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Performance data shows system “teetering on brink” – SAM past president

Following the release today of NHS performance data for January, Dr Nick Scriven, past president of the Society for Acute Medicine, said: “The fact the NHS is teetering on the brink is now such common knowledge that it is no longer a shock to see continuous failure to meet performance targets and even today, with the figures showing the worst ever performance against emergency targets since data collection began, it will barely raise an eyebrow.

“In January activity was stable compared to last year but performance showed more than 2,800 patients waited more than 12 hours for a bed after it was decided they needed one and only 81.7% of cases met the four-hour target.

“We need to bear in mind that this time last year we were in the middle of the ‘flu season’ and we now know for this time period it peaked in the UK in December and weather-wise so far we have had a relatively benign winter.

“What we do know is that if we do see a cold snap now it would send pressure rocketing right back up on all areas, which would put us perilously close to that brink when the system should be equipped enough to have the flex to cope in such circumstances.

“This performance data, however, is not any reflection on the mammoth efforts of frontline staff to deliver in almost impossible circumstances – something reinforced by those who battled last weekend’s wild weather for their patients.

“Recently we have had guidance saying that trusts should try to keep all their ‘extra capacity’ beds open to try to reduce occupancy levels across the board but the big question we have is how on earth can this be done with current staffing levels.

“Questions still need to be answered about how we have got to a point where staffing vacancies are rife, beds have been drastically reduced and promises to resolve key issues such as the pension tax affecting senior clinicians at the start of the year have come to nothing.”

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NHS green initiative ‘a step in the right direction’ says SAM past president

NHS chief executive Sir Simon Stevens has announced the NHS and its staff will step up action to tackle the climate “health emergency” this year with the aim of helping to prevent illness, reduce pressure on A&E departments and save lives.

The initiative follows the launch of the Climate Assembly UK last week, which will discuss how the country can best get to ‘net zero’.

Dr Nick Scriven, immediate past President of the Society for Acute Medicine, said: “We have all seen the results of extremes of hot and cold weather impacting on the frontline of the NHS with people suffering from illness requiring hospitalisation more frequently during these extremes.

“Coupled with the figures confirming the impact of pollution and poor air quality it is time for the NHS and its staff to play their part whenever possible.

“This initiative is a step in the right direction and I look forward to working with colleagues in doing what we can to help.”

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SAM warns changing targets for political expediency “plain wrong”

Following comments made today by health secretary Matt Hancock regarding potentially removing the four-hour emergency access target, SAM president Dr Susan Crossland and immediate past president Dr Nick Scriven raised their concerns.

Dr Crossland said: “Potentially scrapping the target because it is no longer being met shows the disregard this current government has for improving patient care.

“While the four-hour standard is a single point measure, a bit like a sledgehammer to crack a nut, it does and has helped focus the timely care of acutely unwell patients.

“There have been multiple clinical groups working towards the development of new standards, but this is complex work that is still in its infancy.

“We fully support improvement in managing unplanned care and understand that measurement and benchmarking is a vital part of quality improvement.

“We need to be clear that in scrapping the four-hour emergency standard, Mr Hancock must enable us to somehow measure and improve the care we give to patients month-on-month and year-on-year.

“Resources, staffing and infrastructure within the NHS are key to getting this improvement.”

Dr Scriven said: “Changing any target for political expediency alone is plain wrong. In this case, the ‘four-hour target’ has been in place for a long time and has helped the flow of patients from the emergency department over many years despite initial scepticism from the Royal College of Emergency Medicine.

“It has been relatively easy to collect this data and measures exactly the same thing wherever it is done. It has proven that focusing on a specific target can help the patients through the acute end of hospitals in a timeframe appropriate for their illnesses.

“There has been a group – including representatives from the RCEM, the Royal College of Physicians and SAM, working with NHS England over the last few months on the project to replace various access standards including four-hour access with measures that might work better for patients.

“This is not yet, as I understand, in a place to recommend any specific new targets with any firm evidence base behind them.
Interestingly, the test sites for the new measures are not reporting against the current target which, in my opinion, hinders interpretation of the data.

“With the month-on-month deterioration in performance against the old target surpassed by an even bigger failing in December, there are many questions that need answering and simply scrapping the target would be, I think, the wrong thing to do without the clinical backing from experts working in the area.

“If the target were to be removed without this type of clinically-driven data-proven exercise to identify a better one, then it would look like the government removing something purely because it is not now being met by a service under immense strain and would be the wrong thing to do.

“It seems as though Mr Hancock’s statement has preempted and sidelined any possible pending decision from the clinical working groups and has now placed them in an invidious position for what appears nothing more than political posturing.”

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SAM calls for “urgent” government action on NHS following latest data release

Following the release today of NHS performance data for December, which showed 79.8% of patients spent less than four hours in A&E, Dr Susan Crossland, president of the Society for Acute Medicine, said:

“We can honestly say that acute care is facing pressures the like of which we have never seen and the huge jump in patients waiting more than 12 hours should be of serious concern to the government. 

“Almost 100,000 patients waited more than four hours, almost double that of last month. For the first time, the standard was met for under 80% of patients and the inexorable decline in trusts meeting the standard adds more pressure onto the morale of healthcare professional struggling to do their very best for patients.

“The target of 95% for the standard was last met in July 2015. There has been too little support, too late and the Society calls on central government to urgently tackle the shortage of beds, the lack of staff and the social care system so that hospital staff can work in a safe and sustainable system, providing world class treatment to those who need it.“

Dr Nick Scriven, immediate past president of the Society for Acute Medicine, added: “This data shows just what a struggle the NHS faces to meet long-standing targets under ever-increasing demand across the board but hides the fact staff are on their knees trying to keep patients safe.

“Sadly, the failure to meet the access targets for years now seems to have been ‘normalised’ and appears to be routinely ignored or, perhaps worse, minor parts of the data spun for any positive effect that can be gained.

“The really depressing fact is that we have been warning the government and NHS leaders that this is happening time after time and feel our concerns have been largely ignored or marginalised.

“However, we make no apologies in saying that action is needed now to help a system in need rather than trumpeting headlines on projects that might help in 30 years’ time but drain funding away from the frontline.”

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Medics say NHS same day emergency care plan for winter ‘grossly derailed’

Senior medics have said an NHS plan designed to improve urgent care and ease pressure on hospitals this winter has been “grossly derailed”.

In March, NHS England announced every major hospital would provide same day emergency care (SDEC) – also know as ambulatory emergency care – by the end of the year as part of the long term plan.

The service, which sits within acute medical units, offers an alternative to hospital admission for patients with serious medical problems who might otherwise have spent at least one night in a hospital bed.

There are many conditions, such as life-threatening blood clots (deep vein thrombosis), dislodged blood clots (pulmonary embolism), cellulitis, seizures and anaemia, suitable for treatment in this outpatient-based setting.

It was suggested rolling out the concept across the NHS would prevent up to 500,000 overnight hospital stays over the year – and help to ease capacity issues significantly over the winter months.

However, an audit by the Society for Acute Medicine (SAM) found almost half (45%) of SDEC units had their “functioning impaired” by hospital trusts utilising the space as overflow for admitted patients.

In addition, many do not provide evening or weekend services, with a report released by the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) in October showing just over a third of units (35%) were only open five days a week.

“For all its good intention, the NHS’s grand plan to use SDEC to improve care and capacity this winter has been grossly derailed as trusts scrounge for additional beds,” said Dr Susan Crossland, president of SAM.

“This shows firsthand how the unsustainable reduction in bed numbers and lack of investment in adequate staffing over many years is severely affecting the ability of the NHS to deliver on promises such as this one.”

Dr Nick Scriven, immediate past president of SAM, added: “We are increasingly concerned we will never see SDEC fully implemented as desired if units are constantly seen as the ‘easy’ target when under-pressure managers need extra bed spaces.

“Until the NHS can sort out its acute capacity and staffing levels, nothing will get better in this respect and that is not what anyone wants to hear as we move through January when pressures will ramp up further still.”

Dr Crossland said SDEC had the potential to “significantly improve” the capability of hospital trusts manage winter pressures and year-long capacity issues and that failure to establish it fully was a “dereliction of duty”.

“We presented the possibilities achievable with SDEC in our report on winter solutions back in November 2018 when we called for investment in this area yet find ourselves still needing to push the agenda,” she said.

“We strongly endorse and support the provision of these services if they are appropriately resourced and running properly and we call for urgent action to ensure that happens.”

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SAM issues winter briefing as NHS faces “most pressure it has ever seen”

Following the release today of the latest weekly NHS winter sitrep data and the Queen’s Speech, the Society for Acute Medicine has issued a winter briefing on the current state of the health service and the action required to alleviate pressure.

Within the report, Dr Nick Scriven, immediate past president of the Society for Acute Medicine, said: “The NHS is under the most pressure it has ever seen and quite how we will get through the next few weeks and months remains to be seen.

“We need to urgently support our staff throughout the NHS as they are reaching the stage of utter exhaustion after more than two years of unrelenting and increasing stress and workload.

“Promises or commitments of investment today will not make up for years in a matter of months, which is what would be needed to get us through the winter period safely. It is the bare minimum.

“The best option for those in central positions now would be to engage with staff who actually work on the frontline up and down the country to put out realistic messages of how things are and focus on what can make an immediate impact.”

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Society for Acute Medicine – winter briefing 2019/20

This winter could be the toughest yet for both patients and staff in the NHS and funding pledges in the Queen’s Speech will do little to allay the concerns of staff and patients about the ability of hospitals up and down the country to cope.

Any promises or commitments of investment are most certainlly not a cause for celebration, they are simply a necessity the government cannot ignore. Sadly we cannot make up for years in a matter of months, which is what would be needed to get us through the winter period safely.

As late as yesterday (18 December), a Parliamentary briefing paper has laid the statistics bare, quoting that in 2010 only one in 25 people who attended our emergency departments (EDs) were there for over four hours but this year it is one in five who spend more than that time target.

Performance has dropped month-on-month with no major unit achieving the ‘target’ in November 2019 – and fully expected to get worse as winter starts to bite.

The reasons for this are well known and the Society for Acute Medicine, among others, has been warning of the impact for over 18 months now but feel that this has been in vain due to the political vacuum and the ‘Westminster bubble’ focusing on one thing only, Brexit, at the cost of any other issue.

We have released many statements and reports highlighting this and, in recent months, have written twice to the Secretary of State for Health without engagement from him personally in any response. We would be willing to meet Mr Hancock at any time to further discuss our concerns in a constructive manner.

The really significant issues are the ever-rising demand that has not in any way been matched by resource in estates, equipment or staff. The well-known deficiencies in community and social care are heaping further pressure on the acute sector and are now matched by the impact of the so-called ‘pension tax crisis’ that has seen senior workers in the NHS effectively financially punished for trying to go the ‘extra mile’ needed each and every day.

With regards to demand, yesterday’s Commons’ paper showed the rise from 2010 to 2019 in attendances at ED was 15% and in admissions via ED 35%. We also know from the NHS performance statistics that these have risen by probably 3% to 4% in the last year since these figures were prepared. This is in the context of a 10% drop in overnight beds over the same timeframe following much steeper declines in the preceding 20 years. There is no room left for manouevre.

To focus on the pension ‘issue’, this has been a problem building since its ill-conceived introduction in 2016 but it is hitting hard this year and, unless anything substantive is done, the impact will rise year-on-year. It has seen clinicians cutting back on activity, initially to a standard 40-hour contract but now to less in efforts to avoid five-figure tax bills on what is generally income that might not actually be gained as a pension for 10 to 20 years.

This is impacting across the board in clinical and non-clinical areas as described by NHS Providers in a paper released yesterday. For winter it means that trusts will not be able to rely on clinicians picking up extra shifts at weekends and evenings. The response to this is mixed, with the latest ‘quick fix’ being greeted with a degree of scepticism and trusts all interpreting other measures in a very mixed fashion, for example, with the ‘recycling’ of contributions suggested by NHS England being ignored as it was not an absolute mandate and offering ‘solutions’ that only apply to small numbers of those affected (suggestions including some form of help for those with ‘responsibility payments’ or clinical excellence awards).

The Department of Health and Social Care confirmed yesterday it would “carry out an urgent review of the pensions annual allowance taper” to report at the Budget.

So, what can – and should – be done?

We welcome the promise of funding but we feel very wary – with good reason. Figures suggest there is a growing backlog in essential maintenance now estimated at £6.5 billion with £1.1 billion needed for ‘high-risk’ repairs.

We also need some assurance of how and where any finance may be used for the greatest benefit in the most expedient timeframes. The SoS has made very clear his focus is on IT and whole genome testing, but they don’t provide the solutions we need right now.

The IT fixation is particularly problematic given that many NHS units have not progressed beyond Windows 7 and host computers that take 10 minutes or more to start up, with a myriad of different log in procedures and no inter- connectivity.
For senior staff the obvious fix is to not only review the position on pension taxation but to act and act swiftly to have formal plans in place for the next tax year starting April 2020.

For junior staff we need to recognise and reward their working conditions, place more emphasis on a ‘learn not blame culture’ and continue to make medicine an attractive and fulfilling career.

We have a long-term plan for the NHS but still wait for any such declaration for social and community care and, while there is a lot of good intention in the plan, there must be some caution regarding the possibilities.

The main plank for reducing bed pressure is the use of Same Day Emergency Care (SDEC) – AKA ambulatory emergency care – with notable ambitions in this area. The measurement of this is hampered by not actually having a definition of what an ‘open’ unit actually is, allowing many trusts to claim they have a service that is actually nothing of the sort in terms of provision.

Also, there is immense pressure on these areas, most frequently co-located with acute medical units, and data has shown that up to 45% of these units being hampered by being used as ‘overflow’ wards for inpatients. They are frequently seen as easy targets by hard-pressed managers in times of almost constant system stress.

We fear the NHS will never be able to fully implement SDEC fully as desired.

One example of the impact of this can be seen in the recent NCEPOD review of the treatment of pulmonary embolism (blood clots which travel to the lungs) which, in many cases, can be performed through SDEC but, alarmingly, it is often only a 9am to 5pm, Monday to Friday service. More than 10% of the patients included in the NCEPOD review either died from the problem or needed treatment in intensive care.

The NHS is looking at new ways of measuring targets for many areas, including emergency care, but there are growing calls for more openness in this process and concerns that the new suggestions will actually negatively impact on care for the those needing inpatient beds when the focus to meet the target might be on the numerically higher number of those who do not need admitting.

Lastly, but probably most importantly, we need to urgently support our staff throughout the NHS as they are reaching the stage of utter exhaustion after more than two years of unrelenting and increasing stress and workload while under ever-increasing scrutiny and pressure from trusts trying to balance the financial books by every trick in the book regardless of the impact these ‘measures’ will have on the intangible and immeasurable areas such as morale (a new app is not the answer!).

To summarise, the NHS is under the most pressure it has ever seen and quite how we will get through the next few weeks and months remains to be seen.

We ask all those in central positions to engage with those who actually work on the frontline up and down the country to put out realistic messages of how things are and not hide the reality in endless positive spin that no-one working in the NHS believes.

We must, above all, work together to ensure all those people who need help receive it in a safe, dignified and caring manner while protecting the wellbeing of the staff on whom we all depend.

Dr Susan Crossland, President

Dr Nick Scriven, Immediate Past President

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Health secretary ‘needs to face up to realities’ – SAM past president

Following the release today of NHS performance data for November which showed 81.4% of A&E patients were seen within four hours last month, Dr Nick Scriven, immediate past president of the Society for Acute Medicine, said: “In November emergency department figures fell to 81% with my expectation it will be far worse this month bearing in mind the mentioned viruses did not really have effect until December.

“While the Conservatives bask in the glory of an election win, the Secretary of State for Health now needs to face up to the realities of the warnings clinicians have been given for far too long and make an effort to engage and work towards a resolution.

“We have written to Mr Hancock twice outlining our concerns over the past two years but he has failed to engage with us.

“We are now calling for action to ensure the Department of Health and Social Care and the NHS take steps to support staff over what what be an extremely stressful winter.”

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Winter SAMBA – 30 January 2020

Winter SAMBA – 30 January 2020

Winter SAMBA 2020 registration is now open! Please use the form at the end of this post to sign up and take part.

Winter SAMBA will take place on 30 January 2020. 

If you took part in SAMBA19, you do not need to re-register – just log in to the database with the details you used for SAMBA19. If needed, you can add additional users – see the How to guide here.

For Trusts that have more than one hospital, please register each hospital site separately. Please take care to write out the hospital name in full, no abbreviations or the name of the trust. Also, you can specify if you want to be the administrator for your unit, which gives you direct access to the results of Winter SAMBA, as well as the ability to create additional log ins for members of your SAMBA team. You will be sent a link to start uploading your unit data two weeks before the audit date of 30th January 2020.

A Caldicott Approval form will need to be completed for Winter SAMBA – once this form has been completed, it does not need repeating for further SAMBAs in 2020.

Below please find:

Caldicott Guardian form

Winter SAMBA Protocol

Winter SAMBA How to Guide

Winter SAMBA Masterlist

Winter SAMBA Patient Data Collection Form

The unit questionnaire is available in the database.

Please start arranging your Winter SAMBA data collectors for the 30th January 2020 and ensure that your Caldicott Guardian has approved data release. Also, your local audit team should be made aware and approve of Winter SAMBA using your usual local permissions. The data entry deadline is 23:59 on 23rd February 2020.

Any queries, please let us know at samba@acutemedicine.org.uk

 

Cat Atkin, on behalf of the Winter SAMBA team.

Database resources

If you need a new password to the database, please go to: https://data.casecapture.com/account/Login

Follow the link ‘Need to set your password or forgotten your password? click here’

Your username is your email address. Follow the instructions to reset your password.

Administrators: How to add a user to the SAMBA database.

Winter SAMBA

Please fill in this form to register to participate in SAMBA19. Once you have registered, you will receive your SAMBA database log in details via email before the audit date. Please ensure that you register the name of the participating hospital, and not the name of the trust. Thank you very much for your support of SAMBA!
  • Data Protection

    Your registration details will be stored securely within a database at the Royal College of Physicians of Edinburgh (RCPE) in compliance with the General Data Protection Regulation (GDPR) and accessed only by administrative staff working on behalf of the Society for Acute Medicine (SAM) for the purposes of administering your participation in the Society for Acute Medicine Benchmarking Audit (SAMBA) 2019. Your registration details will be shared with the company Net Solving for the purpose of generating the account you will use to access their data collection website. The Society of Acute Medicine will, from time to time, send you email communications relating to your participation in Winter SAMBA 2020. You may also be contacted by email about possible involvement with the next Society for Acute Medicine Benchmarking Audit.
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SAM past president warns norovirus spread a “great concern”

Following data released today by Public Health England and NHS England which shows hospitals across the country closed more than 1,100 beds over the last week due to norovirus, Dr Nick Scriven, immediate past president of the Society for Acute Medicine, said: “This is a great concern on top of a system already pushed to its limits.

“It is worrying for many reasons, one of which is that it is not a “minor” illness and can be fatal for some.

“For the system it closes beds and also slows discharges as you cannot discharge a patient from an affected ward to a care home.

”All in all the rise in norovirus and flu is going to be a severe challenge for a system already stressed to the max.”

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SAMLondon: Registration and abstract submission now open!

SAMLondon: Registration and abstract submission now open!

The Society for Acute Medicine spring meeting will take place on 30 April – 1 May 2020 at Novotel London West, Hammersmith.

SAMLondon is now open for registration and abstract submission at http://www.samlondon2020.org

The conference is aimed at the whole multidisciplinary team who, like you, work day in and  day out, in acute and general medicine.

SAM conferences are rated highly for their friendly, welcoming atmosphere and this is your opportunity to Learn, Network and Enjoy spending time with colleagues who face the same challenges as you.

Programme

12 CPD Points have been applied for by the UK Federation of the Royal Colleges of Physicians (Activity Code: 129059)

Early Bird rate ends 29 February 2020

Register today! 

CALL FOR ABSTRACTS 

Abstract Submission is open until 1 March 2020.

For more information, view the Call for Abstracts

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Leading medical body calls for politicians to address “elephant in the room” following worst performance on record

A leading medical body has called on politicians to address the “elephant in the room” during campaigning before any further “puff” announcements on the NHS are made after the worst A&E performance figures on record were released today.

The Society for Acute Medicine has warned acute and emergency care in the NHS is “imploding” – before the expected winter crisis hits – and there are as yet no credible plans from any parties to deal with it.

Data for October showed only 83.6% of people attending our emergency departments were seen within four hours and, for the sickest patients, this fell to 74.5%.

This is in the context of ever-increasing demand, with a 4.4% rise compared to October 2018 in attendances and a 4.6% rise in admissions over the last 12 months.

“These figures are truly worrying as we haven’t even reached the “traditional” winter period yet,” said Dr Nick Scriven, immediate past president of SAM.

“Urgent action is needed across the health service now to look at the capacity to meet this challenge.”
He said hospitals were under “intense pressure” with many at full capacity, yet politicians were “avoiding the elephant in the room”.

“We have heard so many “announcements” over the last few weeks of half-baked projects that require either thrice promised money or are totally uncosted for the real world.

“With what we have seen with the critical incident over A&E pressure in Nottingham last week – and that is just the tip of the iceberg – this, to me, is simply the reality of the constant warnings made by experts now coming to fruition.

“Yet we are hearing parties talk about how they will be the saviours of the NHS by all manner of ways but the biggest crisis is facing us right now in acute and emergency care as we head into winter.

“We want to know, before any further NHS soundbites and puff about matters that will barely scratch the surface, what every party intends to do immediately after 12 December to prevent the service going into meltdown before Christmas.”

Dr Scriven highlighted the the four-hour emergency access target has not been met since 2015 – the year before the EU referendum took place.

“It is quite ironic to see the NHS being made the focal point of early campaigning, particularly by Boris Johnson and the Conservatives, given that the crisis in emergency care goes back even further than the Brexit debacle.

“When you look at some of the major issues of the moment – Brexit, climate change and healthcare – it is fair game for anyone to ask just what has been going on behind the scenes these last few years.

“The issue for all political parties in this election campaign is engaging the country when I, for one, believe nothing a politician promises in election periods – and there are plenty of those being made.”

He said questions need to be asked as to how, with the spectre of a more severe influenza season, there has been little action to address the growing recruitment issues while a pensions tax crisis has developed which poses an “extreme threat” to staffing this winter.

“There has been is no increase in beds available across the NHS and no reversal of the decline in numbers over the last decades.

“Last winter had no extraneous factors with relatively little flu and no real prolonged severe weather.

“This year we have the prospect of both of these, with the increased norovirus that will bring, alongside thousands of vacancies and senior clinical and non-clinical staff reducing hours due to a ridiculous taxation policy which remains unresolved.”

He added: “Parties really need to start looking at and talking about the hear and now to address the elephant in the room, rather than filling people’s minds with distraction tactics of policies which, if Brexit is anything to go by, will take years – if ever – to be implemented, let along have any impact.

“We have tried to engage repeatedly with the government over the last two years without meaningful reply and have written to the three main parties urging them to address these points without response.

“Frankly we expect better from all those running or hoping to run the NHS and so do patients.”

Dr Susan Crossland, president of SAM, said alongside financial issues and the pensions crisis, there was an “urgent need” to provide psychological support for staff ahead of winter.

“We want to reiterate that, as well as the other urgent problems of finances and the pensions fiasco, support is required for staff from a psychological perspective if we are to stop the NHS grinding to a halt this winter.

“We have tried to engage with parties but they are more intent on cheap point-scoring off each other and PR stunts than listening to the people on the ground and that simply cannot continue throughout this campaign.”

Acute medicine, also known as acute internal medicine, deals with the immediate and early treatment of adult patients with a variety of medical conditions who present to hospital as emergencies.

The specialty receives the majority of patients admitted from A&E and plays a vital role in maintaining the flow of patients through emergency departments to avoid exit block, the term used when patients cannot be moved into a hospital bed.

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Lack of short-term detail from parties “a concern” – SAM past president

In response to the release of details of the Labour Party’s investment plans for the NHS, Dr Nick Scriven, immediate past president of the Society for Acute Medicine, said: “Scanning the headline details of Labour’s plans it does little to address the problems being faced by acute care in the NHS right now.

“We, as would anyone, welcome any proposed investment but I am still very concerned at the lack of short-term detail from all the main parties.

“Buildings, equipment and tussling over who can pledge the largest amount of cash will be meaningless if we don’t have the staff to run the NHS.

“At the moment we are thousands of staff and beds short of being able to cope this winter, let alone think about the next five years.”

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Sharp end of NHS has scarcely had time to breathe – SAM past president

Following the release today of a British Medical Association report calling for 10,000 more beds in the NHS this winter and the announcement yesterday of a critical incident at Nottingham University Hospitals NHS Trust due to A&E pressure, Dr Nick Scriven, immediate last president of the Society for Acute Medicine, said:

“The sharp end of the NHS has scarcely had time to breathe let alone recharge and staff are running on empty and goodwill which is unsustainable in the long-term.

“The four-hour emergency access target has not been met since 2015, yet we have seen very little in the way of addressing this very apparent problem.

“This will be laid bare again during an extremely challenging winter that will be exacerbated by a recruitment crisis and senior doctors working less hours – we are deeply concerned.

“Despite positive statements about new methods of measuring pressure on A&E only last week, it is worrying this incident in Nottingham has happened before winter in one of our biggest hospitals and a pilot site.

“SAM recognises and supports our colleagues out there who are working under such difficult circumstances and we will continue to do all we can to highlight these issues and push for action.”

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Joint statement from RCEM and SAM regarding same day emergency care (SDEC)

There has been much publicity recently around provision of same day emergency care services as outlined in the NHS long term plan.

The Royal College of Emergency Medicine and the Society for Acute Medicine endorse the provision of these services and we are aware that there is a lot of anxiety from both AM and EM clinicians regarding the pace of change.

In reality nearly all acute trusts in the country already deliver some form of same day emergency care and NHS England research suggests that 89% of acute providers have a designated unit where most of the SDEC occurs.

SDEC services are run by a disparate group of clinicians, but the largest cohort of patients are seen by clinicians with a background in acute or emergency medicine. These groups of professionals share this similar patient cohort in relation to those patients who present with SDEC sensitive conditions either to the emergency department, acute medical unit or SDEC. We also recognise that paediatricians have increasingly moved to an SDEC model of care and, more recently, many sites have developed surgical and orthopaedic SDEC pathways and SDEC services for frail patients.

In order to deliver effective SDEC services we need to break down barriers between professional groups and ‘silo working’. We encourage those working in acute care to work together to develop their SDEC services, using local expertise, workforce and organisational structure, and this approach is explicitly supported by the NHS.

The benefits of effective SDEC delivery to teams working to deliver acute care “at the front door” include reducing unwarranted variation in care pathways, streamlining the patient journey, better patient and staff satisfaction, reduction of admissions and improvement of flow in the acute admission pathway.

We hope that the following dispels some rumours, myths and concerns around SDEC delivery:

  • Same day emergency care (SDEC) is synonymous with ambulatory emergency care (AEC). It is the care process whereby a patient who has been referred or self-presented to secondary care in an emergency is assessed, investigated and treated without being admitted to a traditional inpatient bed. This process can occur in several settings including an area of an emergency department or a specific SDEC (AEC) unit typically, but not exclusively under the auspices of the acute medical team. This care would usually be delivered in a four hour to 12 hour timeframe and may be spread out over more than one day if a pathway indicates this. However, the hallmark remains that the patient sleeps in their own bed and not an inpatient hospital one.
  • The ambitions included in the NHS long term plan are to implement SDEC seven days a week, 12 hours a day in every hospital with a ‘type 1’ (consultant-led 24 hour) ED and, in addition, to provide 70 hours of a defined frailty service a week.
  • SDEC should facilitate the right people to be treated in the right place at the right time for that person’s condition and is intended to bring about a positive experience and achieve the best outcomes for that patient.
  • SDEC is not an alternative facility to be used to maintain performance against any time-based target.
  • SDEC is not a space for patients who present to the emergency department who would not have been considered for admission to be managed i.e. “minors” type patients.
  • SDEC is not an alternative to an inpatient bed if that is what the patient needs even at times of system stress and is not a ‘place to wait’ for that bed.
  • SDEC is about a skilled team of healthcare professionals delivering high quality care to a cohort of patients in a safe environment that meets their needs on the same day without admittance.
  • The multi-disciplinary model of SDEC delivery provides a rich environment for training of future clinicians, working in many disciplines who will be delivering acute care
  • In the future the Emergency Care Data Set (ECDS) will be rolled-out across SDEC to make it easier to get high quality data and appropriate remuneration for the work done.
  • For further advice we suggest the websites for SAM/RCEM/AECN/NHSE where much guidance exists to help you.

Dr Katherine Henderson
President
The Royal College of Emergency Medicine

Dr Susan Crossland
President
Society for Acute Medicine

Dr Tara Sood
Chair
RCEM SDEC Special Interest Group

Dr Nicholas Scriven
Immediate Past President
SAM, AIM SDEC Lead

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SAMontheMOOR Presentations

To view the presentations from the SAMontheMOOR conference, click on the links below (more to follow):

THURSDAY 10 OCTOBER 2019

PLENARY 1: ACUTE MEDICINE, ALWAYS FIRST

The Future & Acute Medicine, Professor Donal O’Donoghue

Helping Physicians Practise Well, Professor Sir Terence Stephenson

SAM Fellowship Award: There is no “I” in Team, Dr Phil Dyer

 

SESSION 2.0: DIAGNOSIS & INITIAL MANAGEMENT OF STROKE

Stroke Mimics, Dr Sameer Limaye

The AHP & Stroke Management, Pam Bagot

 

SESSION 2.2: TRAUMA FOR THE ACUTE PHYSICIAN

Major Trauma: The Ones Who Slip Through the Net, Dr Alexandra Danecki

 

SESSION 2.3: THE ROLE OF SIMULATION IN ACUTE MEDICINE

Use of Augmented Reality, Dr James Storey

State of the Art in Simulation, Chris Gay

How to Organise & Fund your Sim Service, Angela Hope

 

SESSION 3.0: MATERNAL MEDICINE: MEDICAL COMPLICATIONS IN PREGNANCY

Lessons Learned from MBRRACE Report on Maternal Mortality, Professor Marian Knight

Why We Need More Obstetric Physicians, Professor Cathy Nelson-Piercy

Improving the Care of Pregnant Women, Dr Anita Banerjee

 

SESSION 3.1: HIGHER LEVEL CARE IN THE AMU

Using Less O2, Dr Reed Siemieniuk

 

SESSION 3.2: MODELS OF CARE

Changing How Hospitals Work, Dr Cliff Mann

 

SESSION 3.3; ORAL PRESENTATIONS 1

Oral Presentations 1

 

SESSION 4.0: THE ACUTE CONSULT: PROBLEMS IN MY PRACTICE

Headaches: An Acute Physician Take, Dr Simon Irving

PE – Thrombolysis or Not? Dr Sarah Rose

Liaison Psychiatry: The Interface Between Medicine & Psychiatry Dr Immo Weichert

 

SESSION 4.1: AMBULATORY CARE

Quality Standards in Ambulatory Care, Dr Sue Crossland

Should We Treat or Just Monitor Subsegmental Pulmonary Embolism in the Ambulatory Care Patient? Professor Dan Lasserson

 

SESSION 4.3: WEE SHORTY’S: IMPROVING SERVICE ORGANISATION & DESIGN IN THE AMU

Wee Shorty’s

 

SESSION 5.0: WHEN ORGANS FAIL

Acute Liver Failure: Causes, Symptoms, Treatments, Tests & More, Dr Paul Southern

Lung Failure: Common Causes & Management, Dr Reed Siemieniuk

AMU Management of AKI: Top 10 Tips, Dr Andrew Lewington

 

SESSION 5.1: WORKFORCE & LEADERSHIP

PA Lessons from the USA, Deborah Galindez

Culture Transformation, John Bacon

 

SESSION 5.2: RESEARCH IN ACUTE MEDICINE

NICE Suspected Neurological Conditions Guidelines, Carole Gavin

NCEPOD Explores the Process of Care for Patients With Pulmonary Embolism, Dr Simon McPherson

Change in Renal Function Associated with Drug Treatment in Heart Failure: National Guidance, Dr Laurie Tomlinson

Population Systems for Acute Care: The PIONEER Digital Innovation Hub & Opportunities for Acute Medicine Research, Dr Liz Sapey

 

SESSION 5.3: ORAL PRESENTATIONS 2

Oral Presentations 2

 

SESSION 6.0: ADOLESCENT MEDICINE: WHAT YOU MUST KNOW ON THE AMU

Complexities in Acute Care Transition, Dr Lorraine Albon

Transitions in Diabetes, Dr Sam Pearson

Transitions in Asthma, Dr Ian Clifton & Dr Emma Guy

Eating Disorders, Dr William Rhys Jones

 

SESSION 6.1: INFECTIOUS DISEASES: WHAT YOU MUST KNOW ON THE AMU

New Treatments for TB, Dr Ian Cropley

GUM Presentations on the Medical Ward, Dr Joanna Glascodine

 

SESSION 6.2: SAMBA: MEASURING QUALITY & COMPLEXITY IN ACUTE MEDICINE

SAMBA19 Main Results, Dr Dan Lasserson

Maternal Medicine & Mental Health, Cat Atkin

Hospital at Home & The Frail Patient, Tom Knight

 

SESSION 6.3: TRAINEES IN AIM

Returning to Work After Illness, Dr Damian Dooey

Using Yoga to De-stress the AMU Workforce, Dr Jonny Coppel & Dr Claudia Sadler

 

SESSION 7: ACUTE MEDICINE, ALWAYS FIRST

IT Advances – The Role in our Future, Owen Williams

The Multi Professional Way Ahead Approach, Professor Mark Radford

High Quality Care For All, Now & For Future Generations, Professor Stephen Powis

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SAMontheMOOR Posters

To view the presentations from the conference, click here

Click on the links below to view the posters displayed at SAMontheMOOR on 10-11 October 2019:

Audit & Quality Improvement Posters 

AQI 06: An educational intervention to improve confidence of acute medical team in using liver cirrhosis bundle in the management of decompensated liver disease

A&QI 11: Characterising the population at risk of acute kidney injury and developing a risk assessment process targeted at modifiable risk factors

A&QI 14: Decompensated cirrhosis care bundle

AQI 17:  ECG operator errors & artefacts

A&QI 22: Foundation Year 1 Acute Medicine Experience Quality Improvement project

AQI 23: Gotta Prescribe ‘em All: Quality Improvement Project On Medication Omissions in the Emergency Department

AQI 25: Implementing, Embedding, and Driving the Medication Safety Agenda for ‘Medication without Harm’

A&QI 26: Improved patient safety, a mouse-click away – Transformation of “Medical Take Lists” from paper to electronic

A&QI 27: Improving AMU to Speciality Handover QI

AQI 30: Improving documentation of ECGs in Electronic Health Record Systems on the Acute Medical Take – A Quality Improvement Project

AQI 36:  Integrating Physical Activity Documentation into the Acute Medical Take

A&QI 38: Is ReSPECT more than a DNACPR form in the Respiratory Department?

A&QI 39: Management of New Onset AF Presenting to the Acute Medical Unit

A&QI 41: Moving towards Medical Subspecialty Take – a Quality Improvement Project

AQI 42: National Audit of Meningitis Management (NAMM): Results from a West Midlands trust

AQI 44: Optimising Arterial and Venous Blood Gas Practice and Interpretation on an Acute Medical Unit

A&QI 45: Point of care testing in ambulatory emergency care in the Queen Elizabeth Hospital King’s Lyn

AQI 46: Reducing length of stay for patients attending an ambulatory emergency care cellulitis clinic: A quality improvement project

A&QI 47: Reducing medication errors on admission to the acute care unit

A&QI 49: Review of patients with chest pains suspected to be cardiac in origin and application of HEART score in AEC

A&QI 51 : Sepsis grab-bag: to aid compliance and improve sepsis management within the golden hour

A&QI 53: Start Smart – then Focus – Are we meeting the targets?

AQI 55: The function of computerised tomography head scans in the assessment of patients who present with drug overdose and a low Glasgow Coma Scale

A&QI 56: The impact of multi-disciplinary action on smoking cessation in the acute medical unit at UCLH

AQI 57: The introduction of telemetry guidelines improves appropriate usage

AQI 58: The Stethoscope – An important medical device or a “Trojan” A Quality Improvement Project from An Infection Control Perspective

A&QI 61: The Utilisation of Age Related D-dimer Measurement in a Clinical Decisions Unit

AQI 62: Use of Lumbar Puncture in Suspected Subarachnoid Haemorrhage

 

Case Report Posters

CR 02: A complicated clot

CR 03: A Hiccup in Diagnosis

CR 04: A Soldier’s Twist of Fate

CR 06: An Atypical Presentation of Guillain-Barre Syndrome masquerading as Acute Stroke in an Acute Medical Admission Unit

CR 07: An unusual case of intermittent dysphagia

CR 08: An Unusual Case of SLE: Pericardial Effusion as Initial Manifestation of the Disease

CR 12: Case Report: Rare lumbar puncture complication – Spinal haematoma causing cord compression

CR 18: D-dimer: Opening Pandora’s Box

CR 20: Hepatitis with Rashes

CR 23: Malignancy or not? A rare case of brown tumors

CR 26: Mystery Anaemia, cANCA vasculitis; Listen to the heartbeat?

CR 29: Rare cause of hypokalemia

CR 30: Re Expansion Pulmonary Oedema – A Clinical Perspective

CR 33: Severe Meningococcal Septicaemia Presenting with DIC and Purpura Fulminans WITHOUT meningitis

CR 35: Spinal shock and flaccid paralysis caused by Streptococcus intermedius

CR 39: The need for re-assessment in acute care

CR 40: Unexplained fatal hypoxia in a previously healthy lady…Acute interstitial pneumonitis and the potential role of vitamin D deficiency.

CR 41: Unexplained Venous Sinus Thrombosis in a 16 year old female – A Clinical Conundrum

CR 42: Unilateral Pulmonary Edema – A poorly recognised radiological finding often misdiagnosed and treated as pneumonia

 

Education Posters

E 13: takeAIM impact on Acute Medicine recruitment

 

Research Posters

R 01: A questionnaire survey on causes of medication administration errors as perceived by nurses working in medical and surgical admission wards

 

Service Organisation & Design Posters

SOD 10: Improving AMU patient transfer system

SO&D 13: Point of care influenza diagnosis in medical assessment unit

SO&D 16: Understanding the role of Acute Medicine Advanced Care Practitioners (ACPs) in Sepsis Mortality improvement using Complex Adaptive System (CAS) thinking

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CQC report highlights “frightening state of affairs”

Following the release today of the Care Quality Commission’s annual state of care report, Dr Nick Scriven, immediate past president of the Society for Acute Medicine, said:

“It is a frightening state of affairs in our acute hospitals if over 25% are deemed as “needing improvement” or “unsafe”in the run up to what could be one of if not the worst winters for us in terms of demand. This is even more concerning when you realise that 52% of our urgent and emergency services fall into this category.

“We have seen this year demand is already more than 5% up on every month last year with no sign of this increase flattening out or any possible respite. I would agree with the CQC in that is a ‘perfect storm’ but we have said the same for various surges in pressure over the last 48 months or so without it really provoking any positive reaction from government.

“At some point in the near future all these sustained and repeated problems with increasing demand, inadequate workforce that is haemorrhaging senior cover, the pension tax crisis, crumbling estates, insufficient community medical care and community social care in general totally under provisioned, we will reach a vital tipping point and care will be compromised despite all the heroic efforts by the human side of this, the staff in post.

“It is good to see The CQC acknowledge that senior staff and managers have a major role to play in that the culture they set is also key to how the system works and without the right culture nothing will succeed.

“We can only hope that over the next few months we do not see any prolonged bad weather nor any kind of influenza increase above seasonal averages.”

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