Doctors working in acute medicine have painted a “worrying” picture of the NHS in a survey reported today (Friday) by the Society for Acute Medicine.
The body, which represents more than 1,000 clinicians who deal with patients who present to hospital with medical emergencies, surveyed its membership ahead of its spring meeting in Cardiff.
Nearly 94% said their units faced regular problems providing a full quota of medical staff for their units and 85% reported permanent medical staff work extra shifts to maintain staffing levels, while 91% said their units employed locum trainees and 60% locum consultants.
More than two-thirds (70%) said their acute medical units do not have a full quota of permanent nursing staff, 67% had experience of patients being moved from their units without being seen by a consultant and 64% recorded consultants being asked to work overnight because of staff shortages.
“During the past winter acute medicine was again at the forefront of supporting the increasingly-pressured NHS to deliver the very best care for patients,” said Dr Mark Holland, president of SAM.
“However, having sought the views of our members, we have identified many barriers impeding them from delivering the care they aspire to give their patients. Clearly we find this very worrying.”
In relation to full medical staffing on acute medical units, which saw almost all respondents report regular problems, 86% said the problems occurred mainly during weekdays out of hours and 84% on weekends.
In addition, more than 57% of units have also faced the situation where they have more patients than beds and 92% of consultants said they regularly started their working day with patients in the emergency department waiting for a bed.
“The range and significance of the problems we have seen suggests that we have a system-wide problem as opposed to isolated pockets of difficulty,” explained Dr Holland.
“The increasing volume of work coupled to a perceived inadequate hospital bed-base were high on the list of concerns of acute clinicians, as was the inability to recruit and retain both medical and nursing staff.
“Most importantly, our members expressed concerns about delivering high quality care when they are seeing and caring for people in inappropriate environments, such as corridors.”
Dr Holland added: “We report these figures and the views of members today simply because they reflect the working conditions in acute medical units up and down the country.
“There is an NHS-wide workforce crisis and everyone acknowledges the desperate need for change.
“An immediate 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.”
Click on the links below to view the posters selected for display at SAMCardiff
More will be added as we receive them
To view the presentations from DAY 1, click here
To view the presentations from DAY 2, click here
Audit & Quality Improvement Posters
AQI 6 Chest Pain – An Ambulatory Emergency Care Pathway
AQI 8 Clinical Coding: No Coding = No income = No hospital
AQI 10 Consenting for Lumbar Puncture using a Standardised Local Procedural Consent Form; A Quality Improvement Project
AQI 12 Follow up of Unprovoked Pulmonary Embolus at Wirral University Hospital
AQI 13 GP to Antibiotics: Delays in Septic Patients’ Journeys
AQI 18 Improving Acute Management of Patients with Decompensated Liver Cirrhosis in First 24 Hours by Introducing a Cirrhosis Care bundle
AQI 27 Improving the Medical Post-take Ward Round with a Structured Pro-forma at Princess of Wales Hospital
AQI 30 Innovative Practice – A Commissioned Service to Deliver Service: Routine HIV Screening within the AMU
AQI 31 LACE Index Tool to Predict Admission in MAU
AQI 37 Outcome of Patients Highlighted with Frailty Admitted to the AMU in Blackpool Victoria Hospital
AQI 38 Plans for the weekend? Ensuring all Patients in an Acute Respiratory Unit have Comprehensive Documented Weekend Plans: A Quality Improvement Project
AQI 43 Short Term Antibiotic Therapy (STAT) for Cellulitis
Case Report Posters
CR 1 A Case of Lead Poisoning
CR 3 Acute Infectious Purpura Fulminans in Adults Secondary to Streptococcus Pneumoniae
CR 5 Atrial Myxoma Presenting as Atypical Chest Pain and Breathlessness
CR 6 Can Acute Stroke Mimic Transient Global Amnesia? To Drive or not to Drive
CR 5 The ‘Hummingbird’ and ‘Mickey Mouse’ Signs. An Unusual Case of Falls Presenting to the AMU
E 1 Creating Change: Improvement in Procedural Skills Training and Confidence for Core Medical Trainees in East Midlands South
E 2 Innovative Online Medical Education Videos – A New Tool for Medical Education?
E 3 Meeting the Learning Needs of Registered Nurses Caring for Acute Medical Patients within an Acute Hospital Setting
E 5 The True Cost of the Special Skill
R 1 A Comparison of NICE’s Sepsis Risk Stratification Tool with Established and Novel Risk Stratification Tools
R 7 First Illness Severity Scores in AMUs, for COPD Admissions, are not Representative of Emergency Department Triage Scores
Service Organisation & Design Posters
SOD 1 A District General’s Experience of Developing an Ambulatory Pleural Clinic
SOD 2 A Survey to Explore GP Perceptions of an AMU; Are we Meeting Expectations?
SOD 3 Admissions and Outcomes on an Acute Dependency Unit: An Observational Study
SOD 5 General Internalists Contribution to Acute Medicine: A Survey at Sandwell & West Birmingham Hospitals
SOD 9 Rota re-design: A Success Story. The Impact of Medical Staffing Change on Acute Medicine at a District General Hospital
SOD 10 Smarter and Safer Handover
SOD 11 The Introduction of ‘NEWS plus’ – Clinical Triggers for GP Admissions in an AMU
Commenting on today’s release of NHS performance data for February 2017, Dr Mark Holland, president of the Society for Acute Medicine, said:
“Over the last three winters the NHS has witnessed a dramatic decline in its ability to meet performance targets.
“The targets have often been criticised in failing to reflect the granularity of health processes. However, their perceived weakness is in fact their real strength as they provide a global measure of performance and, for targets to be achieved, every wheel and cog needs to be working properly.
“Everything is interlinked; a delayed discharge in a patient waiting for social care deprives a surgical patient of their bed.
“It is a fact that the NHS has less beds than other health economies. It is a fact that we have a workforce crisis, which is especially important, and potentially rate limiting, when sustainability and transformation plans (STPs) are rolled out.
“Then there is data. We should collect data to monitor a system and respond appropriately when we need to make things better. The NHS, however, chooses a different approach. Instead of publishing data contemporaneously, it waits two months for the dust to settle. Sadly the dust never settles. We know that data is available in almost real-time every day of every week, so one can only conclude that such delays are tactical?
“Worse still, the NHS chooses to stop measuring performance, as seen with elective surgery on 31st March 2017. While the performance data is painful for politicians, only patients suffer the true consequences.
“In acute medicine we have a specialty that has been shown to increase discharge rates from hospitals but coupled to reduced readmission rates and improved length of stay. We care for the one in five patients who come to our emergency departments and require admission to hospital. Ultimately, we care for many of the patients seen waiting on trolleys in corridors.
“The four-hour emergency access target was established in response to patients waiting on trolleys in corridors. The time has come to rethink our strategy, but especially to expand specialists in acute medicine to help with the challenges faced by patients requiring urgent admission to our hospitals.
“February 2017 may have been a bit better than January 2017. However, disbanding targets is wrong, especially if it is purely for the sake of improving figures. We fear that people might start to see a 90% achievement of the four-hour emergency access target as the norm, as somehow better than what we saw in January 2017.
“The Society for Acute Medicine argues that as long as we are seeing patients in corridors and as long as we do not have beds in our acute medical units when needed, then the fight for better care must go on.”
Please find attached a copy of the House of Lords Report into the sustainability of the NHS published April 5th (The Patel Review)
The key recommendations are
- A tax-funded, free-at-the-point-of-use NHS is the most efficient way of delivering health care and should remain in place now and in the future. For that principle to remain, however, many aspects of the way the NHS delivers healthcare will have to change.
- A political consensus on the future of the health and care system is not only desirable, it is achievable and the Government should initiate cross-party talks and a meaningful national conversation.
- The failure to implement a comprehensive long-term strategy to secure appropriately skilled, well-trained and committed workforce that the health and care system will need is, the biggest internal threat to the sustainability of the NHS.
- There is an indisputable link between a prolonged period of pay restraint, over-burdensome regulation and unnecessary bureaucracy and low levels of morale and workforce retention. The Government should commission an independent review to examine the impact of pay on morale and retention of health and care staff.
- The health and social care systems are interdependent but poorly-coordinated. To allow money and resources to be used more effectively the budgetary responsibility for adult social care at a national level should be transferred to a new Department of Health and Care.
- Policy is now increasingly focused on integrated, placed-based care and so NHS England and NHS improvement should be merged to create a new body with simplified regulatory functions and strong local government representation.
- There is a worrying lack of a credible strategy to encourage uptake of technology and innovation in the NHS. The Government should do more to incentivise the take-up of new approaches and make clear that there will be funding and service delivery consequences for those who repeatedly fail to engage.
- Cuts to funding for the public health budget are short-sighted and counter-productive. National and local public health budgets should be ring-fenced for at least the next ten years. We also need a new nationwide campaign to highlight the dangers of obesity.
- The Government should be clear with the public that access to the NHS involves patient responsibilities as well as patient rights. The NHS Constitution should be redrafted to emphasise this.
House of Lords report on sustainability
NCEPOD are recruiting a multi-disciplinary group of healthcare professionals with a working interest in Acute Heart Failure.
Please see attached poster for more information.
NCEPOD Acute HF Study Case Reviewer Advert_30 March 2017
We recently advertised the next wave of posts for takeAIM fellows. We received some excellent applications but we still need more trainees to join the group (please see advert below). For a whole host of reasons takeAIM is vital to the continued growth of our specialty. During my tenure as President, takeAIM has been the project that I have been most proud to work with. The attitude and dedication of the takeAIM fellows has been truly inspirational.
We have extended the closing date for applications. I am hoping that with a new Training and Education Committee structure, which incorporates all the takeAIM fellows, your ability to make a difference will be even greater than it is now.
If you have any questions or wish to chat with a takeAIM fellow, please contact us at email@example.com and we will put you in contact with someone who can help.
President to the Society for Acute Medicine
It gives me great pleasure to announce that SAMBA2017 will take place on Thursday June 15th 2017. This year we are calling the audit ‘Against the Clock – Time for Patients’.
The SAMBA Academy met on Saturday February 18th 2017. Reviewing feedback from last years participants and based on the data we collected in 2016, it is apparent that admission and assessment processes in acute medicine are becoming increasingly diverse. This year we will collect data at all the points on the patients’ admission journey and provide you with a more detailed report to reflect the work you do. This should allow us to be more inclusive for patients seen by us in the Emergency Department or Ambulatory Care, for example.
SAM will again be investing in an updated data electronic data collection tool which will hopefully eliminate blank responses. We are also commissioning report writing software to get reports out to you earlier and in greater detail. Therefore, we are hoping to make data collection as easy as it has ever been but at the same time using the data to even greater benefit.
Registration is now open!
If you have not already taken part in SAMBA’16 then we would encourage you to register your unit for SAMBA’17 with this link: http://samba.acutemedicine.org.uk
If you took part in SAMBA’16, you can just click on this login to join this year’s audit and refresh your details. You can reset your password if you need to.
We very much hope that this year we can get 100 units to take part. Our 2016 SAMBA report was welcomed by many partner organisations and has helped increase the profile and standing of the Society.
These are difficult time but also exciting times. Please join us, the bigger our voice, the bigger our influence.
SAMBA16 report FINAL
Now that spring has officially started it is time to once again plan for our annual Acute Medicine Awareness Day (AMAD). This will be our 6th AMAD and each time the number of participating units has continued to grow.
For 2017 we have set Wednesday June 21st as the official day for our celebration of all things acute medicine. Of course, we are aware that having us setting the date does not always suit you, so please feel free to hold your event at a time convenient to you in the week of June 21st.
We have a number of resources that we can send to you to help plan and advertise the event.
As always, we will be looking for units to tell us about their plans and the unit with the best event and accompanying picture will win a free place for a non-consultant colleague at a SAM conference.
Acute medicine continues to expand. We now work collaboratively with colleagues from lots of branches of medicine, for example sepsis, teenagers and young adults, acute kidney injury and patients with mental health problems, to name but a few. When advertising your unit this year you have a lot to boast about.
Sarah Donaldson in the SAM office will register your interest and help you get the ball rolling firstname.lastname@example.org
Commenting on NHS performance data for January, Dr Mark Holland, president of the Society for Acute Medicine, said:
“Performance against the four-hour emergency access target has been in constant decline since November 2014 and, despite numerous warnings, guidance, criticism and advice, until now the government has buried its head as deep into the sand as it could possibly get.
“Now it is clear that a mild winter brings the NHS in England to the edge of collapse and we really are close to rock bottom, but we perhaps at least have the opportunity to rebuild – but we must be listened to.
“Yesterday’s budget announcements by the chancellor were a step in the right direction – investment in social care was long overdue – and he is right, it is not just about cash it is about how we invest.
“Acute medicine is ideally placed to provide the strategic tools to help fix the NHS and the solution must involve placing acute medicine at the heart of the strategy to get our hospitals working again – alongside adequate investment in social care.
“For that to happen we need the health secretary to open the door to us.”
The Society for Acute Medicine has today published the document Acute medicine: The solution the NHS chooses to ignore. For more information visit the document here.
By Dr Mark Holland, president of the Society for Acute Medicine
Figures show that, since November 2014, performance data for A&E departments in England to meet the four-hour emergency access target has consistently declined.
This does not reflect the quality of care delivered by our colleagues in A&E departments, instead it tells us that our health economies, both hospitals and communities, are unable to meet the demands of their populations.
Whether money is the sole reason for the declining performance in our health systems still seems to be a matter of debate for some people. What we do know is that, 10 years ago, the NHS was on the up and, in 2009-10, we coped very well with a swine flu pandemic.
In the intervening years funding has decreased and now a mild winter brings the NHS in England to the edge of collapse. Perhaps now that we are close to rock bottom we at least have the opportunity to rebuild.
Acute medicine provides a way for us to relaunch the NHS. In simple terms, acute medicine provides care to adult patients who are admitted to hospital and do not require surgery.
While most people who attend A&E are discharged home, between 20% to 30% are admitted and the majority of admitted patients come to acute medicine. Acute medical patients range in age from 16 to over 100, though the majority of acute medical patients are elderly with multiple illnesses.
Most people who are admitted by acute medicine are ill, bucking the common misunderstanding that all patients, especially older patients, simply need social care. Certainly in the patients I see, general practitioners would struggle to keep them at home and community pharmacists would not prevent their admission.
When A&Es fall over, the patients we see in corridors are mostly waiting for an acute medical bed.
Acute medicine specialists in acute medical units have been shown to:
1. Reduce length of hospital stay.
2. Reduce mortality rates.
3. Reduce readmission rates.
Early assessment of older patients in acute medical units leads to early discharge, again with better long-term outcome measures.
Today, in the light of the A&E figures for January 2017 and yesterday’s Budget which outlined the importance of a health and social care strategy, we call on the government and NHS leaders to place acute medicine at the centre of their strategy to get our hospitals working again.
Acute medicine has been at the forefront in developing seven-day acute care services, as well as ambulatory care, to avoid unnecessary hospital admission.
If it were not for the advances in implementing acute care processes by acute medicine the NHS may well have collapsed already. The untold success storey of acute medicine must no longer remain a secret.
Commenting on today’s Budget announcement, Dr Mark Holland, president of the Society for Acute Medicine, said:
“Any investment in social care and the NHS is welcome but, as the chancellor said himself, it is not just about money but about strategy.
“That is something we in acute medicine, as pioneers of seven-day services, have highlighted consistently while being continuously ignored by the health secretary and wider government, so now is a chance for us to see if the chancellor’s announcement means action rather than a token effort to silence the critics.
“We have been waiting with open arms for Jeremy Hunt to listen to our solutions to pressures in health and social care and hope that the government’s desire to ensure funding runs alongside strategy improvements means we will finally be welcomed to the table.”
Commenting on the RCP London report Against the odds: Experiences from the NHS frontline, Dr Mark Holland, president of the Society for Acute Medicine, said:
“The RCP’s Against the odds report provides an excellent summary of the state of the NHS in England.
“The report tells us very little that we did not already know, however, it does provide an excellent overview of the problems.
“Coming as it does from the RCP, the report brings great authority to the debate which the Society for Acute Medicine welcomes and again asks when action will be taken by the government and NHS leaders to start to put things right.
“It appears that, for over two years, every independent voice involved in healthcare has been warning the government about the crisis in the NHS in England. We hope that this report will at last provide the catalyst for change.”
Following the King’s Fund report into Sustainability and Transformation Plans, Dr Mark Holland, president of the Society for Acute Medicine, said:
“The King’s Fund report provides an intelligent and balanced description of STPs. In acute medicine we continue to face unprecedented demand for our service and so any reduction in the provision of acute care resources at this stage would not be welcome.
“The underlying philosophy of STPs is clearly laudable; the key will be implementation. The virtue of the King’s Fund report is highlighting the need for progress but balancing this with the situation the NHS now finds itself.
“In acute medicine we need to be convinced that moving resources away from hospitals will see a corresponding reduction in our volume of work. The ball is the court of STPs to convince us of their ability to deliver on their promises.
“The King’s Fund report acknowledges our concerns. STPs now have obligation to digest the report and engage in meaningful discussions with stakeholders and those who have expertise in this field, including the Society for Acute Medicine.”
Following the release of NHS performance data for December, Dr Mark Holland, president of the Society for Acute Medicine, said:
“December performance for A&E departments in England was the subject of extensive debate when the NHS teetered on the brink of collapse during the first week of January and this data confirms the grave situation we faced. Things have improved very slightly, although we are still seeing significant pockets of stress in the system that limit the care we aspire to deliver.
“Therefore, the Society for Acute Medicine yet again calls on the Secretary of State for Health to acknowledge the crisis. It is blatantly obvious to frontline healthcare workers and, more importantly, the patients they serve, that our NHS can no longer cope. Our national audit from June 2016 showed that, year-on-year, our performance in acute medicine is decreasing, while the national scandal of social care provision is recognised by a number of independent agencies.
“Over the last decade, demand for emergency care has risen while hospital beds have continued to close. There is a clear story of decline that nearly everyone can see. Jeremy Hunt has previously, and very rightly, highlighted the need to maintain safety and quality in the wake of the Mid-Staffs experience. However, when as professionals we put our hands up and fulfill our responsibility to “say this is not working”, the response from our government is left wanting; we all feel let down.
“We agree that social and traditional healthcare need to be more closely aligned and that care is best delivered in the community. The problem is that the move to community-based services has so far been associated with care moving towards hospitals, not away. Is it not a risk, we would argue a reckless risk, to try and reform the NHS in England by closing beds and adopting a methodology that has failed to provide solutions?
“This winter our NHS is still precariously positioned. Simon Stevens, CEO of the NHS, suggests 2018 might be the worst year. We now say enough is enough. The NHS is about to implode. The truth of the crisis is clear now, the future looks worse. People in England are today receiving acute medical care in corridors and we feel that is a scandal. Yes, in 2017 we are caring for our sickest and most vulnerable people in corridors.”
The Society for Acute Medicine (SAM) welcomes the NCEPOD (National Confidential Enquiry into Patient Outcome and Death) report Treat as One – Bridging the gap between mental and physical healthcare in general hospitals. We agree with the comment in the foreword that “it has been acknowledged for many years that mental health services are a cinderella of our NHS, but after reading this report you may rightly conclude that those mental health patients being treated for physical disorders are seriously disadvantaged”. While most people see acute medicine as a specialty devoted to physical disease, SAM has long argued that we need to return to the basic definition of health, namely physical, psychological and social wellbeing. In the same way that we have championed the need for better social care, we also support any efforts that we, and others, can make to improve the care of patients with mental health disorders.
As with other NCEPOD reports, acute medical units again provide care for the majority of patients, in this case 57.8%. Waiting for patients to be ‘medically fit’ or ‘medically cleared’ before any mental health assessment is undertaken needs to stop. Physical and mental health assessments should be carried out in parallel with each other when possible in order to avoid delays in best managing a patient’s mental health alongside their physical needs.
We need to be better at psychiatric medicines reconciliation on admission, especially psychotropic medications, and documentation of psychiatric medication and treatment on discharge. We need to ensure that mental health assessment is a part of all medical patients’ admission process; it should be part of clerking and routinely asked about on post-take ward rounds, forming part of the senior review and management plan.
All staff working with patients with mental health diagnoses should have training in mental health conditions, including support staff such as porters and security staff. Patients with chronic mental health conditions are at increased risk of medical co-morbidities and nearly 40% are current smokers, so we need to offer more smoking cessation advice and intervention. We know when to refer to psychiatry liaison for self-harm and challenging behaviour, but we are less good at referring for support for those patients with chronic mental health problems.
SAM is committed to implementing the recommendations of the NCEPOD report. In the past, issues related to mental health have formed important educational sessions at our conferences and going forward we will incorporate our response to mental health in our soon to be published strategy and governance structure.
Please see the following Newsletter from Dr Mark Holland, President of the Society for Acute Medicine. SAM Newsletter January 2017.
SAM Newsletter January 2017
Please see the following Newsletter from Dr Mark Holland, President of the Society for Acute Medicine. SAM Newsletter November 2016.
SAM Newsletter November 2016
Please see the following Newsletter from Dr Mark Holland, President of the Society for Acute Medicine. SAM Newsletter October 2016.
SAM Newsletter October 2016