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Senior medic fears repeat of “nightmare winter”

A senior medic fears a repeat of this year’s “nightmare winter” in the NHS due to a “reluctance to think radically”.

Dr Nick Scriven, president of the Society for Acute Medicine, said it was the “definition of stupidity” to believe the current “flawed” system could remain in place when it is no longer effective.

“Earlier this month the latest NHS performance data – for March – showed the service to be running at its worst since records began in 2003/04 and that’s the year-long reality we now face,” he explained.

“We face a triple threat of spiralling agency and locum costs to cover additional beds opened, continued high admissions and a backlog of elective cancellations to recover alongside current bookings – and that is happening right now.

“Now should be the time to start talking and planning – isn’t the definition of stupidity doing the same flawed thing every year expecting it to work when it clearly no longer does?

“There already seems to be a reluctance to even consider thinking about the next pressure points or tackling things now for the future and there is also a very disappointing reluctance to even consider anything vaguely radical.”

A report released yesterday by Lord Darzi suggested the NHS in England needs £50bn more by 2030 to help cope with the ageing population, technology and inflation

But Dr Scriven said while additional funding is needed, immediate actions can be considered now, such as the routine postponement of non-urgent operations during January and February to ease pressure by freeing up beds.

He also said he was “concerned” for the “health and sanity” of “overstretched and unloved staff” who were “worn out” after 17 months of constant pressure.

“Acute medicine in particular is a high pressure and hard work environment that glues together urgent and emergency services and staff are frankly worn out now by 17 months of almost constant pressure,” he said.

“There is only so long and so many times they can go the extra mile before their own health and suffers.

“They need to feel ‘loved’ by the system and that just doesn’t happen enough – if at all – and there is no surer way of demotivating frontline staff than by not starting to think how to make it a bit better.”

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.

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Stark figures ‘clearest indication’ of eternal winter – SAM President

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

“These stark figures – including a further drop in A&E performance and 5,000 delayed patient transfers – are the clearest indication yet of the eternal winter we now face in the NHS and this should be a turning point in how we approach all planning from now on.

“As we settle into spring hospitals remain under immense pressure and I am unsure how on earth we are going to catch up with elective surgery given some non-urgent operations continue to be cancelled in parts of the country.

“The fear is patients will feel the effects of this year’s winter for weeks and months to come so there is a desperate need for much earlier winter planning if we are to avoid a repeat of this nightmare.

“We need to see continuous, accurate and timely data on whole system performance, a review of targets and how they are implemented and, most importantly, a rethink on how we are going to cope with future winters.”

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Pre-planned operations ‘should be cancelled for two months each year’

By Ella Pickover, Press Association health correspondent

Scrapping all pre-planned procedures for two months of the year may be one radical solution to the NHS’s winter pressure problems, the Society for Acute Medicine has said.

In an interview with the Press Association, Dr Nick Scriven, president of the society, which represents doctors who specialise in the care of adults who are admitted to hospital as an emergency, said some doctors have called on the health service to consider stopping elective activity throughout January and February.

Hospitals in England were told to delay elective operations and routine outpatient appointments throughout January this year due to severe winter pressures.

But they were advised that urgent cases and cancer care should still proceed as planned.

Dr Scriven questioned whether postponing elective procedures should become a routine measure to help ease pressure on hospitals.

This winter hospitals were forced to open previously-closed “mothball” wards and turn investigations areas into makeshift wards.

Dr Scriven said that he had even heard of one hospital which had closed a birthing unit for a few days to make space for medical patients in need of inpatient beds.

He said that the NHS had “just coped” over winter but this was based on the goodwill of staff.

When asked what the solution should be, he said: “People in power have to sit up and take notice that this isn’t going to get better and unless something radical is done it is going to get worse.

“There are the things that people always talk about, like this year the NHS suggested that people should suspend elective activity for a month, should that be a routine thing?

“To free up the extra ward in every hospital in January and February.

“That would be one radical thing.”

Meanwhile, no more acute beds should be closed, he added.

The comments come after a document published on the House of Commons Library highlighted the significant pressures on the health service in England over winter.

Hospitals almost full to capacity, long waits for patients and ambulance delays were featured in the document.

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Disposables cup numbers highlight ‘great inefficiencies’ in NHS

Following a Press Association investigation which found the NHS in England has purchased more than half a billion disposable cups over the last five years, Dr Nick Scriven, president of the Society for Acute Medicine, said:

“Aside from the harsh environmental impact of such vast numbers, we also have to consider the great inefficiencies of such huge amounts of waste.

“With additional government funding in the NHS barely covering the cost of the last three months, any issues we can tackle which save cash to spend on frontline patient care are vital.”

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Effects of winter to last “for weeks and months to come”

A leading doctor has warned patients will feel the effects of winter on the NHS “for weeks and months to come” as operations continue to be cancelled across the country.

Dr Nick Scriven, president of the Society for Acute Medicine, said hospitals remained under “immense pressure” into spring which indicated the “desperate need” for earlier winter planning.

He also said he had “grave concerns” about the lack of timely data on performance across the NHS and the easing of targets including four-hour emergency access and non-urgent care within 18 weeks.

“As we settle into spring hospitals remain under immense pressure and I am unsure how on earth we are going to catch up with elective surgery given some non-urgent operations continue to be cancelled in parts of the country,” he said.

“The fear is patients will feel the effects of this year’s winter for weeks and months to come and there is no clearer indication of the desperate need for much earlier winter planning if we are to avoid a repeat of this nightmare.

“From now on we call for continuous, accurate and timely data on whole system performance, a review of targets and how they are implemented and, most importantly, a rethink on how we are going to cope with future winters – including the best use of all healthcare resource through hard times.”

Dr Scriven said clinicians in acute and emergency medicine had been working “flat out” for 15 months and it was “distressing” to hear of colleagues not being utilised – an issue highlighted in BBC documentary Hospital.

“There are only so many times acute medical teams can go so far beyond what previously was ‘normal’ – the wells of resolve, energy and hope are running desperately low,” he explained.

“It is distressing for those working so hard to see on national television hospital colleagues complaining they are twiddling their thumbs with nothing to do despite advice for staff to be made available on the frontline during times of significant pressure.

“It all smacks of a lack of preparation and that is not acceptable when medical groups have been warning of the eternal winter in the NHS for the past three years.”

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.

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SAM president says ‘worrying’ report shows need for system-wide change

In response to a report released today by NHS Providers on the outlook for the NHS over the next year, Dr Nick Scriven, president of the Society for Acute Medicine, said:

“This is a very worrying report which comes a day after the Department of Health and Social Care announced millions of pounds of grants for various hospitals projects and days after proposing pay rises for non-medical staff.

“The gloomy nature reflects the feeling on the ground that without major system-wide change nothing will improve in the acute care of our frailest patients.

“The warning that meeting the A&E performance target looks impossible is particularly concerning as this is when people are at their most vulnerable.

“While funding is important in helping to address some of the issues facing the future of the health service, it will not solve the systemic problems that exist, with much greater focus needed on involving frontline clinicians in decision-making.

“We again call for government to liaise urgently with frontline clinicians and work together to try to avert the disaster that NHS Providers is foreseeing.”

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NHS pay deal ‘a step in the right direction’ – SAM president

Dr Nick Scriven, president of the Society for Acute Medicine, said: “We are happy that the pay restraint has been lifted for the people who are the very lifeblood and glue that hold the NHS together but we cannot hide behind the headline figures being trumpeted in the press.

“It has been calculated that these staff have seen a 14% drop in real-terms income since 2011 and despite the rise over three years this could actually mean a further drop.

“Also it has to be noted that the actual rises averaged across the workforce included in this is roughly 3% this year then 2% and 1% in the two subsequent years so we await further details.

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Doctor says NHS pressure ‘won’t relent’ until after Easter

A leading doctor has said pressure on the NHS “won’t relent” until after Easter at the earliest.

Dr Nick Scriven, president of the Society for Acute Medicine, said the NHS had been “brought to its knees” this winter and staff will be further stretched into next month.

He also said stopping the release of weekly performance data was – which ended two weeks ago – was “misleading”.

“With the general population trends along with the constant reduction in acute hospital beds, every winter has been getting progressively worse in the NHS and this year the flu surge brought it to its knees,” he said.

“The pressure is ongoing – there is no let up at all – and nothing will realistically change until after Easter, which will further stretch the workforce who are the lifeblood of the NHS.

“Just because NHS England’s weekly figures have stopped it does not mean all is well.

Dr Scriven said the suspension of non-urgent surgery in January “helped” but that it may not have been implemented fully and was withdrawn too early.

The advice from the National Emergency Pressures Panel (NEPP) ran from the start to middle of January but was extended until the start of February.

“The cancellation of some non-urgent surgery helped but I am not sure how far it was actually implemented and was probably rescinded too soon,” he said.

“Last autumn, NHS Improvement said the system had not recovered by October from the previous winter and this is without a doubt worse than that.

“Those in charge really need to start thinking about how we can sustain acute and urgent care going forward and plan in advance to maximise preparation.”

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.

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SAM president ‘strongly urges’ government to investigate 10,000 deaths

Following an editorial published in the British Medical Journal which highlighted there have been more than 10,000 “additional deaths” in England and Wales over the first few weeks of the year, Dr Nick Scriven, president of the Society for Acute Medicine, said:

“The service has never been this stretched and the steady loss of acute bed capacity and social care has left the NHS barely able to cope.

“The deteriorating emergency department waiting time figures and now these striking mortality statistics represent only part of the human cost of a service poorly prepared in all respects for winter.

“All of those working in acute medicine focus heavily on patient safety and lead the way in with initiatives such as surviving sepsis, but all such advances will be undone by a poorly prepared and resourced health service.

“The evidence of disaster on the horizon for the NHS continue to stack up and something has to change for the future or this decline will become difficult to overcome.

“We strongly urge the government to investigate the cause of the additional 10,000 deaths raised in this analysis so we can understand exactly the factors behind them.”

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Medic warns extra funding for emergency departments alone ‘won’t improve patient flow’

A leading medic has warned increased funding for emergency departments alone will not improve patient flow in hospitals.

Dr Nick Scriven, president of the Society for Acute Medicine, said the it would provide no “quick fixes” for the NHS due to the wide-ranging problems it faces.

He spoke out following calls last week from the Royal College of Emergency Medicine (RCEM) urging members of the public to write to their MPs to request more funding for A&Es nationwide.

“We note the call last week from RCEM for people to write to their MPs asking for extra funding for emergency departments but, in our view, this will not proved any significant quick fixes as there are many, many problems,” he said.

“These range from staff recruitment and retention in acute and emergency units right through to community care, so extra cash simply for EDs will not make any difference to patient flow in general and thus not unblock hospitals.

“The Department of Health and Social Care needs to engage with a broad range of organisations working at the sharp end of healthcare in planning for the future if we are to resolve the mess we have found our system in.”

Dr Scriven said pressure continues to remain high throughout the health service and that there has been “no let-up” for months.

“The Society for Acute Medicine has been saying for months now how the whole system has been under intense pressure for so many reasons.

“Alongside the bad weather over the past two weeks – which is still being felt in units across the NHS – we have hospitals still operating at near full capacity.

“Without the heroic efforts of so many staff it could have been far worse and we all need to show appreciation for that.”

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.

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Winter has had ‘immense impact’ on NHS staff – SAM vice-president

Following the release of NHS performance data for February, Dr Sue Crossland, vice-president of the Society for Acute Medicine, said:

“This winter has had an immense impact on the wellbeing and long term resilience of the core blood of the NHS – its staff – and the true cost of their incredible efforts may not be known for a long time.

“Staff will be tired, worn out and, unless the NHS leadership and management is careful, will feel that all their efforts have not been recognised in any tangible fashion.

“It is ok for leaders to say well done but this has little meaning for the vast majority of those going the extra miles every single shift under huge strain with vacancies rife.

“The efforts made this winter have been immense and so far beyond the ‘normal’ it is incredible – but this cannot go on without major risks to the wellbeing of these people and the safety and quality of patient care.

“While it is laudable for the Prime Minister to acknowledge how hard people are working, we cannot let this hide the massive issues in the NHS this winter has uncovered.

“We cannot let what has happened over the preceding nine weeks become ‘normal’ for the service and it is essential we plan more effectively and much earlier.”

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SAM president says ‘shocking’ case shows need for review of care for vulnerable patients

Following an inquest into the deaths of two patients in Leeds after an attack on a hospital ward by a patient with paranoid schizophrenia in 2015 which had gone unreported, Dr Nick Scriven, president of the Society for Acute Medicine, said:

“This is shocking case that has gone unreported since 2015 and it forces us all to look at how and where we treat some of our most vulnerable patients.

“Recent changes will mean that more often an acute medical unit will be seen as a place of safety as an emergency department is no longer said to be a safe place.

“Staff and acute trusts must be aware of this and fully trained, or at least fully supported, by mental health specialists, but this will require extra resources at a time when the system is at breaking point.

“We need a total rethink on how and where we can meet these peoples physical and mental needs and trusts must be open and honest in the future around this area and investigate and report this type of incident openly.”

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Acute medicine ‘should be at the centre of NHS strategy’ – SAM president

The National Audit Office has today released its report Reducing emergency admissions which found emergency admissions grew by 24% from 2007-08 to 2016-17.

In response to the report, Dr Nick Scriven, president of the Society for Acute Medicine, said: “This report epitomises the issues we face in the health service by failing to recognise the contribution of the specialty of acute medical in ensuring safe and quality care is sustained despite almost intolerable pressures on the NHS.

“At the moment our health economies, both hospitals and communities, are unable to meet the demands of their populations, funding has decreased and a even a mild winter brings the NHS in England to the edge of collapse.

“Acute medicine provides care to adult patients with a variety of medical conditions who are admitted to hospital and do not require urgent surgery and, while most people who attend A&E are discharged home, between 20% to 30% are admitted.

“Most people who are admitted by acute medicine are ill, bucking the common misunderstanding that all patients, especially older patients, simply need social care and, when A&Es fall over, the patients we see in corridors are mostly waiting for an acute medical bed.

“The specialty has been shown to reduce length of hospital stay, mortality rates and readmission rates and has been at the forefront of developing seven-day services, as well as ambulatory care to avoid unnecessary hospital admissions. In fact, the 79% the NAO quote as not needing a bed were almost certainly looked after by acute medicine in ambulatory care when previously they would have needed an inpatient bed for potentially several days.

“If it were not for the advances in implementing acute care processes the NHS may well have collapsed already, so the government and NHS leaders need to place acute medicine at the centre of their strategy to get our hospitals working again.”

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SAM president says next few days will ‘particularly stretch’ hospitals

Following ongoing severe weather across the UK and the release of the latest weekly NHS performance data, Dr Nick Scriven, president of the Society for Acute Medicine, said:

“The severe winter weather is an added burden on top of the recent “usual” winter and today and the next few days will particularly stretch trusts with staff struggling to get to work and ambulance trusts having immense problems getting patients to and from hospitals.

“A lot of hospitals will cancel routine work over the next few days as a consequence of both of these.

“The latest weekly performance figures provide stark reading with 18,000 patients in hospital for more than 21 days and bed occupancy still at 95%.

“The National Emergency Pressures Panel met this week and issued a thank you and acknowledged worst winter ever with weeks more to go but no real practical help.

“There have been no words from he Secretary of State regarding the NHS going extra mile in this weather, yet we find ourselves in he midst of extreme conditions which have piled the pressure on our already-stretched hospitals.

“This week really has shown the passion, dedication, commitment and care of staff in our acute medical units and throughout hospitals in the most testing of conditions.

“If this winter doesn’t demonstrate the desperate need to bring planning forward then what would?”

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Senior medics warn of ‘great concern’ for week ahead in NHS

Leading doctors have warned of their “great concern” for the NHS in the week ahead with bitterly cold conditions and widespread snow forecast.

Temperatures reached -9C on Saturday night as the Met Office warned parts of England and Wales were likely to see their coldest spells of weather since at least 2013 – and perhaps since 1991.

“The onset of a spell of extremely cold weather is of great concern for acute medical units who are already struggling with the widely reported stresses of this winter,” said Dr Nick Scriven, president of the Society for Acute Medicine.

“Daily temperatures below the normal ambient level increase illness and hospital admission rates for cardiovascular and respiratory illnesses, particularly among those aged 65 and over.

“Last week’s performance figures showed an 11% rise on the previous week in influenza admissions along with sustained dangerously high bed occupancy rates, so the situation is grave.”

He said handling of winter preparations and the ongoing challenges on the frontline nationally showed there was “little understanding of how unamangeable things have become”.

Figures released last week by NHS Improvement showed there were more than 100,000 unfilled vacancies in the NHS and trusts predicting a year-end deficit of £931 million.

“There is little on the horizon in the way of optimism for the future state of the acute services given the massive staffing issues and strain on resources made evident this last week,” said Dr Scriven.

“So far this winter we have seen the NHS survive on the goodwill and effort of hard-pressed staff of all levels who have gone the extra mile to ensure safe and high quality treatment in the most difficult of circumstances.

“However, the challenges keep increasing and this week is another example of how the authorities simply cannot gamble on hard-working staff saving the day – it is not sustainable or fair and will be the downfall of our health service.”

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.

More

NHS vacancies ‘a marker of the strain’ staff are under – SAM president

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

“As we enter the eighth week of severe and unrelenting pressure flu rates are still high and occupancy remains well over 90% in general, with thousands of extra beds required with the staff to care for them and major delays in ambulance handovers.

“Staff have worked harder than ever this year in providing the best, safe and compassionate care they can, but it is at a cost and a strain – there are more than 26,000 registered nurse vacancies in acute hospitals with some acute medical units reporting up to 25% vacancies.

“This is a marker of the sheer strain people are under and it is unsustainable. There are also 7,893 medical vacancies in the same trusts, meaning £292 million extra has been needed to try to keep safe staffing levels at the front end of hospitals.

“This week, NHS Improvement said national performance for October to December – when only 81% patients at major A&Es were treated in four hours – was ‘testament to better operational planning’ and that is, quite frankly, absurd.

“That will not ring true for those working at the sharp end in emergency departments and acute medical units, with long waits and horror stories the clear message arising from this winter.”

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Doctor warns NHS ‘remains under great stress’

A leading doctor has said the NHS remains “under great stress” – with a “re-escalation in pressure” following recent cold weather.

Dr Nick Scriven, president of the Society for Acute Medicine, said attempts to return to “normal business” had created “unsustainable working patterns” for staff caring for patients on acute medical units.

“As we enter the seventh week of sustained acute medical pressure, the system remains under great stress,” he said.

“The influenza surge may have peaked but is still a highly significant problem and, on top of that, the last seven days has seen the first real continuous period of cold weather since Christmas.

“This has caused a re-escalation in pressure which will not be seen in figures until this time next week.”

He also warned assurances that bed occupancy figures were “misleading” and that the reality was “very different”.

“NHS England suggests that overall bed occupancy figures have eased a little but the reality on the front line is very different,” he explained.

“The easing really only reflects that beds in surgical units are empty at midnight when the official data is counted.

“Acute medical wards will still be running at occupancy rates of more than 97%.

“In one hospital reported ot me the official figures suggested occupancy of 90% but the teams on the ground calculated medical bed occupancy was at 97.8% with ‘extra capacity beds’ and patients outlied to non-medical wards.”

Dr Scriven said the introduction of a ‘full capacity boarding’ protocol incorporated into NHS Improvement guidance whereby patients are moved from emergency departments to wards that may or may not have a free bed “merely hides suffering and indignity from official gaze”.

“From the ED perspective this eases figures and jams but it is opposite of caring, compassionate and safe care.

“The true misery and risks associated with this policy need urgent examination.”

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.

More