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Leading medic sets out vision for ‘vibrant, improving and caring’ NHS

“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.”

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