Top doctor warns “isolation culture” could send NHS into winter chaos

A top doctor has said there is a “culture of isolation” among medical and healthcare bodies which could send the NHS into chaos this winter.
Dr Nick Scriven, president of the Society for Acute Medicine, said there were multiple groups trying to “solve” winter pressures but “nothing joined up” – with direction from the secretary of state for health “almost non-existent”.

“There are currently lots of different areas and groups, including the Royal College of Physicians, Academy of Royal Colleges and NHS Improvement’s emergency care intensive support team (ECIST) and the getting it right first time programme (GIRFT), all putting their own spin on things,” he explained.

“Clearly there has already been lots of focus on accident and emergency departments, with the government’s pledge earlier this year of an extra £100 million for struggling units and various announcements from the Royal College of Emergency Medicine.

“However, this is all muddying the waters and resulting in a lack of team-working, with direction and leadership, as well as public acknowledgment of the major issues we face, from the health secretary almost non-existent.”

Dr Scriven, who warned last month that a bad flu season could “overwhelm” hospitals, reiterated his concerns about a lack of plans to cope with a winter crisis and said trusts were “still focused on short-term financial savings”.

“The NHS has not really recovered from last winter including a disillusioned workforce being asked to do more with less every day,” he said.
“Despite all the talk, there is little progress with any winter plans, with trusts still focused, it feels, on short-term financial savings with no long or even medium-term planning – it is all quick fixes with no real concept of the future.

“What this means is that we end up with the government backing off and leaving professional bodies and groups to fend for themselves and their areas, which can be divisive and distracts everyone from the real issues which need tackling if we are to overcome this unrelenting tide.”
Dr Scriven called on the secretary of state to take responsibility for ensuring the NHS is as prepared as possible and to develop a “united approach” to the pressures being faced by hospitals across the country.

“We know there are three significant factors which need addressing immediately if we are to begin developing medium and long-term plans to develop a sustainable NHS in the face of a growing frailer and older population – capacity, an obsession with the four-hour emergency access target and social care,” he said.

“There is currently insufficient capacity in hospitals. With trusts trying to save costs there is less spare space in the system with no spare staff if needed so, if extra capacity is made available, it is last minute, ad hoc and expensive (locums and agency staff) which reduces efficiency and increases risk.

“Without a robust plan forcing trusts to cancel elective work any minor surge will cause issues.”

He added: “We also know trusts ‘treating’ the emergency access ED target in isolation end up hiding problems and stresses deeper in hospitals and there is not enough community care of sufficient quality to meet any demand.

“These issues don’t come as any surprise, so how long are we to go on without the secretary of state being held to account for not addressing the problems we know have the potential to push the NHS into utter chaos this winter?”

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