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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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