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NHS solution needed to prevent exhaustion and stress among staff – SAM president

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

“The last six weeks has seen the acute services of the NHS under a sustained period of stress due to ‘normal’ winter pressures along with a surge in influenza.

“Neither of these were unpredictable but both have combined to cause the issues that have been widely reported across the country.

“Last year we coined the phrase ‘eternal winter’, but the last month and a half has shown an even steeper decline in performance as demonstrated by all the data available – particularly around ambulance delays, the four-hour emergency target and bed occupancy both in acute beds and critical care.

“We warned the government about this in the autumn and, despite the mantra that the NHS had never been as well prepared for winter, more than a quarter (28%) of acute clinicans felt worse off than the previous year.

“Clinicians are telling us of their efforts and sacrifices but we want this type of work pattern to be reined in to avoid colleagues becoming exhausted and stressed.

“We do not currently have a sustainable model and, despite the health secretary’s very public defence of the NHS over social media with the US president, we are yet to see such engagement or be invited to his table to offer input into a meaningful and long-term solution.

“Simply lowering targets for treatment and discharge times from emergency departments as was released quietly last week will not help patients and will merely mask the issues.”

Additional informaton:

In a survey conducted by the Society for Acute Medicine last month (January 2018), 76% of clinicians working in acute medicine felt their hospitals were not adequately ppepared for winter, 59% were ‘very concerned’ about the state of their local NHS services and 97% were concerned with the position of the NHS.

In the second week of January, almost half of respondents (48%) felt their units could become ‘unsafe’ due to the pressure of numbers.

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SAM president comments on cancellation of urgent operations

Commenting on an article in today’s Guardian regarding the cancellation of urgent surgery at some hospital trusts, Dr Nick Scriven, president of the Society for Acute Medicine, said:

“The cancellation of life-saving or life-prolonging operations is an extremely serious event that was not sanctioned in advice from NHS England’s national emergency pressures panel regarding winter pressures. This will have major impacts on patients and could be a risk to their lives.

“The stress for these patients must be unimaginable. To be told you need major potentially lifesaving operations and then have them cancelled, against what is in national guidance, must be horrendous.”

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SAM president warns healthcare workers ‘becoming increasingly anxious’

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

“Although flu rates might well have peaked, but they are still high and causing increased hospital admissions.

“Many units have ‘flu’ wards open and, with strict infection control processes as a result, each suspected case in a hospital causes additional stress to the bed management system with beds/bays having to be kept closed.

“Healthcare workers – especially junior doctors – are becoming increasingly anxious given the pressures they all work under very day and the deeply concerning court ruling in the Dr Bawa-Garba case.

“Rota gaps, staff shortages and IT issues are a daily occurrence in most of our units and need addressing urgently if we are to stabilise the health service in the coming weeks.

“The massive rise in admissions since Christmas is now being felt as pressure beyond emergency departments, with rising delayed discharges and longer stays.

“Many hospitals are still running at around 95% bed occupancy despite additional capacity being opened.

“Doctors in acute medicine are often the ones charged with looking after additional patients and have been under even greater strain since NHS had go ahead to return to ‘usual business’ which is a concern.”

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SAM president highlights ‘concern’ over High Court judgement

Following the decision of the General Medical Council to take its own tribunal’s decision to suspend Dr Hadiza Bawa-Garba to the High Court to be quashed, Dr Nick Scriven, president of the Society for Acute Medicine, said:

“Along with a vast number of people associated with healthcare, we as a society have been following the repercussions of the tragic case of JA.

“Our foremost concern is patient safety in our acute medical units. As with most commentators we have noted with concern the latest judgement resulting in the doctor being erased from the register along with the nurse involved, while the employing organisation, despite many systematic errors, seems to have escaped public or professional censure – with both healthcare workers in effect being scapegoated.

“We have read and fully agree with and endorse the statement from Professor Dacre and the Royal College of Physicians of London, along with the concerns she raises.

“We reiterate the advice to all those working in healthcare to demonstrably escalate safety concerns to more senior doctors and managers but fully recognise the immense difficulties and stresses a large number of people are working under.

“We have noted the update from the chief executive of the GMC and echo the advice given on how/where to escalate concerns.

“As an organisation we will continue to support all staff working in frontline medical units who are going beyond ‘the norm’ on a daily basis in efforts to keep patients safe despite enormous pressure on the entire health care system.”

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Lifting elective surgery suspension will ‘heap pressure on system’ – SAM president

Following the National Emergency Pressures Panel’s (NEPP) decision to advise ending the suspension of non-urgent operations, Dr Nick Scriven, president of the Society for Acute Medicine, said:

“This decision will heap pressure back on the system as hospitals try to get their backlogs sorted while coping with winter.

“I really do feel sorry for the bed managers who are now going to be placed in a near impossible position.”

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‘Pressures in system remain high’ – SAM president

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

“Pressures in the system remain high and it really is offensive and disingenuous to see the Prime Minister only yesterday remain adamant that the NHS was better prepared than ever this winter.

“In our own recent survey, more than three-quarters of clinicians working in acute medicine felt their hospitals were not adequately prepared for winter this year and 28% felt in a worse position than last year.

“The major concerns raised were a lack beds, inability of emergency departments to cope with numbers and staffing shortages among nurses and junior doctors – we need a system redesign not baseless reassurances.

“The overall mood among healthcare staff is that they remain anxious and depressed and we simply cannot afford a repeat of these dire circumstances again.

“The National Emergency Pressures Panel has not publicly said anything yet for beyond the end of January regarding elective surgery and trusts are continuing to make decisions week by week, so we could see the recent disruption to services continue for weeks to come.”

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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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