Significant patient harm and trauma likely across NHS in coming weeks

Dr Tim Cooksley, immediate past president of the Society for Acute Medicine, has warned the next few weeks will see an increasing number of patients suffering significant harm and trauma as “predictable perfect storms” push the NHS into turmoil.

He said long queues of ambulances outside hospitals and prolonged periods of corridor care were “inevitable” at the start of the new year.

Writing in the The BMJ (03 January), Dr Cooksley raised concerns about how this month will see increases in covid, influenza and respiratory syncytial virus (RSV) alongside the longest junior doctor strike in history which started yesterday (Wednesday) and runs until 7am on Tuesday.

He also suggested it could take at least 10 years to return to the delivery of high quality care in the NHS – and urged political leaders to act on the principles developed by medical colleges and societies to support recovery in the interim period.

“The NHS remains under immense pressure with each part of the system experiencing greater demand than its capacity which is continually accentuating the problem,” he said.

“This is most vividly illustrated in urgent and emergency care settings, where media images over the next few weeks will inevitably portray long queues of ambulances outside emergency departments and patients experiencing prolonged periods of degrading corridor care. 

“Publications will feature stories of patients who have suffered significant harm and trauma due to delayed ambulance responses. 

“Each winter in the past decade has become slightly worse and that trend, which has not been reversed, has resulted in a dire situation which may not yet have reached its peak.

“Last winter this was exacerbated by a further covid wave, high levels of influenza and a group A streptococcus outbreak with challenging cold weather.

“This January will again see increases in covid, influenza and probably respiratory syncytial virus (RSV) alongside the longest junior doctor strike in history – but these also arrive at a time of already overcrowded hospitals with dangerous levels of occupancy.”

Dr Cooksley outlined his frustrations at the lack of recognition and action of the leading cause of the crisis engulfing the NHS – workforce and capacity.

“At its heart, the crisis remains remarkably simple: there is insufficient workforce and capacity to meet the demands of an increasingly ageing population with multiple health issues. 

“There is no resilience to cope with any excess strain caused by any of the highly predictable “storms.” High staff absence levels, burnout, and low morale continue to permeate throughout the NHS. 

“High mortality rates and increasing numbers of patients waiting more than 12 hours in emergency departments illustrate the problem.

“The solutions are not easy, nor are they quick, and it will take at least a decade to return to the delivery of high quality acute care.”

Dr Cooksley said the lack of a long term strategy for urgent and emergency care will “condemn” it – and calls on political leaders to act now on the advice of clinicians about how to prevent further decline.

“This uncomfortable reality needs political acceptance and a realisation that a focus on “short-term wins” without a comprehensive long term strategy will condemn urgent and emergency care and the NHS as a whole to further deterioration,” he explained.

“Too many deeply unacceptable occurrences are now perceived as “business as usual”—corridor care, high vacancy rates and poor levels of staffing, long waiting lists and, more recently, industrial action. All need focus, although arguably only industrial action has an immediate solution.

“Collaborative position statements from medical royal colleges and societies have outlined the key clinical principles to support recovery. 

“These are focused on improved communication between clinicians, continuity of care and logistics with locally led innovation.

“It is essential that service and political leaders provide the resources needed and reduce unnecessary bureaucracy to enable national and local clinical leaders to drive forward and implement these changes.”

He added: “The long term workforce plan desperately needs the support of a long term pay structure which, alongside clinical and capacity plans, will be essential to rebuild the NHS. 

“Innovative clinical solutions and dedication of staff continue throughout the NHS, but unless workforce and capacity are tackled then the inevitable future winter storms will continue to flood the system.”