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Acute medicine: The solution the NHS chooses to ignore

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.

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