A leading medic has said some NHS hospitals struggling to recover from winter have “bounced unexpectedly” into a summer crisis due to soaring temperatures across the UK.
Dr Nick Scriven, president of the Society for Acute Medicine, said many hospitals had seen a large increase in attendances and admissions due to dehydration – particularly among the elderly.
He said this had added to pressures on emergency departments and acute medical units over recent weeks – derailing attempts to recover ground lost over the winter period.
His comments came as the Met Office said this summer is set to become the hottest since records began, with warnings the heatwave could persist in some parts of the UK, mainly the south and east, until mid-August.
Temperatures are expected to reach up to 31C over the weekend and the mid-30s from next week.
“We know about the effect cold weather has on health but the recent hot weather has reminded us that heat can be equally as dangerous for people, not only the frail elderly but also those working outside,” said Dr Scriven.
“Hospitals are seeing large numbers of patients, particularly the elderly, requiring hospital treatment for dehydration and it’s affects and that is stretching capacity in some areas.
“The concern is that, certainly in some hospitals, we have bounced unexpectedly from the recent extreme winter into a summer crisis when hospitals will be attempting to get back on track.”
Dr Scriven said it was “an important time” to remind people to take care in the hot weather and do what they can for the elderly.
“Although everyone is at risk during periods of extreme heat, the elderly are a particular concern and, wherever possible, people should do what they can to look out for their relatives and neighbours,” he said.
“Just keeping check on them, ensuring they are cool and well hydrated and have people they can call on can all help to avoid hospital admission in this vulnerable group.”
Following Prime Minister Theresa May’s cabinet reshuffle, which saw former health secretary Jeremy Hunt replaced by former culture secretary Matt Hancock, Dr Nick Scriven, president of the Society for Acute Medicine, said:
“I have somewhat mixed feelings about this reshuffle.
“On the one one hand we are saying goodbye to a health secretary who has been more interested in scoring political points than listening to the views of the frontline.
“On the other, in what is a crunch year in determining if the NHS is able to cope with another winter crisis, we are unable to hold Mr Hunt to account.
“The jury will be out on the new health secretary to see if he is able to put his financial skills to good use and ensure adequate funding and appropriate use of resources for the NHS in the coming months and years.
“We look forward to meeting Mr Hancock as soon as possible to talk about frontline pressures in the NHS, something we never achieved with his predecessor.”
“As the NHS approaches its 70th birthday, those who work in acute medicine need to reflect on how far the specialty has come, what it stands for and what challenges are on the horizon. Acute internal medicine is a relatively young specialty with the Society for Acute Medicine due to celebrate 20 years in 2020.
“It has overcome many adversities to get where it is today. It took several years for the royal colleges to acknowledge its value and it wasn’t until 2008 that the Royal College of Physicians was actively promoting it. Even since then people have continued to question its value, including one person memorably calling acute physicians the ‘traffic wardens of general medicine’.
“In the last two to three years, however, the specialty has become mainstream, with places at the ‘high table’ of medicine. It is a valid belief that without acute internal medicine and acute medical units the last two winters would have brought the NHS catastrophically to its knees.
“It is to the great credit of all those multi-disciplinary teams that the service has survived and patients get high class urgent medical care.
“It is an interesting observation that many of the worst-performing hospitals with regards the emergency department four-hour target are those with systems that lessen the effectiveness of the AMU by splitting up the patients who need help when we know that many are frail with multiple issues.
“The current acute internal medicine team is proactive and promotes team working from many disciplines/trades in medicine for the good of the population. The specialty now has a voice in the world and is not afraid of challenging poor practice, previously untouchable notions or practices that are perceived as barriers to the system, especially when things get even more hectic than the normal ‘eternal winter’ in the NHS.
“So where next? Obviously the NHS needs to start now in reviewing activities and planning for the next onslaught – it is interesting that the secretary of state for health and social care still maintains that, in 2017, planning started earlier than ever before and the NHS was better placed than ever before. He repeated that statement at the RCP conference last week and implied that last year’s planning started in April. Many people working or being treated in 2107/18 would not recognise this.
“We need answers as to why the system was 4,000 beds short for many months and why figures show several thousand more deaths than previous years. One common statement between us and the politicians is that scenes depicted in winter cannot happen again but, so far, there doesn’t appear to have been any actions to back up the rhetoric.
“What can we in acute medicine do? Primarily we need to look after the staff who look after the patients – without the caring, highly-skilled people who work in our units we would be nothing. We need to care for them, support them and nurture them to give them the time and space not only to recover but to enhance and develop their skills. This applies to all staff.
“One example SAM is trying to push is the development of a transferable qualification for our vital advanced practitioners to recognise and reward their skills and wish to help. We need this to make certain this group of important workers – who are relatively new to our workforce – feel valued and supported and do not leave us. SAM has asked the RCP for help in this but it is taking far too long to respond to this urgent need.
“In the bigger picture, it is our duty to make certain that any extra funding is used wisely and not frittered away on projects without proven benefit to the greatest number of people – a start would be to release funds to staff the extra beds we so vitally need to relieve some of the pressure at the sharp end of hospital health care.
“If we can sort this to give the system breathing space, only then can we have the time and capacity to invest in all those things that are longer term aspirations to improve the nation’s health for years/decades to come. At the same time, we need to invest in technology that works for those providing care and actually enhances the way they look after patients and not add to the time burden for admin that virtually all electronic patients care systems to date have done.
“However, to do this, the powers that be need to urgently realise that they need the right experts giving them advice and that those experts reflect the realities of medicine in 2018 in the hundreds of hospitals up and down the country outside of the traditional massive tertiary units in our largest cities where practices and case mix do not reflect the majority of the country.
“Only by doing this will we serve the whole population and ensure the NHS remains a vibrant, improving and caring institution entering its 71st year and beyond.”
Commenting on a Sky News interview regarding staffing and cancer outcomes with NHS chief executive Simon Stevens, Dr Nick Scriven, president of the Society for Acute Medicine, said:
“NHS staffing is central to the success of the service and its ability to cope as a whole, not just in specific areas.
“There remains an NHS-wide workforce crisis and everyone acknowledges the desperate need for change.
“A critical objective must be to improve the working environment for our staff to enhance recruitment and maintain retention.
“We need to make substantive posts as attractive as locum positions, a move which would enhance our service and save money.
“We also need more beds, with the NHS 4,000 short during the last winter crisis and wards are closed up and down the country.
“The long-term ambition must be to proactively have these open with staff trained appropriately and working in areas of care they are used to.”
A senior medic has said details of the £20 billion a year cash promise for the NHS announced by prime minister Theresa May will be “crucial” to its impact.
Dr Nick Scriven, president of the Society for Acute Medicine, said it was a “welcome boost” but it must be spent on “proven effective measures”.
“This cash promise from the prime minister is a welcome boost for the NHS but, as usual, the details will be crucial to see what will be helped but at what cost and which areas remain at financial risk,” he said.
“There are so many areas of the NHS, both in and out of hospitals, that need money and it is the responsibility of the health service to use it wisely and in areas where the most benefit will be felt.”
He added: “It must translate to better care for the many poorly people who depend on urgent and emergency care as well as doing something for those reliant on primary care.”
Dr Scriven spoke out ahead of Acute Medicine Awareness Week (18 to 22 June), which will see staff in acute medical units across the country undertake activities and provide information for patients and visitors to improve understanding of the specialty.
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.
He said the announcement of further funding for the NHS would provide an opportunity to utilise and enhance the areas of healthcare which have proven successful despite a squeeze on resources.
“Additional funding in the NHS must be spent on proven effective measures and not smaller so-called vanity projects that may have vociferous media profiles,” he said.
“Acute medicine has been at the forefront of developing seven-day acute care services, as well as ambulatory care, and has overseen reductions in length of hospital stays, mortality and readmission rates.
“Its success has resulted in many people not needing to stay in hospital more than 24 hours who previously might have stayed three days or more.”
He added: “Now the money seems forthcoming we call on leaders to put acute medicine at the centre of their strategy to get our hospitals working again.
“It will be imperative for the secretary of state to meet with a broad range of staff at the sharp end of acute care to discuss the next steps and the implementation of additional resources.”
We have received permission to share the following presentations from the conference. More will be shared in due course. Click on the links below to view.
Thursday 3 May
PLENARY 1: ORGANISING THE BEST HEALTHCARE
Realistic Acute Medicine
SESSION 2.1: ORAL PRESENTATIONS OF THE BEST ABSTRACTS
Oral Presentations of the Best Abstracts
SESSION 3: BRIDGING THE GAPS
Diabetes Mellitus: Our Role in Preventing Long-term conditions
SESSION 3.1: PSYCHIATRIC EMERGENCIES IN ACUTE MEDICINE
Recognising and Reducing Suicidal Behaviour
Psychiatric Presentation of Physical Illness
SESSION 4.1: THE ACUTE CONSULT
My patient has had a Stroke: Do I just give an Aspirin
Friday 4 May
SESSION 5: CARE OF OLDER PEOPLE
Hospital at Home
Admission Avoidance: The Dutch Way
Acute Frailty Network
SESSION 5.1: SAM & DAM TRAINEES: INNOVATIONS & IT IN ACUTE MEDICINE
Digitalising Paediatric Resuscitation
Acute Medicine in the Cloud
SESSION 6: TOXICOLOGY
Antidotes: Unusual Suspects
SESSION 6.1: RARITIES IN ACUTE CARE
Sickle Cell Crisis in Western Europe
Acute Care: The Dutch Way
Acute Care: The British Way
Almost the Last Word
A senior medic has said NHS leaders must “think radically” about capacity in hospitals to avoid another winter crisis – including a potential two-month suspension of non-urgent surgery.
Dr Nick Scriven, president of the Society forAcute Medicine, said the “massive challenges” in delivering acute and emergency care this year “will not go away or lessen in any way” over the coming years.
He also said there was no “quick fix solution” and a “long-term review and overhaul” could be needed “to make any gains”.
“The NHS is struggling to cope with yearlong pressure, worsened in winter, and the capacity to treat all patients quickly and safely,” he said in an editorial published today by the British Journal of Hospital Medicine.
“The pressure is on to find a way forward and improve matters including thinking what might have been previously unthinkable. We simply cannot allow what has happened in 2017–18 to become the ‘norm’.”
His comments come ahead of NHS chief executive Simon Stevens’ speech at the NHS Confederation conference in Manchester in which he will call on hospitals to cut stays of more than three weeks by 25%.
“We welcome Mr Stevens’ comments and the fact someone is thinking about the next winter season, but to achieve further reductions in length of stay will almost certainly require investment in both hospital and community care,” said Dr Sriven.
“Some of those who now need to stay in hospital are far sicker and frailer than before and, as a result, the length of stay for those inatients will rise, while the main blocks will be seven-day access to diagnostics and the availability of therapy staff to keep patients fit and mobile.”
Dr Scriven said the closure of wards across the country was “hampering efforts” to tackle capacity issues while simultaneously “draining” hospital trusts financially due to reliance on expensive agency staffing.
“Wards are closed up and down the country – the long-term ambition must be to proactively have these open with staff trained appropriately and working in areas of care they are used to,” he explained.
“This could realise long-term financial savings as well as patient care improvement as a result of an eventual ability to ‘self-staff’ and no longer rely on expensive agency staff.”
In addition to the yearlong rollout of NHS England winter situation reports, health promotion, community care access for the frailest in the population and the sharing of effective models of care, Dr Scriven urged the consideration of an annual two-month break in elective operations.
“For at least two years we know that the pressures on the system have caused last-minute delays and cancellations of thousands of operations, leaving patients suffering and teams frustrated,” he said.
“Why not consider running a full elective service for 10 months of the year and restrict surgical activity to urgent and lifesaving procedures during times of highest pressure.
“This may be unpalatable to many but it would have advantages – patients would know in advance a date for treatment that is much more secure than it is currently, patients would avoid the stress of last minute cancellations, surgical colleagues could plan more effectively and surgeons could work at the ‘front end’ in winter supporting the acute wards.
“This would free up bed capacity and trained nurses along with generically training junior doctors to support patients – of course it needs planning and this has to be a long-term solution to give patients and healthcare organisations time to work it through.”
Following the decision of members of 13 unions which represent NHS staff to accept a 6.5% pay deal, Dr Nick Scriven, president of the Society for Acute Medicine, said:
“We are glad that this rise has been agreed by the majority of staff who have considered the proposals for themselves and read the details behind the headline figures.
“Staff are the lifeblood and glue that hold the NHS together and it should be remembered that they have seen a 14% drop in real-terms income since 2011.
“So while it is welcome to see staff being recognised, it has been a long time coming and we now need to continued action including the necessary funds required to keep the NHS safe and sustainable.”
Following a report published by the think tank Global Future on the reliance of the NHS on overseas staff, Dr Nick Scriven, president of the Society for Acute Medicine, said:
“This new message from the Global Future think tank has added to the feeling that the government needs to urgently look at the visa issue for doctors currently not on the shortage-occupation list.
“Staffing remains one of the largest challenges facing the NHS and these skilled practitioners not being able to work in the NHS remains a massive issue both for patient care at the front end of medicine but also the financial costs associated with trying to fill gaps with locum or agency staff to keep patients safe and waiting lists down.
“We hope that this submission to Downing Street is listened to and action is forthcoming.”
Commenting on a report released today by the Nuffield Trust which shows the number of patients being readmitted to hospital in an emergency with potentially preventable conditions has grown significantly in the last seven years, Dr Nick Scriven, president of the Society for Acute Medicine, said:
“This report truly highlights the problems faced by acute hospitals in that in order to admit the unstable and unassessed, we are having to press harder and harder to discharge patients with the inevitable consequences of readmissions.
“This really hits the frailest who are at risk. Some of the figures are disturbing and could be indicative of hard-pressed staff not able to deliver the care they would like to give – this relates in particular to the pressure sore data.
“Sometimes we have to acknowledge that we need to keep patients in hospitals longer than we would hope to give them a chance to recuperate enough not to need a readmission.
“This is where community care should be picking up the load and really we would ideally rethink the now almost total lack of community beds.
“Each readmission is a tragedy for the individual concerned in that it further puts them at risk of declining health in a downward spiral and, in my view, is often a consequence of units and individuals being totally overstretched by demands on them.”
The SAMBA18 site is now live and ready for you to register!
Please go to https://samba.acutemedicine.org.uk
Once you have registered we will then approve your account and send an email with instructions on setting your SAMBA18 password.
On the SAMBA website you will find Caldicott approval forms, FAQs, a ‘How to’ guide and much more.
Any questions or queries please feel free to contact the SAMBA team firstname.lastname@example.org
Thank you for your support for SAMBA18
Dan Lasserson, on behalf of the SAMBA team
Commenting on the NHS key statistics briefing paper (May 2018) published by the House of Commons Library, Dr Nick Scriven, president of the Society for Acute Medicine, said:
“This data is essentially a resume of the massive pressure the NHS has been under and must act as a prompt to government and those who organise the NHS into action now.
“It shows 18% of type 1 emergency department patients waited more than four hours in April and these are patients who are ill (i.e. not minors).
“It’s sad that we still have to comment on performance when we should be now planning for the immediate and longer term.”
Following an article published today by the Health Service Journal which reported the Care Quality Commission has assumed standards in the health and social care sectors could deteriorate in 2018-19, Dr Nick Scriven, president of the Society for Acute Medicine, said:
“It is good to hear such frank views from the regulator but we need to see a reaction from the Department of Health and Social Care in terms of a response.
“We need a plan to turn this trend around without it being a stick to beat staff with – even the secretary of state has acknowledged they can’t work any harder.”
Commenting on a report released today by NHS Providers which says promises to bring more patient care closer to home by prioritising NHS community services have fallen flat, Dr Nick Scriven, president of the Society for Acute Medicine, said:
“This is shocking news and extremely concerning. From my point of view the only thing preventing the total meltdown of our acute hospital services is community care in its broadest sense.
“Almost all the plans for how the NHS as a whole is meant to cope with demand both in short term (i.e. winters) and the longer term as in the five-year plan and, more recently, the proposed ‘STPs’ are predisposed on increased care closer to home for patients, both preventing admissions to hospital and also providing timely care after the acute illness has past.
“This report gives a much-needed but frankly distressing wake up call to all those who currently write the policies and tell us year on year things will be better, mainly because of better (i.e. more costly) community care projects.
“On a slightly smaller scale, many hospitals up and down the country have capital and staffing plans based on proposed community care projections and if, as is shown, these are nothing but pipe dreams it will mean the financial and operational viability of many units will be on a knife-edge
“Going forward, without proper long-term investment in this vital area of care for millions of people, the acute sector could be plunged into another cycle of increasing demand that can barely be met and that will not only be in the ‘winter pressure’ season but day on day every month of the year.”
Following reports published today of a letter sent by the UK Statistics Authority to NHS England regarding a lack of progress made on addressing concerns around the accuracy of accident and emergency waiting times statistics, Dr Nick Scriven, president of the Society for Acute Medicine, said:
“We really need to have accurate data on how our systems are performing and to hear that these recommendations have not been implemented is distressing. The cornerstone of any plans we can make for next winter hinge on having a realistic picture of how things actually are.
“There is also the matter of timely data and how this is disseminated to those who need to know [via NHS England weekly winter sitrep reports]. This year the sitrep reporting period officially finished at the beginning of March. Since then we have had patchy monthly figures of limited detail but can we now even trust that?”
The Society for Acute Medicine’s 7th Acute Medicine Awareness Week is going to be taking place week commencing Monday 18 June 2018 in all the acute medicine units throughout UK. Units are advised to choose any day that is convenient for them within the week for the celebration of everything acute medicine.
Registrations for the Awareness Week are now open! To register, please complete the registration form here and return this to Elin Andersson, email@example.com, to register your participation for the week. Please tell us what date you have chosen to celebrate everything Acute Medicine in your department.
Send us the picture of the day to the SAM facebook page. A panel of judges would choose the first place winner from the participating centres who will receive a certificate signed by the SAM President and gift prize.
A resource pack of tips and information can be downloaded from SAM website through this link:
If you are looking for any ideas of what to do please look at the activities through the link below which were organised by SAM members in previous year.
This year Acute Medicine Awareness Week is been organised in collaboration with takeAIM Fellows. Please visit our website, http://www.takeaim.org.uk/ for everything Acute Medicine and to download AMAW18 materials
Following the release of NHS performance data for April, Dr Nick Scriven, president of the Society for Acute Medicine, said:
“The NHS has faced massive challenges in delivering acute and urgent care this year and these will not go away or lessen in any way over the next years and decades.
“There were more than six million emergency admissions in April, the four-hour target was 2% down on the previous year and 5,000 beds were taken up by delayed discharges – there is little sign of any let up.
“There is an absolute need to start reflecting on what has happened and plan ahead and factored into this must be an understanding of how essential it is to get it right to ensure the workforce has adequate time to recover and energise.
“We wait in great anticipation for the secretary of state’s long term plan for the NHS to be unveiled but it must also be made very clear that short term planning is crucial if we are to create a safe, quality and sustainable service for patients all year round.”
View the Presentations from the conference here
Click on the links below to view the posters selected for display at SAMsterDAM2:
Audit and Quality Improvement Posters
AQI01: A quality improvement project to look at the use of clotting screens on patients admitted to AAU and a further cost-benefit analysis
AQI03: Age Adjusted D-dimer, Ready for Prime Time?
AQI04: Ambulatory Paracentesis – An audit and quality improvement project
AQI05: An evaluation of volume status assessment in acute kidney injury: A quality improvement project
AQI06: Delivering the fastest thrombolysis in acute ischaemic stroke in the UK: The quality improvement journey of a small rural district general hospital
AQI07: Did adding the EMR score to the Query PE proforma improve the management of patients with Pulmonary Embolism?
AQI08: Don’t just Datix®, try Greatix! Excellence Reporting on an AAU
AQI10: Enhancing the discharge process on the Clinical Decisions Unit
AQI11: Improving Fluid Management in AKI Patients: The ‘MAGNETIC’ Intervention
AQI12: Investigation of Acute Headaches on Ambulatory Emergency Care (AEC)
AQI13: Measuring ‘True Admission Avoidance’ in Ambulatory Care
AQI14: Patient Safety: Introduction of ward round safety checklist on AMU in Chester
AQI16: Reducing drug errors during medical admission
AQI17: Sprotte® the Difference
AQI19: The introduction of a dedicated discharge summary doctor improves patient flow during weekends at Bradford Royal Infirmary
Case Report Posters
CR02: A Case of Bilateral Adrenal Haemorrhage Post Total Knee Replacement with a Possible Link to Apixaban
CR04: Another case of hyperkalaemia?
CR05: Kikuchi’s disease in a returning traveller
CR06: Lactic Acidosis in Type-1 Diabetes Mellitus: What possibilities you consider?
CR07: More, Less or Both?
CR09: Scurvy, 250 years after Lind
CR12: What comes first? Heart or platelets….
E01: Acute medical emergencies: Our experiences of developing a teaching programme for medical students using simulated real-life scenarios
E02: Acute Medicine Finishing School
E05: Capabilities in Practice – A Novel Assessment Method for Postgraduate Physician Training
E06: Development of Simulation-based education for acute medical emergencies in Wales
E07: Education challenges on the AMU
E08: Is it time for a formal undergraduate Acute Medicine curriculum?
E09: Permanent skin pigmentation following extravasation of iron infusion
E10: Strong Transitions: The ultimate medical registrar preparation course
R01: A systematic review and meta-analysis on the effect of statins and antiplatelet drugs on D-dimer levels
R02: Arterial Blood Gas Analysis: As safe as we think? A multicentre retrospective cohort study
R03: CAM-ICU may not be the optimal screening tool for early delirium screening in older ED patients
R04: Comparing the predictive value of qSOFA score and SIRS criteria in COPD patients in the ED
R05: Comparison of the impact of AKI between common acute medical diagnoses
R07: Disease perception and clinical impressions of patients, nurses and physicians predict 30-day mortality and other adverse outcomes in older emergency patients
R09: Effect of appropriate empirical antibiotic therapy on mortality in patients with bloodstream infection is confounded in a general heterogeneous population
R10: Elderly patients visiting the ED in the Netherlands: A profile of patients’ and healthcare providers’ perspectives on preventability
R11: How do clinicians judge whether a patient is hypovolaemic and in need of intravenous fluid resuscitation: A qualitative study
R12: How does multiple myeloma present to acute services? Data from the TEAMM (Tackling Early Morbidity and Mortality in Myeloma) Trial
R13: Impact of Geographical Localization of Physicians to a Single Unit on Physician-Nurse Communication
R14: Long completion times in the ED: A root cause analysis
R15: POCUS in Recognising Papilloedema and Raised ICP on the Acute Medical Unit
R17: Prognostic value of quick-SOFA (qSOFA), Systemic Inflammatory Response Syndrome (SIRS) and clinical bedside judgement in the ED
R19: Repeated vital sign measurements in the ED predict patient deterioration within 72 hours: A prospective observational study
R21: Screening for vulnerability at the ED: Predictive value of frequently used screening instruments
R22: Screening instruments for identification of vulnerable older adults at the ED: A critical appraisal
R23: The influence of vasoactive medication on heart rate variability in patients presenting with sepsis at the ED
R25: Vital signs and impaired cognition in older ED patients: the APOP study
Service Organisation and Design Posters
SOD01: A morning cuddle – The impact of a morning AMU huddle
SOD02: A Novel Ambulatory CT Pathway for the AMU
SOD03: Adherence to Geriatric ED guidelines in routine care
SOD04: Annualisation of weekly working hours to implement Consultant delivered service during unsocial hours and Consultants Satisfaction
SOD06: Logistic Differences in EDs in The Netherlands
SOD07: Management of AF in Medical Ambulatory Care reduces hospital admissions and is cost effective
SOD09: Rota Change in Acute & General Internal Medicine: Improved Patient Care & Junior Doctor Training at the Front & Back Door- AMU Placement Blocks the Way Forward!
SOD10: Routine HIV testing in a West Midlands AMU
SOD11: takeAIM: A national campaign dedicated to addressing a recruitment shortfall in AIM to the NHS
SOD12: The Electronic Whiteboard in the Combined Assessment Unit Innovation in Flow, Governance and Process Efficiency
SOD15: Underutilisation of the ambulatory setting for investigation and management of suspected pulmonary embolism at a London teaching hospital
More posters will be added as we receive them
Following the announcement of secretary of state for health and social care Jeremy Hunt’s priorities for the upcoming long term plan for the NHS reported today by the Health Service Journal, Dr Nick Scriven, president of the Society for Acute Medicine, said:
“We thank the health secretary for his candour in saying that we cannot face another winter like this and simply asking staff to work harder is not the answer.
“He says we need to transform the way the NHS works to ease pressure on the frontline over winter.
“However, we are sceptical that a 10-year plan will be feasible and viable and are very wary of the “transformation plans” currently on the table.
“Without radical short-term planning, we will continue to see the struggles faced over the past year and the government must work with frontline staff to tackle these urgently.”