The House of Commons’ Science and Technology Select Committee has released its report into the flu vaccination programme in England following a review earlier this year.
The Society for Acute Medicine would like to thank the Science and Technology Select Committee for seeking our expert opinion in this review.
We agree with the finding that leads them to question the extremely low uptake in social care workers and a large variability in hospital staff uptake of the vaccine.
We agree that the flu vaccine is an extremely important part of annual winter plans and, as such, any initiative that improves vaccination rates in those at risk and those caring for the at risk needs promoting.
As it stands today we do not know the impact influenza will have on us this year but we need to prepare as though it will be as widespread as last year, both with the vaccination programme but also making adequate provision in hospitals for the increase in attendances and admissions we expect to see over the next four months.
Following the publication of a freedom of information request by the Press Association which has revealed the General Medical Council (GMC) spent almost £30,000 fighting the case against paediatric specialist Dr Hadiza Bawa-Garba, Dr Nick Scriven, president of the Society of Acute Medicine, said:
“This was a tragedy on several levels, not least the death of a young boy.
“The ongoing damage is that the medical profession has lost faith in our regulatory body and that the vital learning through sharing experience may not be the same again.
“These figures will shock and further anger the medical profession as the money will have been raised by doctors’ GMC subscriptions and was used in a way the majority of doctors opposed.
“We need the GMC to make a concerted effort to rebuild trust with its members.”
Following the announcement the government is set to introduce statutory regulation for physician associates, Dr Nick Scriven, president of the Society for Acute Medicine, said:
“We are delighted to hear the news from the health secretary that he is supporting and starting the process to obtain legislation to regulate physician associates.
“They are already a truly valued extra source of skilled healthcare workers and we look forward to the future when they, as he says, can fulfil their great potential.”
Following the release of NHS performance data for September
, Dr Nick Scriven, president of the Society for Acute Medicine, said:
“The relentless pressure seen throughout the year is an indication of what is in store this winter.
“The sporadic funding announcements we’ve seen will serve only to help trusts maintain stretched services, not improve capacity and resource to the level it is required.
“That requires long-term planning and investment throughout the NHS and social care and a desire to focus on effective systems and processes as opposed to patchy cash injections which fall well short of the level required to oversee real change.”
Following the publication of the Care Quality Commission’s State of Care report for 2017/18, Dr Nick Scriven, president of the Society for Acute Medicine, said:
“Recent announcements of cash injections in the NHS and social care are useful for headlines but, in reality, most of this money is going towards keeping afloat ravaged services as opposed to substantive operational plans.
“Without proper long-term investment in social care, frontline healthcare services will be faced with increasing demand that can barely be met and short-term funding will simply enable struggling providers to keep going on a tightrope.”
Ahead of health secretary Matt Hancock’s announcement of a £240 million investment in social care to help avert a winter crisis in the NHS this year, Dr Nick Scriven, president of the Society for Acute Medicine, said:
“Any investment is welcome but we fear this is far too late to help in the coming months as it takes time for cash to work through to useful frontline resource.”
The takeAIM conference is a one day event, specifically designed for Medical Students, Foundation Doctors, CMTs, ACCS Trainees and Allied Health Professionals. The aim of the conference is to deliver relevant and useful clinical updates on top acute medical topics, as well as provide career information for those who are considering a career in Acute Internal Medicine.
There is a single conference fee of £70 (£50 for undergraduate students) which can be paid by debit or credit card via our secure payment portal on completion of your registration.
Poster Competition: Submit Your Abstract by 28th October.
After completing your registration please consider submitting an abstract for entry in our poster competition. Further details can be found here.
We look forward to seeing you on Saturday 10th November!
the takeAIM fellows
Click on the links below to view the posters displayed at SAMBournemouth:
Audit & Quality Improvement Posters
AQI 01: 4 Question Test (4QT) to Predict Dysphagia in Frail Patients on Admission
AQI 03: A comprehensive service evaluation and quality improvement project looking at the use of lumbar puncture (LP) in our Ambulatory
A&QI 05: A Multi-faceted Approach to Improving the Door to Needle Time for Neutropenic Sepsis in a District General Hospital
AQI 09: A&E – What a headache
AQI 10: Ambulatory Care unit QIP in a district general hospital. Are we utilising ambulatory care unit effectively?
A&QI 12: An evaluation of the efficacy of the “intra-take” ward round on the Acute Medical Unit at West Middlesex University Hospital
AQI 13: An evaluation of the function of our Medical Short-Stay Unit (MSSU) and validation of the ability of the MSSU score to identify patients
A&QI 15: Assessing the common diagnostic tools in Subarachnoid Haemorrhage
AQI 21: Cancer patients’ admission in a newly established ambulatory emergency unit
AQI 23: Correctness of diagnosis and Management of urinary tract infection at Whipps Cross Hospital
A&QI 24: Cross departmental study investigating recording of patients’ weight prior to prescription of weight-based drugs: acute assessment units vs wards
AQI 25: Delayed patient’s length of stay; results from the London Day of Care Survey (DoCS)
A&QI 26: Developing a new pathway for patients with suspected DVT: Providing a more streamlined route from Primary Care to Acute Medicine
A&QI 27: Development of a patient information leaflet to improve care of patients with deep vein thromboses
AQI 29: Does a Specialist Early Therapy Assessment decrease length of stay for frail patients attending the Emergency Department
A&QI 31: Electronic Do Not Attempt Cardio-Pulmonary Resuscitation (DNACPR): Too Far? An evaluation of practice within Gerontology, King’s College Hospital, London
AQI 36: High Flow Oxygen Therapy in ICU or in the wards?
A&QI 40: Impact of rapid influenza testing on antimicrobial utilisation
AQI 46: Improving escalation of care decision making on the acute medical take
AQI 47: Improving Medical Handover at Addenbrookes Hospital
AQI 48: Improving Medical Handover at Fairfield General Hospital: a Quality Improvement Project
AQI 49: Improving Patient Experience: patient understanding of their care on the AMU
AQI 50: Improving the uptake of HIV testing for clinical indicator conditions in the Acute Medical Assessment Unit in Cork University Hospital
A&QI 53: Introducing Safety Huddles into an Acute Medical Unit
A&QI 54: Introduction of TLoc Bundle
AQI 55: Investigating associations between Frailty, Therapy Complexity and therapy time
AQI 59: Pan-London Day of Care survey: common reasons for in-hospital delays
AQI 63: Reducing errors in blood test ordering
A&QI 66: Rethinking Patient Referral: Findings from a GP-to-Acute Medicine Referral/ Audit
AQI 71: The Appropriateness of Use of Prothrombin Complex Concentrate in a Large Tertiary Centre
AQI 78: Urine sampling – choosing the right bottle: a quality improvement project
A&QI 79: Use of an electronic toolkit in improving care of patients with decompensated liver cirrhosis
AQI 80: Using National Early Warning Scores to Predict Length of Stay and Appropriate Use of Short Stay Medical Teams
A&QI 81: Using qualitative methodology to progress a stalled quality improvement project to implement “single clerking” in a small district general hospital
Case Report Posters
CR 04: A rare diagnosis presenting as a posterior circulation stroke
CR 07: An Atypical Case of Miller Fisher Syndrome in a Young Man: A Neurological Dilemma
CR 09: An Unusual Cause for Hypokalemia
CR 10: Breastfeeding almost killed me – A case of lactation anaphylaxis
CR 14: Crowned dens syndrome: an unusual cause of fever and neck stiffness
CR 16: E-thrombosis: A (thought) provoking case of DVT?
CR 17: Enterovirus encephalitis presenting with acute psychosis
CR 19: Great minds think alike: a complex acute neurological presentation of Multiple Sclerosis mimicking cerebral metastases
CR 20: If you hear hooves think horses… but occasionally it will be a zebra
CR 21: In Mondor where the thrombus lies: An unusual case of thrombophlebitis of the thoracoepigastric vein
CR 32: Symmetrical peripheral gangrene – a VERY rare presentation of Plasmodium Falciparum Malaria
CR 35: The Combined Oral Contraceptive Pill: A Rare Trigger for Acute Kidney Injury
E02: Asked to SIM patient – a pilot simulation programme to improve the confidence at the new FY1 on call
E 09: Multidisciplinary Simulation Training Experience for Acute Diabetes and Endocrine Emergencies
E 11: Preparing to be the Medical Registrar On-call: Core-Medical Trainee (CMT) Simulation Program
E14: Surviving Nights – Benefits of near-peer teaching for new FY1 doctors
R11: Feasibility of measuring Resilience and explanatory variables in Acute Medical admissions
R 13: Is a wait in the Emergency Department (ED) associated with an increased Length of Stay (LOS)?
R15: Procalcitonin use in the presence of ambiguous physiological parameters: a help or a hindrance?
R 16: The challenge of prognostication and making ceilings of care decisions
R 18: The Spectrum, Assessment, and Diagnosis of Neurovascular Ophthalmic Presentations Referred to the Acute Medical Unit in Cork University Hospital
Service Organisation & Design Posters
SOD 01: Ambulatory management of acute pulmonary embolism at Poole Hospital NHS Foundation Trust
SOD 04: Developing and Enhanced Care Unit on the AMU
SOD 07: Impact of the integration of a pharmacist into the acute medical clerking team
SOD 11: Nurse-led screening of acute medical admissions: right-siting and readmissions
SOD 15: Staff Engagement on the Acute Medical Unit
SOD 16: Talking the Language of Frailty from the Front Door
A leading doctor has said the country cannot allow Brexit to overshadow concerns being raised by senior medics about the ability of the NHS to cope this winter.
Dr Nick Scriven, president of the Society for Acute Medicine, said issues around social care, funding, staffing, pay and morale “need to be addressed urgently” but are being “somewhat lost in the mire”.
He has also urged the health secretary to work with specialists in acute medicine to “help overhaul” urgent care by “taking more interest in what is working on the ground right now”.
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.
“This week has seen Brexit return to take over and my concern is that the government does not take leave of its responsibility to prepare the NHS adequately for the tough months ahead and listen to the frontline,” said Dr Scriven, speaking at SAM’s annual two-day conference in Bournemouth.
“When asked recently what the Department for Health and Social Care should be focusing on, 1% of clinicians in acute medicine said Brexit, while 40% said social care provision, 26% funding, 16% staffing and 13% morale linked to nurses’ pay – this tells us a story.”
To coincide with the conference, SAM has published a report – Society for Acute Medicine Benchmarking Audit (SAMBA) 2018 – on the performance of acute medical units.
The audit, which covered 127 units and 6,114 patients over a 24-hour period in June, showed more than two-thirds of hospitals (69%) had a bed occupancy of more than 90% – which is above the recommended safe level of 85%.
In addition, 45% of units had no advanced nurse practitioners, 60% had no access to social workers to help speed up the provision of social care support and a fifth of patients had been readmitted to hospital within 30 days.
The audit did highlight the success of ambulatory emergency care, a service which provides same-day emergency care, with 80% of patients assessed, diagnosed, treated and discharged on the same day – but only 20% of patients received their first medical assessment in ambulatory care.
“Our data, collected on a given day in June when we would traditionally be experiencing some respite, showed almost 70% of hospitals had bed occupancy of more than 90% and that is a concern as we head into winter aware the NHS is 3,100 beds short of the number it required last year to cope,” said Dr Scriven.
“Familiar themes have cropped up again – bed capacity, social care and staffing – yet we can see success in the development of ambulatory emergency care, where large numbers of patients are being seen, treated and discharged on the same day.
“At present, however, less than 20% of patients are seen in ambulatory care units and many do not run in evenings or at weekends due to funding and staffing, but increasing this to just 30% would have a transformative effect on capacity nationally.”
He added: “Patients suitable for treatment in ambulatory emergency care take up two bed days on average if admitted to medical wards, so we really need our leaders to start taking more interest in what is working on the ground right now.”
In a speech to members which will be delivered later today, Dr Scriven will say: “Yet again, this winter will be bad and we know without doubt the NHS will creak under the pressure, but acute medicine is the glue that holds the NHS frontline together and we will look after each other.
“However, we must continue to fight for what we believe is the best care for our patients and hold people in power to account.”
The 7th Society for Acute Medicine Benchmarking Audit (SAMBA18) provides a snapshot of the care provided for acutely unwell medical patients in the United Kingdom (UK) over a 24-hour period on Thursday 28th June 2018.
The report is written for the benefit of everyone involved in acute medical care, including healthcare professionals, commissioners of healthcare, all UK governments and, most importantly, patients and the public.
The report has been sponsored by the Society for Acute Medicine (SAM). Everyone involved in conducting the study and writing the report have provided their time voluntarily. Collecting data and running SAMBA in participating hospitals is a huge undertaking and therefore both the Society and SAMBA team extend a huge thank you to everyone who participated this year.
The only reason to undertake all this hard work is to improve the care we provide for patients. We hope we have gone some way to achieving our goal, although we know there is more work to do. We look forward to hearing your views and having you joining us for future SAMBAs.
SAMBA18 Interim Report
Following the release today of NHS performance data for August, Dr Nick Scriven, president of the Society for Acute Medicine, said: “This data shows the system is under more pressure than ever before and, as we move closer to winter, there are grave concerns as to the ability of the NHS to cope.
“The winter plan published this week by NHS Improvement offered little help for those on the frontline, while the recent government announcement of funding for 900 extra beds leaves us 3,100 short of the additional amount required last year.
“Alongside a staffing crisis, this all presents a massive concerm for those in emergency and acute medicine who have worked through two intense winters and six months of unremitting pressure.
“At the end of the worst of the winter pressures earlier this year, we suggested the NHS needed to consider a more formal suspension of non-urgent surgery during the busiest periods and we again say that, although unpopular in some quarters, it needs re-examining.
“Nothing can be worse for a patient than having planned care cancelled at the last minute and only an NHS-wide and mandated reduction in elective operations might avoid this scenario while giving hospitals a chance to cope with urgent care.”
Leading doctors have welcomed the Department of Health and Social Care’s announcement of a £145 million investment to help NHS hospitals cope this winter.
However, they have warned the additional 900 beds will not “scratch the surface”, falling 3,100 short of what was required last year, so the support of clinicians will be “imperative” to the success of any preparations.
“We are pleased at this positive action as staff on the frontline have been calling for much greater efforts to help better prepare hospitals for the growing pressures of winter for the past three years,” said Dr Nick Scriven, president of the Society for Acute Medicine.
“Although 900 extra beds are welcome, we note last winter the total number of extra beds in use was 4,000, so this additional investment will need to be combined with efforts to engage with clinicians as to how to prepare effectively.
“A recent survey of our members showed that 60% of staff, at present, feel worse prepared for this winter than last and morale has been battered due to a lack of respite during a high pressure summer.
“Added to that we have the realisation the union recommended pay deal was far from the deal envisaged for the vast majority of staff and, for medical staff, below inflation yet again.”
Dr Susan Crossland, vice-president of SAM, added: “This announcement is good news, but there is a long way to go and, as the group who look after both the largest proportion of those admitted as emergencies and those who avoid an admission by using ambulatory emergency care, we have a wealth of experience to share with those who seek to make policy and plans.
“So far we have not been offered an opportunity to help so we would urge the health secretary to engage with us to look at solutions which can complement this additional funding announcement.”
Acute 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 helps maintain the flow of patients through emergency departments to avoid exit block, the term used when patients cannot be moved into a hospital bed.
Following a warning from Royal College of Physicians’ president-elect Dr Andrew Goddard about the impact of Brexit on the NHS workforce and international recruitment, Dr Nick Scriven, president of the Society for Acute Medicine, said:
“We, like the RCP, find this extremely worrying in current financial and staffing climate.
“We know many of our medical and nursing posts on the ‘frontline’ of urgent care are unfilled or occupied by highly skilled hard working people from outside the UK.
“We fully support Dr Goddard’s closing remarks regarding a challenge for the government to provide certainty.”
Following the release of NHS performance data for July, Dr Nick Scriven, president of the Society for Acute Medicine, said:
“These figures show the additional strain the health service has been under during the recent spells of extremely hot weather in the UK.
“We know the heatwave has led to increases in attendances and admissions, particularly among the frail elderly suffering from dehydration resulting in a range of medical problems.
“Attendances to emergency departments were up 4.9% and admissions to hospitals by 5%. A lot of these people were actually very sick and nearly a third of those attending major emergency departments needed admission which is higher than any previous July.
“What is of particular concern now, however, is that the summer months are traditionally the time acute hospitals and frontline staff have to recharge the batteries – this year we have had no respite and draining conditions.
“Last year NHS leaders admitted it took until October to recover from winter 2017 and we are now only a few months away from the next onslaught.
“However, the winter-type levels of activity we have seen in recent weeks have given the new health secretary an insight into the sorts of issues we are likely to see intensify by the end of the year.
“On the plus side, this may have triggered alarm bells earlier than normal and lead to some positive actions being put in place to help us contend with the inevitable winter pressures we will face.”
As the UK heatwave continues, Dr Nick Scriven, president of the Society for Acute Medicine, reflects on the effects of recent high temperatures across the UK and warns of further strain on the NHS.
“There was an increased pressure both on emergency departments and the number of admissions numbers during the main part of the heatwave.
“Previous studies in America have shown that pressure due to heat-related conditions can last up to eight days after the temperature drops from the highest levels.
“The overall numbers may not turn out to be massive as the effect was not present for months but the pressure was real and felt at the frontline.
“Heatwaves causing dehydration can lead to many issues, especially in the frail elderly, causing dizziness and falls through to an increased risk of infections (particularly urinary), heart attacks and strokes.
“The other heat-related issue is air quality the can really affect those with respiratory conditions such as asthma or COPD. This would have been much more prevalent in big cities
“I would not be surprised at all if an effect on mortality is shown. In Aug 2003 there were roughly 2,000 extra deaths attributed to the heatwave and again it was in the over 75s and those in south east England (mostly London).
“Temperatures this weekend are going to be even higher than before with even more risks of illness and death and considerable strain on the NHS staff working in often intolerable conditions.
“Compounding the heat is the fact that this is prime holiday season and there is little slack in the system regarding staff numbers as this is traditionally the time we have to recharge ahead of winter.”
As the UK heatwave continues, Dr Nick Scriven, president of the Society for Acute Medicine, said:
“Most of our hospitals are designed and built to keep patients warm throughout the year but in high temperatures they can become overheated rooms with little ventilation.
“This is bad for patients who even if they do not enter hospital dehydrated can become so but also for staff having to work in sweltering conditions.
“This is physically and mentally draining – the usual solution you see in wards is a desk fan or a wall mounted fan blowing the hot air around.
“Admission levels are high and some units saw winter levels of activity yesterday with a lot of respiratory symptoms presumably due to air quality.”