Leading doctor says Brexit shouldn’t overshadow NHS crisis

A leading doctor has said the country cannot allow Brexit to overshadow concerns being raised by senior medics about the ability of the NHS to cope this winter.

Dr Nick Scriven, president of the Society for Acute Medicine, said issues around social care, funding, staffing, pay and morale “need to be addressed urgently” but are being “somewhat lost in the mire”.

He has also urged the health secretary to work with specialists in acute medicine to “help overhaul” urgent care by “taking more interest in what is working on the ground right now”.

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.

“This week has seen Brexit return to take over and my concern is that the government does not take leave of its responsibility to prepare the NHS adequately for the tough months ahead and listen to the frontline,” said Dr Scriven, speaking at SAM’s annual two-day conference in Bournemouth.

“When asked recently what the Department for Health and Social Care should be focusing on, 1% of clinicians in acute medicine said Brexit, while 40% said social care provision, 26% funding, 16% staffing and 13% morale linked to nurses’ pay – this tells us a story.”

To coincide with the conference, SAM has published a report – Society for Acute Medicine Benchmarking Audit (SAMBA) 2018 – on the performance of acute medical units.

The audit, which covered 127 units and 6,114 patients over a 24-hour period in June, showed more than two-thirds of hospitals (69%) had a bed occupancy of more than 90% – which is above the recommended safe level of 85%.

In addition, 45% of units had no advanced nurse practitioners, 60% had no access to social workers to help speed up the provision of social care support and a fifth of patients had been readmitted to hospital within 30 days.

The audit did highlight the success of ambulatory emergency care, a service which provides same-day emergency care, with 80% of patients assessed, diagnosed, treated and discharged on the same day – but only 20% of patients received their first medical assessment in ambulatory care.

“Our data, collected on a given day in June when we would traditionally be experiencing some respite, showed almost 70% of hospitals had bed occupancy of more than 90% and that is a concern as we head into winter aware the NHS is 3,100 beds short of the number it required last year to cope,” said Dr Scriven.

“Familiar themes have cropped up again – bed capacity, social care and staffing – yet we can see success in the development of ambulatory emergency care, where large numbers of patients are being seen, treated and discharged on the same day.

“At present, however, less than 20% of patients are seen in ambulatory care units and many do not run in evenings or at weekends due to funding and staffing, but increasing this to just 30% would have a transformative effect on capacity nationally.”

He added: “Patients suitable for treatment in ambulatory emergency care take up two bed days on average if admitted to medical wards, so we really need our leaders to start taking more interest in what is working on the ground right now.”

In a speech to members which will be delivered later today, Dr Scriven will say: “Yet again, this winter will be bad and we know without doubt the NHS will creak under the pressure, but acute medicine is the glue that holds the NHS frontline together and we will look after each other.

“However, we must continue to fight for what we believe is the best care for our patients and hold people in power to account.”