Medics warn flagship NHS project to reduce hospital admissions “stalling”

24 November 2021

Senior medics have warned a flagship NHS England project to improve urgent care and reduce hospital admissions is stalling due to inappropriate use and a lack of investment. 

The Society for Acute Medicine (SAM) says Same Day Emergency Care (SDEC) – also known as ambulatory emergency care – has the potential to “play a vital role” in managing patient flow and prevent thousands of unnecessary overnight stays. 

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

There are many conditions, such as blood clots (deep vein thrombosis), dislodged blood clots (pulmonary embolism), skin infections (cellulitis), fever in cancer patients undergoing chemotherapy and anaemia, suitable for treatment in this outpatient-based hospital setting. 

It is run by specialists in acute medicine, also known as acute internal medicine, who deal with the immediate and early treatment of adult patients with a variety of medical conditions who present to hospital as emergencies. 

NHS England announced in March 2019 that every major hospital would provide SDEC by the end of that year as part of the long term plan – potentially preventing an additional 500,000 overnight hospital stays over the course of 2020 and beyond.

However, a recent SAM audit found significant inconsistencies in the delivery of SDEC services which medics say is due to a combination of inappropriate use of the units as overflow for admitted patients and funding gaps. 

“SDEC has the potential to play a vital role in improving care and reducing admissions but progress is stalling and there are significant inconsistencies in the delivery of these services,” said Dr Tim Cooksley, president of SAM. 

“We first highlighted in 2018 how SDEC had the potential to prevent thousands of overnight admissions over the crucial winter months of January and February with the proper investment and resourcing. 

“Despite NHS England then making it a priority in March 2019, by the October of that year we reported almost half of SDECs had their functioning impaired by hospital trusts utilising the space as overflow for admitted patients. 

“On top of this, despite various funding announcements for urgent care over the past couple of years, much of this hasn’t been directed to SDEC services to help to reduce capacity issues.” 

The latest Society for Acute Medicine Benchmarking Audit (SAMBA), a snapshot of the care provided by acute medical units for 9,000 patients over a 24-hour period in June, showed despite 98% of hospitals having some form of SDEC, only 22% of patients received their first assessment and subsequent treatment there. 

This was the same as 2019 and falls below the 30% target set by NHS England, with only a quarter of SDECs achieving that number – a drop from 35% of units in 2019 – which results in many patients who may have avoided a hospital stay being admitted for a night or more.  

Dr Cooksley said: “The lack of progress in improving the number of patients receiving their care in SDEC reflects the pressures on acute medical services, that hospitals are not utilising it in the right way and has not been given the attention and investment it needs in order to grow and reach its potential. 

“The number of NHS hospital beds has reduced by 11% over the past decade and bed occupancy was around 90% long before the pandemic – both reasons this option to alleviate pressures on hospitals and improve patients’ experiences and access to care is so vital.” 

He added: “If all units had achieved the NHS England target of 30% receiving their first assessment and treatment in SDEC on the day of our SAMBA audit, that would have prevented 350 admissions on that day alone. 

“Over January and February in mid-winter this would equate to more than 20,000 overnight stays being avoided, so we need to ensure these units are both being used appropriately and have the resources needed to make this happen.” 

Dr Susan Crossland, immediate past president of SAM, said: “Our data shows that despite the clear benefits of SDEC and NHS England’s focus on maximising its potential, there is vast variance in the way these services are being delivered. 

“This presents a huge missed opportunity for patients to benefit from efficient and effective medical care and to reduce hospital admissions at a time when the NHS is under ever-increasing strain.” 

Dr Nick Scriven, a former president of SAM who has campaigned to resolve issues around the use and funding of SDEC since 2018, added: “The prospect of what lies ahead this winter is truly daunting as not only do we have the threat of increasing cases of Covid-19 and flu, we now have those patients whose conditions have worsened over the past 18 months and an NHS infrastructure creaking at the seams. 

“We urge NHS England to work with us so we can establish urgently how we can ensure SDEC is protected and given the resources needed so it can operate effectively and help to offer up a form of solution at a time when the NHS has few options at its disposal.”