SAM president warns NHS pressures show no sign of abating

The president of the Society for Acute Medicine (SAM) has today (09 April) warned NHS pressures show no sign of abating and the system is becoming “increasingly compromised”.

Dr Tim Cooksley said patients were being put at risk due to overcrowding in hospitals and long handover delays preventing ambulances from getting back on the road.

He said staffing and capacity issues were the two “fundamental issues” and “honest discussions” were required to resolve them.

SAM is the national representative body for the specialty of acute medicine, which 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 helps maintain the flow of patients through emergency departments to avoid exit block, the term used when patients cannot be moved into a hospital bed.

“The NHS and social care continue to be under immense strain and the system is becoming increasingly compromised,” said Dr Cooksley.

“Understandably, the Government wants to focus on elective (non-urgent) recovery and move forward from Covid, but the strains on the ground make this seem a distant prospect currently.

“There will be no elective recovery without addressing urgent and emergency care. 

“The reality is that we are seeing overcrowding in acute care settings with patient flow throughout the system impaired and patients stuck for long periods in emergency departments and acute medical units (AMUs) which results in worse patient outcomes.

“Due to this, paramedics are then stuck unable to transfer their patients into hospitals and get back on the road, resulting in 999 patients being left at home for longer periods without clinical assessment and treatment which potentially has a significant impact on their outcomes.

“These were problems that existed before Covid, however, they are now exacerbated by high staff absence levels, fatigue and low staff morale worsened by often not being able to deliver the standard of care they wish.” 

Dr Cooksley said while hospitals continue to work tirelessly to ensure they provide timely care for unwell patients, “the ability to do so is being increasingly challenged”. 

“Last week saw 71,088 staff in acute trusts in England absent from work through sickness with 40.6 per cent due to Covid-19-related reasons, while more than a quarter of ambulance handovers were delayed by more than half an hour,” he said. 

“There were more than 16,000 patients in hospital in England with Covid – 20,000 across the UK – and more than 13,000 patients in hospital in England were medically fit for discharge. This is a system stretched for multiple reasons.” 

Dr Cooksley said the new NHS England discharge taskforce will hopefully help those patients well enough and wanting to be home to do so, but cautioned its impact would be dependent on significant further investment in social care.  

“Workforce and capacity remain the two fundamental challenges,” he said.

“Honest and transparent discussions about how these immense issues are solved is essential. 

“We have developed six areas of focus to help NHS trusts improve hospital flow – Six to Help Fix – which cover protecting Same Day Emergency Care, optimising diagnostics, ward round and handovers, staffing, access to acute medical units and how other specialities utilise acute care. 

“We also need to see prioritisation of staffing in emergency departments and acute medical units to safe levels across teams to support assessments and treatment but, ultimately, we need short-term and sustainable long-term plans for high quality health and social care of which both staff and patients can be proud.”