Senior medic says NHS leaders must “think radically” about capacity

A senior medic has said NHS leaders must “think radically” about capacity in hospitals to avoid another winter crisis – including a potential two-month suspension of non-urgent surgery.

Dr Nick Scriven, president of the Society forAcute Medicine, said the “massive challenges” in delivering acute and emergency care this year “will not go away or lessen in any way” over the coming years.

He also said there was no “quick fix solution” and a “long-term review and overhaul” could be needed “to make any gains”.

“The NHS is struggling to cope with yearlong pressure, worsened in winter, and the capacity to treat all patients quickly and safely,” he said in an editorial published today by the British Journal of Hospital Medicine.

“The pressure is on to find a way forward and improve matters including thinking what might have been previously unthinkable. We simply cannot allow what has happened in 2017–18 to become the ‘norm’.”

His comments come ahead of NHS chief executive Simon Stevens’ speech at the NHS Confederation conference in Manchester in which he will call on hospitals to cut stays of more than three weeks by 25%.

“We welcome Mr Stevens’ comments and the fact someone is thinking about the next winter season, but to achieve further reductions in length of stay will almost certainly require investment in both hospital and community care,” said Dr Sriven.

“Some of those who now need to stay in hospital are far sicker and frailer than before and, as a result, the length of stay for those inatients will rise, while the main blocks will be seven-day access to diagnostics and the availability of therapy staff to keep patients fit and mobile.”

Dr Scriven said the closure of wards across the country was “hampering efforts” to tackle capacity issues while simultaneously “draining” hospital trusts financially due to reliance on expensive agency staffing.

“Wards are closed up and down the country – the long-term ambition must be to proactively have these open with staff trained appropriately and working in areas of care they are used to,” he explained.

“This could realise long-term financial savings as well as patient care improvement as a result of an eventual ability to ‘self-staff’ and no longer rely on expensive agency staff.”

In addition to the yearlong rollout of NHS England winter situation reports, health promotion, community care access for the frailest in the population and the sharing of effective models of care, Dr Scriven urged the consideration of an annual two-month break in elective operations.

“For at least two years we know that the pressures on the system have caused last-minute delays and cancellations of thousands of operations, leaving patients suffering and teams frustrated,” he said.

“Why not consider running a full elective service for 10 months of the year and restrict surgical activity to urgent and lifesaving procedures during times of highest pressure.

“This may be unpalatable to many but it would have advantages – patients would know in advance a date for treatment that is much more secure than it is currently, patients would avoid the stress of last minute cancellations, surgical colleagues could plan more effectively and surgeons could work at the ‘front end’ in winter supporting the acute wards.

“This would free up bed capacity and trained nurses along with generically training junior doctors to support patients – of course it needs planning and this has to be a long-term solution to give patients and healthcare organisations time to work it through.”

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