NHS will see ‘pockets of meltdown’ this winter – Dr Mark Holland

A leading doctor has warned the NHS will see “pockets of meltdown” this winter as the system struggles to cope with growing pressure.

Dr Mark Holland, president of the Society for Acute Medicine, said resilience was being “put to the test like never before”.

He also said it was “essential” the discharge and social care process was overhauled to release pressure on urgent and emergency care services.

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.

“Last winter the NHS buckled, but the processes acute medicine had embedded in the healthcare system in the UK played a large part in getting us through,” said Dr Holland, speaking ahead of the start of SAM’s two-day international conference in Edinburgh in partnership with the Royal College of Physicians of Edinburgh.

“The concern we have now, however, is that hospitals where performance is already weak will find it very difficult to cope during the winter and that will lead to pockets of meltdown.”

To coincide with the conference, SAM has published a report – Society for Acute Medicine Benchmarking Audit (SAMBA) 2016 – on the performance of acute medical units based on speed of assessment, access to clinical decision makers with four hours and a consultant review within 14 hours.

The audit, which covered 94 units and 4,140 patients, showed 81% of patients were seen by a consultant within target time, 69% by a competent decision maker within four hours and 69% had an early warning score recorded on arrival – though only 41% of patients received all three.

“The findings are that, while we are still doing well on average and some units are doing very well, there is a spread and variance in what we achieve and, overall, performance has dipped over the last three years,” said Dr Holland.

“This tells us that, despite the brilliant work of acute medicine practitioners to maintain quality and safety – and there are some fantastic examples of staff going above and beyond – our resilience is being put to the test like never before and that is not sustainable in the long-term.”

He said that, as was the case with NHS performance data, it was “vital” individual trusts that were struggling to cope were not “hidden” by better performers who average out statistics.

“Through our SAMBA audits, we know some trusts are performing and coping well despite the difficulties they face, but there are others in a bad, maybe critical way,” he said.

“It is vital struggling hospitals are not hidden by average statistics boosted by better performers to ensure those most in need receive the help and support they require to prevent failure in those trusts this winter.”

Following the release of NHS England’s performance data for July last week, which showed there were 184,200 total days of delays in discharges compared to 147,400 in the same month last year, Dr Holland called the situation “disastrous”.

“At the core of the issues facing the NHS is the rapidly increasing number of delayed discharges. The figures are spiralling and are fast becoming disastrous.

“If hospitals cannot discharge patients then the system comes to a halt.

“We need an overhaul of the discharge and social care process nationally so we can release pressure on front of house services in our hospitals – it is a national emergency.”

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