NHS England “should focus on the fundamentals” – SAM President (11 September)

Commenting in The BMJ (11 September) on NHS winter planning following comments made by NHS Chair Penny Dash at a King’s Fund event, Dr Vicky Price, president of the Society for Acute Medicine, said:

“Penny Dash is right that the NHS cannot keep producing the same winter plan and expecting a different result. The pressures we once associated with winter are now present throughout the year, so preparation has to move beyond short-term seasonal measures.

“Redesign of urgent and emergency care is important, but it cannot simply mean trying to divert more patients away from A&E or reduce admissions. Long waits are a symptom of poor patient flow across the whole hospital and wider health and care system.

“In the run-up to winter, NHS England should focus on the fundamentals: sufficient staffed bed capacity, effective seven-day discharge services, properly resourced acute medical units and Same Day Emergency Care, a strong multidisciplinary workforce, and community and social care services capable of supporting patients before and after hospital. These are the same priorities we have put directly to the Secretary of State.

“We also need to make sure patients who do need hospital care can move through it quickly. Acute medicine and SDEC can prevent unnecessary admissions and accelerate assessment and treatment, but only if they are protected from becoming overflow areas for patients waiting for beds.

“Staff are already describing relentless pressure and very low morale. They will continue to work tirelessly through winter, but goodwill cannot compensate indefinitely for structural problems that remain unresolved.

“The challenge is not simply to survive another winter. It is to build a system that works properly every day of the year.”