plays a vital role in maintaining the flow of patients through emergency departments to avoid exit block, the term used when patients cannot be moved into a hospital bed.

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SAM president warns of winter that ‘may break backbone’ of NHS

Commenting on a report released today (Thursday) by NHS Providers on preparations for extra winter pressures, Dr Nick Scriven, president of the Society for Acute Medicine, said:

“While staff on the frontline will, as always, pull out all the stops to provide safe care, the fact remains the NHS is 1,400 beds short of what it needs this winter.

“The fear is that we have not faced an infection crisis over winter for several years and if the Australasian experience is repeated here the system will be swamped as never before.

“There is a real sense of foreboding that this may be the winter that finally breaks the backbone of the service.”

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Extra winter cash ‘will just about cover agency spend’ – SAM President

Following the chancellor’s budget announcement of an extra £2.8 billion in funding for the NHS which includes £350 million for this winter, Dr Nick Scriven, president of the Society for Acute Medicine, said:

“The additional £350 million will just about cover agency spend this winter if it has not already been earmarked or spent by trusts which are covering debts from last year.

“We have frontline staff working harder than ever and achieving daily miracles managing to patch together safe care for those who need it and that will continue despite this increase.

“Over the last 15 years, the number of people requiring admission has risen by 40% while the number of available acute medical beds has fallen by 20%.

“For as long as the government fails to provide the investment adequate for an NHS which is contending with older, frailer and more complex patients then we will struggle to compete against the eternal pressures we face.”

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SAM president warns NHS ‘faces turmoil’ this winter

Commenting on an analysis by the Health Foundation which suggests at least £360m extra funding may be needed for the NHS to meet the four-hour A&E target this winter, Dr Nick Scriven, president of the Society for Acute Medicine, said:

“The NHS has not recovered from last winter and we have a disillusioned workforce being asked to do more with less every day.

“We know there is currently insufficient capacity in the system, with the number of beds decreasing and medically-fit patients being unable to be discharged due to a lack of infrastructure

“We face turmoil if the system comes under pressure as it simply does not have the capacity to sustain and, despite all the talk, there is little progress with any long or medium-term winter plans despite the same issues occurring. All we see are unsustainable quick fixes.”

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Top doctor warns “isolation culture” could send NHS into winter chaos

A top doctor has said there is a “culture of isolation” among medical and healthcare bodies which could send the NHS into chaos this winter.
Dr Nick Scriven, president of the Society for Acute Medicine, said there were multiple groups trying to “solve” winter pressures but “nothing joined up” – with direction from the secretary of state for health “almost non-existent”.

“There are currently lots of different areas and groups, including the Royal College of Physicians, Academy of Royal Colleges and NHS Improvement’s emergency care intensive support team (ECIST) and the getting it right first time programme (GIRFT), all putting their own spin on things,” he explained.

“Clearly there has already been lots of focus on accident and emergency departments, with the government’s pledge earlier this year of an extra £100 million for struggling units and various announcements from the Royal College of Emergency Medicine.

“However, this is all muddying the waters and resulting in a lack of team-working, with direction and leadership, as well as public acknowledgment of the major issues we face, from the health secretary almost non-existent.”

Dr Scriven, who warned last month that a bad flu season could “overwhelm” hospitals, reiterated his concerns about a lack of plans to cope with a winter crisis and said trusts were “still focused on short-term financial savings”.

“The NHS has not really recovered from last winter including a disillusioned workforce being asked to do more with less every day,” he said.
“Despite all the talk, there is little progress with any winter plans, with trusts still focused, it feels, on short-term financial savings with no long or even medium-term planning – it is all quick fixes with no real concept of the future.

“What this means is that we end up with the government backing off and leaving professional bodies and groups to fend for themselves and their areas, which can be divisive and distracts everyone from the real issues which need tackling if we are to overcome this unrelenting tide.”
Dr Scriven called on the secretary of state to take responsibility for ensuring the NHS is as prepared as possible and to develop a “united approach” to the pressures being faced by hospitals across the country.

“We know there are three significant factors which need addressing immediately if we are to begin developing medium and long-term plans to develop a sustainable NHS in the face of a growing frailer and older population – capacity, an obsession with the four-hour emergency access target and social care,” he said.

“There is currently insufficient capacity in hospitals. With trusts trying to save costs there is less spare space in the system with no spare staff if needed so, if extra capacity is made available, it is last minute, ad hoc and expensive (locums and agency staff) which reduces efficiency and increases risk.

“Without a robust plan forcing trusts to cancel elective work any minor surge will cause issues.”

He added: “We also know trusts ‘treating’ the emergency access ED target in isolation end up hiding problems and stresses deeper in hospitals and there is not enough community care of sufficient quality to meet any demand.

“These issues don’t come as any surprise, so how long are we to go on without the secretary of state being held to account for not addressing the problems we know have the potential to push the NHS into utter chaos this winter?”

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Readmission figures ‘worrying and require investigation’ – SAM president

Commenting on figures which show the number of patients in England being readmitted to hospital within 30 days of discharge has risen by nearly a quarter in the last four years, Dr Nick Scriven, president of the Society for Acute Medicine, said:

“These figures are worrying and follow quickly on the heels of failures to meet A&E and ambulance targets across the NHS and require further investigation and analysis by NHS England.

“The significant issues we are seeing on the healthcare system means errors made or social care inadequate are impacting on patients and carers but also putting unnecessary extra pressure on front door teams.”

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Leading doctor warns NHS could “break far worse” this winter

A leading doctor has warned the NHS could “break far worse” this winter as the system faces the prospect of a major flu outbreak.

Dr Nick Scriven, president of the Society for Acute Medicine (SAM), said despite much talk nationally of adequate preparations, frontline staff feel there is “nothing new other than crossed fingers”.

He also said elective, or routine, activity “will almost certainly cease for several months” as hospitals struggle to cope with growing pressures as a result of a reduction in the number of beds and the ongoing crisis in social care.

“Over the last two to three years we haven’t had to deal with any major outbreaks of infection such as norovirus or flu, but this year we are predicting a bad flu season that will overwhelm us after what we’ve witnessed in Australia and New Zealand,” he said.

“For all the talk of preparations, on the ground it feels as though there is nothing new this year other than crossed fingers – which is fair comment as the government has failed to tackle effectively the issues behind the pressures we face.”

He added: “If, as we expect, we see a flu outbreak, I think the NHS – in terms of both beds and clinical staff – will break far worse than last year and elective activity will almost certainly cease for several months.”

Dr Scriven pointed to a decline in bed numbers – with an estimate of 5,000 additional beds required to enable the NHS to survive the winter months – delayed discharges and recruitment difficulties as the “determining factors”.

Acute medicine, also known as acute internal medicine, deals with the immediate and early treatment of adult patients with a variety of medical conditions who present to hospital as emergencies.

The specialty receives the majority of patients admitted from A&E and plays a vital role in maintaining the flow of patients through emergency departments to avoid exit block, the term used when patients cannot be moved into a hospital bed.

“We constantly see the government roll out the same lines, such as the increasing numbers of patients being treated in the NHS every year and the investment being made in social care,” Dr Scriven said.

“The problem is, how can an argument be made for increasing numbers of patients being handled effectively when the number of beds available is not only not growing but is actually decreasing.

“Added to the ongoing issues of medically-fit patients being unable to be discharged due to a lack of infrastructure, we face turmoil if the system comes under pressure it simply does not have the capacity to sustain.”

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