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Hospitals ‘not prepared for next six months’ say medics

Three-quarters of medics in urgent and acute care believe hospitals are not prepared to cope over the next six months.

In addition, just under three-quarters (70%) say they will not be able to provide the level of care they would want to over the same period.

The findings come from a snapshot survey conducted by the Society for Acute Medicine, which represents clinicians working in acute medical units across the UK who specialise in the management of patients with medical emergencies.

Dr Nick Scriven, immediate past president of SAM, said the NHS was already at a “tipping point” with rising Covid-19 admissions “before we get anywhere near the routine challenges of winter” such as flu, norovirus and other respiratory illnesses.

He warned despite the significant role of acute medical units in alleviating pressures on emergency departments by reducing exit block, the term used when patients cannot be moved into hospital beds due to a lack of availability, the speciality was “at risk”.

Among other issues highlighted in the survey was the use of same day emergency care (SDEC) units – facilities designed to alleviate pressures on emergency departments and bed capacity by providing urgent care without the need for overnight admission – with just a third of respondents (34%) saying SDEC was functioning effectively.

The limitations being experienced in SDEC included reduced beds due to social distancing (41%), admitted patients occupying beds (36%), restrictions on staff numbers due to redeployment and sickness (19%) and access to diagnostics (18%).

“Acute medical units have been at the forefront of looking after probably the majority of those hospitalised with Covid-19, including delivering advanced respiratory care, so the views of our members are deeply concerning,” said Dr Scriven.

“Despite the above, all of this work was carried out with 30% of our teams, mostly skilled nurses but also doctors, redeployed to other clinical areas due to their high-level skills around emergency/urgent care and specialist patient support.

“Unfortunately, with ongoing Covid work and rising rates, many of these people have not returned to our base units so our exhausted front door workforce is being – and will be – pressed even harder.“

Dr Scriven said this, alongside a lack of additional funding from the government to boost acute medicine over winter and compromised SDEC units, lay at the root of concerns among medics for the next six months.

“As a Society, we have significant fears that, although very much needed, the financial help given to the emergency departments to help them manage Covid during the challenging winter period will be an isolated fix,” he explained.

“We have concerns that the benefits of this will not filter down below EDs and will indeed disadvantage those patients who, to-date, have been admitted to acute medical units directly without using ED services (40% of our workload) or streamed directly to us without triage/assessment.

“Our units will be under the same pressures to maintain safety – perhaps more so given the need to space out beds/segregate patients according to Covid risk – when most of our estate is actually fixed and the only way to reduce the risk is to take beds out of our systems with potentially dangerous consequences.”

Dr Scriven added that the “misuse” of SDEC units by hospital trusts utilising the space as overflow for admitted patients “must end” to avoid unnecessary patient admissions during winter.

“This ‘easy fix’ should not be supported within the NHS and it is something we have raised with the Secretary of State for Health and Social Care, the Health and Social Care Committee and the opposition in the hope firm action is taken.

“We are also calling for the use of finance perhaps originally earmarked for EDs to help SDEC areas become ‘Covid-safe’ and able to open seven days a week throughout the winter season which, with a 5% increase in patients, could help save 14,000 overnight admissions over winter.”

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