Briefing paper shows “dire” state of emergency access – SAM president

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.