Following the release today of NHS performance data for June, Dr Nick Scriven, president of the Society for Acute Medicine, said:
“The system remains under significant strain and one wonders how many more times performance targets have to be missed for government and NHS leaders to accept they have failed to meet the challenges presented to them over recent years.
“This is meant to be the time when services are least stretched and staff have an opportunity to draw breath but the numbers are staggering – more than 17,500 people needing emergency admission every day in June with a 5% increase in 12 months and the number of patients “stuck” in acute beds is identical to to this time last year (4,500).
“These two mean the pressure remains relentless and people are suffering delays in getting care, notably the 12-hour breach number was 375% more this June compared to 2018.
“As we lurch from one period of pressure to another without any noticeable respite there is now an incredibly serious worry on the horizon in Australian flu which could cause chaos in the UK.
“If the experience in Australia – 75,000 cases up on the same period in 2018 – is replicated then we would see a similar situation to the “bad” winter of 2017 well before we move into winter proper.
“It would be unknown how the NHS would cope given that even in the middle of summer many of our hospitals still have a large proportion of so-called extra capacity in use.
“There would need to be some very firm finger crossing for us to avoid disaster given the current challenges, particularly given the likely lack of senior staff available to provide service-saving overtime due to the now well-publicised and unresolved issues with tax and the NHS pension scheme.”
Following research released today by BBC News which found a quarter of patients in England wait longer than an hour to receive antibiotics when sepsis is suspected, Dr Nick Scriven, president of the Society for Acute Medicine, said:
“We recognise the immense amount of work put in by frontline staff to achieve what they have managed to do in improving the care of patients with sepsis but many other critical conditions too that are equally as life-threatening.
“We would like to be able to get to a place where all these people are treated in an optimal way for their condition. There is a slight concern that by pretty much focusing targets on one measure – giving antibiotics – there is a risk that other highly important treatments may not be delivered in time.
“We must also be mindful that, in a proportion of cases, antibiotics might not be the best treatment for issues. SAM will continue to press for the best possible treatment for all those who present to our overstretched NHS.”
By Dr Susan Crossland, vice-president of the Society for Acute Medicine
The new NHS patient safety strategy was launched this week by Dr Aidan Fowler, NHS national director of patient safety.
He has promised to listen and work continuously to improve patient safety within the NHS.
He spoke of insight, involvement and improvement as the three cornerstones of this and announced plans to replace the National Reporting and Learning System with a new Patient Safety Learning System.
Although it may be semantics, it acknowledges that while accountability can be important, the fear of blame rather than learning and sharing is a barrier to improvement.
He sees the medical examiner system as having an integral role in scrutinising death and has revamped a new Patient Safety Alert Committee to respond to new and emerging risks.
Involvement was a big theme, with a big role for patients and their advocates and a new Patient Safety Syllabus. There were various safety Improvement programmes announced, including medicines and mental health, and priority for learning from incidents around older people and those with learning disabilities.
The Society for Acute Medicine welcomes the new framework – the high risk environment members work in means that patient safety is always at the forefront of what we do.
We support the involvement of patients and their carers and would also like to see involvement at the grass roots of the NHS, a bottom-up approach from the front line.
As always, an engaged and full strength workforce will be integral to these plans and we continue to work with others in order to achieve this.
By Dr Nick Scriven, president of the Society for Acute Medicine
As we come to the end of Acute Medicine Awareness Week 2019 there needs to be a pause in the Brexit shambles and party political posturing to really consider the impact of the two recent reports on our greatest asset – the 1.3 million people who work within the NHS.
Without this massively diverse group of workers dedicated to the service we would not have what we cherish and the whole service would have fallen apart under the unrelenting pressure years ago.
The first report to be released was the ‘Closing the Gap’ paper from the Health Foundation, Nuffield Trust and Kings Fund. This paper highlighted the ongoing pressures and laid out suggestions over seven main areas covering recruitment, retention, service design and social care with particular emphasis on the major struggles facing both primary and secondary care.
The second paper was the leaked and then released ‘Interim NHS People Plan’ authored by the team led by Baroness Dido Harding. Much like the earlier report, this focused on making the NHS a better place to work and making the workforce fit to deliver the aspirations of the Long term Plan. This was welcomed as it was released but more recently there have been several critical appraisals that have not been so kind.
As a Society we fully endorse the sentiments underpinning this work but, like others, we do have some reservations about how realistic and deliverable it is as the interim plan is long on aspirations but rather short on detail and, crucially, is reliant on a still to be released financial plan.
One thing SAM clearly agrees with is the plan around developing the multidisciplinary team including both advanced care practitioners (ACPs) and physician associates (PAs). We are currently working with the Royal College of Physicians and Health Education England on a project that should really benefit and add ‘value’ (in all respects) to the ACPs working in acute medicine and we continue to support the drive to regulate the PA profession to enable them to take on further roles they will be ideal for.
We are concerned at the pace this is moving and wonder where the stumbling block is to progression but, for the sake of this dedicated and new group of workers, it must be overcome as soon as possible to prevent them becoming disillusioned in the NHS.
Furthermore, SAM is extremely disappointed at some of the headlines coming from certain areas of the medical profession in effect criticising and belittling these two groups. In my opinion, this reflects very badly on those doctors who shared their negative views and shows a profound lack of understanding in just how valuable these people are. After all, there is more than enough ‘work’ to go round.
While we acknowledge the need to train and recruit more workers, it needs to be said that these are long term plans – e.g. it takes 10 to 15 years from someone entering medical school to becoming a GP or consultant) and the real action needs to be focused on staff retention by making the NHS a better place to work.
There is a lot to be said around the current tax/pension issue catching lots of senior staff in a punitive financial trap leading to experienced staff reducing hours and being unwilling to cover gaps due to the threat of five-figure tax bills. It seems as though this particular ball is being passed around various government departments with, so far, no acceptable solution proposed and with the only glimmer of light being the health secretary Matt Hancock saying he is ‘open to talks’.
However, the biggest issue that faces the whole workforce is the culture that predominates and needs fixing from the top down. While there are many fabulous examples of trusts with great leadership and cultures, there are far too many with negative ones with staff downtrodden by covert and overt processes and diktats that range from ‘inconvenient’ to outright bullying.
It is a sad reality that while most senior boards have the right ideas they are often blind to the way in which those under them achieve results and, as a clinician, it pains me to say it is often senior clinicians in manager roles who are the worst offenders in the way they treat their teams.
The ‘inconvenient’ type of issue can be the hospital where the only form of catering after 5pm weekdays and all weekends is via vending machines – woe betide any staff member who is working evenings/nights and wants a healthy diet.
The more unsubtle issues have been raised in reports on junior doctors’ lives but it is telling that more than one CEO is reported to have said to their teams ‘this is dreadful but it isn’t here, is it?’ to be met with a total lack of eye contact and much foot shuffling.
Unfortunately, the cultural issues are more widespread than just among doctors and there are examples of how ‘difficult’ things are for all groups. One example is around mandatory training – pay progression can be limited by not achieving total compliance but wards are so stretched with staffing there is no time on shift or available computers access to do this and online systems close on multiple weekends for updating or servicing.
Moreover, if a ward manager maybe allows some leeway to take this into account they risk having their own pay progression withheld. Other examples for doctors include the non-release of rotas, inhumane rota patterns, refusal of leave due to arcane HR practices and negative environments where criticism is routine but praise rare.
Recruitment practices are another area that needs examining. I am not certain if it is just the NHS but a phenomenon that is recognised in virtually every area is the person who has been promoted out of harm’s way or has had a job ‘created’ for them to reward not excellence in care but ‘loyalty’ to the organisation that is too often the priority of those appointing to lower and middle grade managerial roles.
Lastly, we must work at creating a culture where critical thinking on all aspects of work is encouraged and people are not afraid to speak out for the fear of ‘punishment’ or retribution and the NHS must not become ‘Orwellian’ in expecting blind obedience at any cost.
They say that the first stage in solving issues is recognising the problem and the two publications mentioned have certainly done that but we need some rapid and concrete progress across the whole system to protect our workforce colleagues and make the NHS a place where people feel valued and want to work.
We in acute medicine and SAM totally understand the whole team ethos and 100% value each and every one who works in our units. We have stated our willingness to work with the NHS on workforce issues and await any invitations to do so and a last message to Mr Hancock is that there is no IT substitute for good people doing good work.
Commenting on the release today of NHS performance data for May, Dr Nick Scriven, president of the Society for Acute Medicine, said: “Emergency access is in a dire state and, given that a new crisis engulfs the NHS almost every month, it is hard to see how patients and staff can be reassured that we will ever get back on a stable footing.
“We have seen huge increases in pressure against a backdrop of falling numbers of GPs, cuts to social care which will take years to repair, vacancies among nurses with no laws to ensure safe staffing and a decrease in beds.
“There is now the current pensions tax issue which is catching lots of senior clinicians in a punitive financial trap and leading to experienced consultants reducing hours and being unwilling to cover gaps due to the threat of five-figure tax bills.
“What I find most disconcerting is how we do not see these major problems being resolved and then, within a short period, see another and I fear for how long it can go on like this.”
By Dr Nick Scriven, president of the Society for Acute Medicine
As we move ever closer to the new ‘world’ of whatever access targets are released for testing across the NHS, it is a sobering reminder of where we are as a briefing paper for Parliament clearly shows the dire state of emergency access across the service.
The paper pulls no punches and is, in my opinion, a ‘must read’ for anyone considering themselves for office as well as those charged with putting their ideas into practice.
It must really serve as a wake-up call for the DHSC and the SOS if he can tear himself away from the campaign trail.
The paper starkly shows that the four-hour target has not been met in the NHS since July 2015 and this year has been the worst ever on record with currently more than 12% of patients in our front door departments for more than four hours.
This figure is artificially improved as it includes minor injury units etc and the key figure for those who attend our main 24-hour casualty departments is horrendously low with more than 18% missing the target in 2018/19 and figures of 24% over this winter.
Partly this is due to demand, but the paper points out that the average rise in attendances is 3999/day and the number of people exceeding four hours has risen by 5394/day. Only three NHS trusts have achieved the 95% target in the last six months. The other statistic that is mentioned is the ‘trolley wait’, meaning waiting over 12 hours from a person being said to need admission to getting a bed on a ward.
People in the service fully realise that this is open to manipulation as there is no hard-standard start point but, nevertheless, it is staggering to see that the number who fall into this bracket as risen 1249% in the last five years.
We know demand is ever-soaring but what of the most important resource in the NHS, its staff? In the last pages of the paper figures are presented. For primary care the figures have been well-publicised, with a fall in GP numbers particularly those working as partners (down 12 % in four years). Access to primary care is crucial as they are the gatekeepers for many and are vital in knowing how to avoid hospital care if possible and trying to maintain health for all those in their practices.
Lastly we need to look at bed availability and occupancy. There is no new news in saying we have less beds than before but, despite the demand, we have 5.4% less acute/general beds now than in 2011 with occupancy of those beds ‘only’ 91.7% this winter.
There should be no apology for presenting these figures yet again as they must be seen for what they are and what the represent as well as setting any context for new measures that will come in. These must be worked on and reviewed by all to ensure they are workable, not too onerous to collect, not ‘gameable’ but, most importantly, they must reflect and represent the day-to-day realities for all our patients who need urgent care and not those with cherry picked, perhaps high media profile, conditions.
We need all those with relevant expertise to sort this out and not let them fall foul of political manoeuvring or demands needing ‘quick fixes’ or ‘better figures’ to serve whatever purpose suites on any certain day.
We have received permission to share the following presentations from the SAMontheTYNE conference. Click on the links below to view.
Thursday 2 May
Bricks & Mortar for Acute Care, Sir James Mackey_
Sick Enough to Die, Kathryn Mannix_
SESSION 2: RESPIRATORY
Interstitial Lung Disease on the AMU_Ian Forrest
COPD Hospital and Home Care Acute Medicine, Carlos Echevarria
SESSION 2.1: POINT OF CARE ULTRASOUND IN ACUTE MEDICINE
Why We Should All Want to be FAMUS, Nick Smallwood
More Signal, Less Noise, Marcus Peck_
SESSION 3.0: NEUROLOGY
Thunderclap Headache & Acute Neurology Service, Amal Samaraweera_
Embedding Simulation on the AMU, Naomi Warren_
Epilepsy Management, Rhys Thomas_
SESSION 3.1: EDUCATION & TRAINING
The Future of Internal Medicine Training, Alastair Miller_
Embedding Simulation on the AMU, Nadia Stock
SESSION 4.0: DIZZINESS & SYNCOPE
Should I Still Request a Holter Monitor, Iain Matthews_
Dizziness, Joanna Lawson_
Frailty, Steve Parry_
SESSION 4.1: THE ACUTE CONSULT
New Psychoactive Substances, Simon Thomas_
Friday 3 May
Early 1: Multiprofessional Developments within SAM, Laura Jennings_
Early 2: SAMBA19_
SESSION 5.0: GASTROENTEROLOGY
IBD on the AMU, Ally Speight_
Acute Upper GI Bleeding, John Morris_
SESSION 5.1: ORAL PRESENTATIONS
SESSION 6.0: INFECTIOUS DISEASES
Bugs & Drugs, Nikhil Premchand_
The Influence of Influenza, Ashley Price_
SESSION 6.1: TRAINEES
Training in Acute Medicine, Anika Wijewardane_
What I Wish I Knew When Applying for Consultant Jobs,Ben Lovell_
takeAIM Fellowship, Peter Ng_
PLENARY 7: REALISTIC MEDICINE
Realistic Medicine, Helen Mackie_
Zen & the Art of Acute Medicine, Vince Connolly_
And SAM Looks Forward To, Nick Scriven_
A top doctor has said the government “must get a grip” on its handling of the NHS or face inflicting “irreparable damage” on the workforce.
Dr Nick Scriven, president of the Society for Acute Medicine, said England was “lagging way behind” its devolved counterparts on the introduction of safe nurse staffing levels.
And he warned there was a “real prospect” of a shortage of doctors as a result of failing to address the pensions tax crisis promptly, fill senior vacancies and tackle the uncertainty caused by Brexit.
“It really is quite astonishing to see what has happened to the NHS in recent years – the government must get a grip on its management or face the real prospect of causing irreparable damage by driving staff away,” said Dr Scriven.
“On big issue after big issue we have seen the government fail to make decisions or act quickly enough, such as the junior doctor contract saga, the state of social care provision and the reduction in acute bed numbers.
“That is all playing out again right now, with targets remaining unmet, the pensions crisis unresolved and eating away at the consultant workforce, no laws to ensure safe staffing levels and no answer to the growing number of vacancies.”
Despite 40,000 nurse vacancies in England, there is no law related to nurse staff – despite legislation being in place in Wales, a bill introduced in Scotland and a framework in place in Northern Ireland.
Meanwhile, with 10,000 consultant vacancies, some doctors are reducing hours or turning down additional work due to the tapered annual allowance, introduced in 2016, which reduces the tax-free amount that anyone earning over £110,000 can save into a pension each year, leading to tax demands so high some doctors have had to remortgage their houses to pay.
In addition, senior doctors retiring after 40 years on a final salary of £100,000 – or a shorter period on a higher salary – are opting to retire early to avoid being penalised by an additional lifetime allowance tax on their pension pots.
“For a service that relies on senior staff regularly going many extra miles to try to shore up rotas and creaking winter services, removing what are punitive additional taxes must surely be an absolute priority,” said Dr Scriven.
“We are in a situation where additional blocks of work, such as an extra weekend to fill a gap or cope with pressure, could lead to a five-figure tax bill for a doctor simply trying to do what is best for patients.
“More often it will mean a consultant no longer offering to work routinely beyond the basic contracted 40 hours a week which has consequences with rota gaps in acute services unfilled or doctors no longer offering to do extra work to reduce waiting lists.”
Dr Scriven said that while the problem is “biting” on older, more experienced doctors, more younger clinicians are “looking ahead” and staying on the basic NHS contract.
He added: “From figures recently released, well over 20,000 doctors have been hit with tax bills in excess of £10,000 in the last few years.”
A recent Society for Acute Medicine survey identified staffing as a major concern of frontline staff, with 60% of respondents believing any Brexit arrangement will negatively impact further on what is already a crisis.
In addition, more than half (55%) said that regardless of the political arena, workforce issues – including staffing numbers and morale – were their biggest current worry.
“Despite these significant and multiple problems, the Prime Minister has now announced her departure while the health secretary is busy preparing for his leadership bid,” said Dr Scriven.
“Yet again, this demonstrates the disconnect between the Westminster bubble and the issues that are eating away at our healthcare services – and the consequences could be terminal.”
The Society for Acute Medicine’s 8th Acute Medicine Awareness Week is going to be taking place week commencing Monday 10 June 2019 in all the acute medicine units throughout UK. Units are advised to choose any day that is convenient for them within the week for the celebration of everything acute medicine.
Registrations for the Awareness Week are now open! To register, please complete the registration form here and return this to Elin Andersson, firstname.lastname@example.org, to register your participation for the week. Please tell us what date you have chosen to celebrate everything Acute Medicine in your department. Please send us your registration form by 5pm on 4 June in order to receive AMAW merch such as balloons, canvas bags and buttons.
Please click here to download your AMAW19 resource pack.
If you are looking for any ideas of what to do please look at the activities through the link below which were organised by SAM members in previous year.
This year Acute Medicine Awareness Week is been organised in collaboration with takeAIM Fellows. Please visit our website, http://www.takeaim.org.uk/ for everything Acute Medicine.
The hashtag for this event is #AMAW19, follow SAM on @acutemedicine & takeAIM on @take__AIM
SAMBA19 registration is now open! Please use the form at the end of this post to sign up and take part.
For Trusts that have more than one hospital, please register each hospital site separately. Also, you can specify if you want to be the administrator for your unit, which gives you direct access to the results of SAMBA19, 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 27th June 2019.
You will find the Caldicott Guardian form, a SAMBA19 protocol, a SAMBA19 How to Guide and Masterlist below.
Caldicott Approval SAMBA19
SAMBA 19 How to Guide
SAMBA19 Patient Data Collection Form
The unit questionnaire is available in the database.
Please start arranging your SAMBA19 data collectors for the 27 June 2019 and ensure that your Caldicott Guardian has approved data release. Also, your local audit team should be made aware and approve of SAMBA19 using your usual local permissions. The data entry deadline is 23:59 on 14 July 2019.
Any queries, please let us know at email@example.com
Dan Lasserson, on behalf of the SAMBA19 team.
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.
The FAMUS group were delighted to be short-listed for a BMJ award in the Education category. This is an excellent recognition of the work the team have done to bring point of care ultrasound to trainees across the UK.
The nomination recognises the work the team have done in bringing FAMUS from a neat idea of a few enthusiasts, to the recognised curriculum and standardised teaching materials (including famus.org.uk, the e-LFH module and our YouTube channel) that we have today.
Welcome to SAMontheMOOR, being held on the 10-11 October 2019 at the Harrogate Convention Centre.
For Abstract submission, registration and programme information go to www.samonthemoor.org
The conference offers 12 CPD points and will update your skills and knowledge in many areas of clinical practice within acute medicine that you encounter daily. Our conferences are open to all members of the multidisciplinary team who work in acute and general medicine, ranging from doctors in training through to senior consultants, nurses, physiotherapists and pharmacists. The conference offers an entirely independent programme, based on the most recent research and development in acute medicine and has been designed by a multidisciplinary team who work at the front door in acute and general medicine on a daily basis.
View the Programme
Registration now open!
To register, please click here.
- Early Bird Discount Ends: 30 June 2019
- Late Payment Fees Begin: 1 September 2019
Abstract submission is open until 29 July 2019.
For more information, view the Call for Abstracts.
Commenting on the release today of NHS performance data for April, Dr Nick Scriven, president of the Society for Acute Medicine, said:
“Today we have seen frankly appalling performance figures which are going largely unnoticed. The NHS should be embarrassed by them.
“There are massive issues across the health service despite Easter and good weather which should provide relief but instead it has been busiest April ever with the worst performance in just about any urgent metric.
“The “solution” can’t be to ease targets – we urgently need clinically-led reviews of services and engagement from the secretary of state who is today is tweeting about cricket when he really needs to get his eye on the ball.
“The comments today by NHS England on zero tolerance for patients staying longer than six hours in emergency departments are also ill-judged.
“It is fine rhetoric but could cause serious issues for hard-pressed trusts with potentially unstable patients being moved to unsafe areas just to beat a clock.”
To view the presentations from the conference, click here
Click on the links below to view the posters displayed at SAMontheTYNE:
Audit & Quality Improvement Posters
AQI 01: A Closed Loop Audit on Transforming Clinical Guidelines at Dudley Group NHS FT
AQI 03: Assessing and Improving the Quality of Fluid Balance Charts in Medical Wards at a Tertiary Care Hospital in London
AQI 11: Identifying and Improving Delays in Processing ‘To Take Out’ (TTO) Medications
AQI 17: Intravenous Iron Infusions on AMU – Are They Being Used Appropriately?
AQI 19: Management of Homeless Patients in Hospital
AQI 22: Patient flow through the AMU: A Quality Improvement Journey
AQI 23: Point of Care Ultrasound in Acute Kidney Injury: Rapidly and Reliably Images at the Point of Admission
AQI 24: Reducing Malignant Ascites Admissions to Ambulatory Care Using Indwelling Peritoneal Catheters
AQI 25: Risk Stratification in Neutropenic Sepsis using the MASCC Score: Can Patients be Discharged Earlier?
Case Report Posters
CR 01: A Case of Paraneoplastic Brainstem Encephalitis Associated with Non-Cutaneous Merkel Cell Carcinoma
CR 03: CRPS Presenting on the AMU: An Under-recognised Cause of Limb Swelling
CR 04: Gitelman Syndrome with Resistant Symptomatic Hypokalaemia Persisting Post Miscarriage
CR 05: I Smell a Rat
CR 06: Interpretation of INR with Rivaroxaban in the Context of Acute Liver Failure Due to Hepatitis A
CR 08: Pseudoangioedema – An Important Presentation to Recognise
CR 09: Pseudohamoptysis – An Uncommon Presentation of a Common Symptom
CR 11: Surviving the Un-survivable
E 01: SAM: A Thematic Analysis
E 02: A Chronological Review of Simulation Training for Medical Trainees Across the Norther Deanery
E 04: Acute Simulation for Foundation Doctors: Is it Worth the Effort?
E 07: Communicating Confidence: Peer Led Small Group Teaching to Improve Confidence in Approaching the MRCP PACES Communication and History Taking Skills Stations
E 08: Improving Education Via the Acute Medicine (AIM) Team; A Pan Medical and Multidisciplinary Approach
E 11: Delirious Tea Trolley Teaching!
E 12: Registrar Readiness – What Does our Medical Admissions Unit Have to Offer?
R 02: Early Warning Scores: A comparison of the National Early Warning Score and a Mono-Parametric Early Warning Score in a UK Hospital
R 03: Feasibility Study of Ambulatory Care for Adult Patients (AMBUCAP) Admitted to the Medical Wards of a Tertiary Referral Hospital in Botswana
R 07: Streamlining Inter-Hospital Communicate by Reducing Avoidable Switchboard Delays
R 08: The Diagnostic Accuracy of Sepsis Scores, and Clinical Bedside Judgement (CBJ) in Sepsis in the ED Using an Expert Panel Reference
R 11: Validation Study of Age-Adjusted D-Dimer Cutoff Levels to Exclude Venous Thromboembolic Disease
Service Organisation & Design Posters
SOD 03: Audit to Assess the Use of the Royal London Hospital (RLH) Ambulatory Care (AC) Service in Providing Admission Avoidance and Supportive Discharge to Patients
SOD 05: Development of an Ambulatory Care Pathway for Hyperglycaemia
SOD 06: Empowering the AMU to Transform End of Life Care
SOD 09: Improving the Care of In-patients with Acute Kidney Injury in an Acute Hospital
SOD 11: Paramedic Direct Referrals to Senior Clinician: Is this the Way Forward? A Pilot Project in Acute Medicine and Ambulatory Care at the John Radcliffe Hospital
SOD 12: Reducing Delays in the Discharge Process on an AMU
SOD 13: Surgical and Medical Acute Recovery Team (SMART) – A Collaborative Approach with the Community Enabling Patients to Receive Hospital Treatments in the Community
SOD 14: The Cold Truth about ‘Winter Pressure’ in a District General Hospital. A Retrospective Analysis of Mortality by Month of Admission to an AMU
SOD 17: The Specialist Physiotherapist in Ambulatory Emergency Care: Developing a Frailty Pathway in the Ambulatory Unit at the John Radcliffe Hospital, Oxford
SOD 18: The Weekend is a Weak-End for a District General Hospital. A Retrospective Analysis of Mortality by Day of Admission to an AMU
SOD 20: When WILL the Doctor See You?
SOD 21: Winter Pressures: A Novel Approach to a Well-Known Problem
SOD 22: The CPSP (College of Physicians and Surgeons Pakistan) Scholarship Program and The Dudley Group NHS Foundation Trust – A Symbiotic Relationship
A top doctor has warned the upcoming bank holiday could break NHS hospitals that are already struggling with winter levels of pressure.
Dr Nick Scriven, president of the Society for Acute Medicine, said the system had not recovered from an “Easter hangover” – and the three-day weekend could “exacerbate things further”.
He said medics from across the country had reported unprecedented numbers of attendances at emergency departments over the past two weeks, with some seeing around 80 more patients than normal for this time of year.
He warned that many hospitals had been on high alerts levels and any outbreak of norovirus combined with the usual post-bank holiday influx of severely unwell patients who had delayed seeking help could be “disastrous”.
“I am deeply concerned about the reports I am hearing from colleagues across the country and indeed what I am seeing on the ground,” said Dr Scriven.
“It felt like things were improving but the four-day Easter caused havoc, with hospitals that had only just been recovering from another difficult winter back to square one.
“Some hospitals are seeing up to 80 more patients in emergency departments than normal for this time of year and the bank holiday weekend could really stretch services and put a huge strain on drained staff.”
He added: “Most hospitals have now decommissioned any additional winter resources, so any slight rise in pressure through a norovirus outbreak or influx of severely unwell patients could prove disastrous.”
Dr Scriven said while the public could help in some way by utilising care in the community over weekends – such as GP hubs, 111 for non-emergencies, minor injuries units and pharmacies – responsibility rested with the government and NHS leaders.
“While the senior leadership continues to trot out the line that the NHS is busier than ever, they can’t escape from the reality that there is a staffing crisis, social care funding has been inadequate and bed capacity has been cut massively.”
Acute medicine receives the majority of patients admitted from A&E and helps maintain the flow of patients through emergency departments to avoid exit block, the term used when patients cannot be moved into a hospital bed.
More than two-thirds of acute and emergency medics believe a no-deal Brexit will impact their ability to deliver care – and more than half think the ongoing uncertainty has already affected their hospitals.
The findings come from a snapshot survey conducted by the Society for Acute Medicine (SAM), the national body for the specialty which deals with immediate and early treatment of adult patients with a variety of medical conditions who present to hospital as emergencies.
Acute medicine receives the majority of patients admitted from A&E and helps maintain the flow of patients through emergency departments to avoid exit block, the term used when patients cannot be moved into a hospital bed.
The UK has been given an extension to the Brexit process – which was initially due to be resolved by 29 March – by the European Union until 31 October.
In response to the question ‘Do you think a no-deal Brexit will impact on our ability to deliver acute medicine?’, 72% answered yes, 8% no and 20% were unsure, while 60% said their hospitals had already been affected.
Additionally, almost half (48%) feared a managed Brexit with a deal would still cause disruption to services, with most concern around the effect on medical staffing (37%), non-medical staffing (27%) and medical supplies (25%).
Almost all respondents (90%) said they would not change their original vote if there was a second referendum.
“We have been warning for some time now about the negative impact of Brexit on the NHS and I said recently how it has acted as a smokescreen for the government over the issues engulfing frontline healthcare,” said SAM president Dr Nick Scriven, speaking at the organisation’s two-day conference – SAMontheTYNE – in Newcastle.
“These concerns have now been reinforced by many those of those in acute medicine – doctors, nurses and support staff – and sends a message that this situation is harming the delivery of services to patients.
“In our view, it is no coincidence that we are seeing continuous poor performance – with a record low again in March – and a growing staffing crisis at the same time as the withdrawal debacle bounces from one embarrassment to the next with next to no recognition of the ongoing healthcare issues in the national media
“What is particularly significant now, given where we are at, is that a large proportion have voiced concern over ongoing events, so I would urge politicians to end their dithering and, at the very least, not make this any worse than it already is for patients and healthcare professionals alike.”
Outpatients receiving urgent and emergency care across the NHS are set to benefit from new standards developed by two leading medical bodies.
The Royal College of Physicians of Edinburgh (RCPE) and the Society for Acute Medicine (SAM) have jointly produced standards for same day emergency care, also known as ambulatory emergency care (AEC).
AEC is a service that provides same day (outpatient) emergency care to hospital patients where they can be assessed, diagnosed, treated and are able to go home the same day without being admitted overnight.
In a report released in November, Winter 2018/19 in the NHS: The solutions, SAM called on the government and NHS leaders to “realise urgently” the potential of AEC.
The Society estimated that just a 5% increase in the number of patients who receive their first assessment and subsequent treatment in AEC could save an additional 238 overnight bed stays – equating to the prevention of 14,042 overnight admissions over the months of January and February.
As a result of SAM’s focus on AEC and data published in the Society for Acute Medicine Benchmarking Audit, AEC was incorporated into the NHS Long Term Plan and, in March, NHS England announced every major hospital will provide same day emergency care services by next winter.
“The Society urged the government in the report ‘Winter 2018/19 in the NHS: The solutions’, to look at “how much could be achieved with investment in this area” and address why the implementation of AEC units was “not standard or uniform” across the country,” said Dr Scriven.
“This was followed by the incorporation of AEC into the NHS Long Term Plan with a target of increasing the proportion of patients looked after in this way and the establishment of a joint NHSE/NHSE/specialist societies group to make this a reality by late 2019.
“Underpinning the process has been a real need for standards written by a group of experienced physicians who work in that area and are seen as subject ‘experts’.”
He added: “This is the first time that standards for AEC units have been produced and it is hoped that all providers, those writing policies and those commissioning services will adopt them as soon as possible.”
Dr Mike Jones, director of training at RCPE and a consultant in acute medicine, said:
“AEC is an important service which provides same day hospital care to patients. AEC units treat a wide variety of common conditions including headaches, diabetes, deep vein thrombosis and cellulitis.
“These joint standards by RCPE and SAM aim to define the standards that should be adopted in ambulatory emergency care units. We think that patients deserve to be seen by a doctor or a nurse promptly, and then to have the best treatment possible.
“We believe that these standards will speed-up and improve patient care and ensure that patients have clear advice on what to do if their condition deteriorates after being discharged from hospital.
“They should also reduce admissions and readmissions, free up valuable hospital beds for those patients who most need them and provide a much needed boost for our hard-pressed hospitals, the staff who work in them and the NHS as a whole. “
The standards say:
- Patients should be initially seen within one hour of entering an AEC unit.
- Patients will be initially examined by a doctor or nurse, and an assessment will be made based on their symptoms, past medical history and details of any medications they are taking. Patients may need to have some diagnostic tests, like an X-ray or ultrasound scan, and the aim is to get the test results to patients on the same day.
- During the period of care under the ambulatory team, patients should have clear written instructions for if they feel they are deteriorating or if they wish to discuss concerns prior to their next scheduled visit.
- Patients should be seen promptly and certainly within one hour by a clinician who has the capabilities to assess and investigate the patient’s symptoms and signs. This clinician should have immediate access to a more senior clinical decision maker for review when the presentation proves more complex.
- All units undertaking AEC should regularly survey a representative and consecutive number of patients under their care. This should take the form of a short questionnaire. At least 5% of all patients should be surveyed and the total time spent in the unit for each patient should be calculated. This data should be used to improve patient care.
- A consultant physician should be available on the hospital site day and night throughout the opening times of the AEC unit, to review AEC patients.
- A nominated clinician from the multi-disciplinary team (MDT) should take responsibility for the overall leadership of the AEC unit to ensure there are active clinical governance and quality improvement processes and strategies.