By Dr Mark Holland, president of the Society for Acute Medicine
“Just over a year ago we suggested that the NHS in England faced a ‘perfect’ storm. In the intervening period we have seen record increases in emergency department attendances, record numbers of patients who are fit to leave hospital but where there is no social care to support a safe discharge and where the four-hour emergency access target is continually missed.
“Now we approach the eye of the storm.
“In acute medicine, we are responsible for the care of adult patients who present to hospital with an acute medical illness but do not require surgery. This can represent at least 20% of emergency work.
“With an increasing demand for our services, we now struggle to consistently have beds available in acute medical units for our patients. The knock-on effect is over-crowding in the emergency department. The main reasons we fail to create beds is because we cannot move patients to specialty wards, as the wards are full of patients who are fit to go home and awaiting social care. In summary, the system is blocked.
“Over the last two years things have become progressively worse. We are now approaching the Christmas and New Year period. Traditionally, we manage to discharge lots of patients before Christmas, as elective surgical work is not routinely performed over the holiday period. Starting on December 24 2016 and up to January 3 2017, there are seven days with emergency cover only in our hospitals. Over this period we will continue to admit acutely unwell patients and, paradoxically, we will appear to have sufficient beds as much of the non-emergency work is not taking place.
“However, come the first week in January, we will have patients spread around our hospitals, often in inappropriate specialty beds. This is bad for the patients in those beds and for the system as a whole as we cannot admit routine cases. The strain on social services will be even greater as we struggle to clear the backlog.
“This scenario is not new. However, this year, our resilience to cope will be stretched as never before. Our Secretary of State for Health has previously beat the drum for better seven-day services, so surely he knows that the consequences of our Christmas and New Year service will be infinitely more damaging, stretching well into January.
“The Prime Minister must acknowledge that social care is now a national crisis. It is in a critical condition and won’t be cured with half-measures. Short-term plans will struggle to fix the problem now and won’t be enough to fix the problem in the future.
“The government has decimated social care funding and demonstrated its disregard for the situation and its impact on the NHS by failing to acknowledge it in the recent Autumn Statement.
“Regardless of today’s announcement, the current scale of the problem is enough to tip the NHS over the edge this winter.
“This is too little too late.
“If we arrive in January with the NHS in England paralysed, is there a plan B?
The events of the Christmas and New Year period are totally predictable. My fear this year is the magnitude of the problem but, moreover, our ability to cope and recover in January. As in every other year, my colleagues will keep the ship afloat over the holiday period and, more importantly, provide safe, compassionate care to the most vulnerable members of our society.
“The question this year is the extent of the fallout in January.”