Medics say NHS same day emergency care plan for winter ‘grossly derailed’

Senior medics have said an NHS plan designed to improve urgent care and ease pressure on hospitals this winter has been “grossly derailed”.

In March, NHS England announced every major hospital would provide same day emergency care (SDEC) – also know as ambulatory emergency care – by the end of the year as part of the long term plan.

The service, which sits within acute medical units, offers an alternative to hospital admission for patients with serious medical problems who might otherwise have spent at least one night in a hospital bed.

There are many conditions, such as life-threatening blood clots (deep vein thrombosis), dislodged blood clots (pulmonary embolism), cellulitis, seizures and anaemia, suitable for treatment in this outpatient-based setting.

It was suggested rolling out the concept across the NHS would prevent up to 500,000 overnight hospital stays over the year – and help to ease capacity issues significantly over the winter months.

However, an audit by the Society for Acute Medicine (SAM) found almost half (45%) of SDEC units had their “functioning impaired” by hospital trusts utilising the space as overflow for admitted patients.

In addition, many do not provide evening or weekend services, with a report released by the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) in October showing just over a third of units (35%) were only open five days a week.

“For all its good intention, the NHS’s grand plan to use SDEC to improve care and capacity this winter has been grossly derailed as trusts scrounge for additional beds,” said Dr Susan Crossland, president of SAM.

“This shows firsthand how the unsustainable reduction in bed numbers and lack of investment in adequate staffing over many years is severely affecting the ability of the NHS to deliver on promises such as this one.”

Dr Nick Scriven, immediate past president of SAM, added: “We are increasingly concerned we will never see SDEC fully implemented as desired if units are constantly seen as the ‘easy’ target when under-pressure managers need extra bed spaces.

“Until the NHS can sort out its acute capacity and staffing levels, nothing will get better in this respect and that is not what anyone wants to hear as we move through January when pressures will ramp up further still.”

Dr Crossland said SDEC had the potential to “significantly improve” the capability of hospital trusts manage winter pressures and year-long capacity issues and that failure to establish it fully was a “dereliction of duty”.

“We presented the possibilities achievable with SDEC in our report on winter solutions back in November 2018 when we called for investment in this area yet find ourselves still needing to push the agenda,” she said.

“We strongly endorse and support the provision of these services if they are appropriately resourced and running properly and we call for urgent action to ensure that happens.”