Senior medics warn NHS pressures unsustainable and national plan required urgently

The Society for Acute Medicine (SAM) has warned that pressures being seen across the NHS are at unsustainable levels and a national plan is required urgently (06 August).

Many hospital trusts are running on bed occupancy levels between 95% and 98% despite opening escalation beds – with some at 100% occupancy.

This comes at a time when newly-graduated doctors are arriving on wards with little time to settle in and hard-pressed, exhausted staff are being asked to work more hours.

They warn that current solutions being proposed to tackle long delays in emergency departments amid staff shortages, a lack of beds and poor social care provision will simply move the problem along rather than resolve it. 

“This is the first time in my memory things have been so hard at this time of the year when, traditionally, there is a slight lull in demand that gives the NHS time to recover some lost ground” said Dr Nick Scriven, past president of SAM.

“We are seeing long delays in our emergency departments and many trusts are running on bed occupancy levels in the 95% to 98% region despite having opened escalation beds, hence increasing the denominator in that equation.

“Some major hospitals are even quoting 100% occupancy figures and the stresses in the system are those typically and previously associated with the worst winters, not just increased winter pressures which have become the norm in recent years.

“We are concerned, though, that we have talked about these issues for so long now and we are at a point when the situation is unsustainable, so a national plan of action that really leads to change is required urgently.”

Dr Scriven said solutions proposed to increase flow through hospitals and release blockages in busy emergency departments were the “least bad” rather than “proven” options.

“The proposed answers or solutions so far, such as off-loading ambulances into unstaffed corridors or the previously mentioned ‘reception tents’ raise the prospect of implementing ‘least bad’ solutions rather than proven and evidence-based practices,” he said.

“We are seeing corridor care – previously very much maligned as unsafe – moving from the pressure points of the front of emergency departments along to other departments that, in all likelihood, will be far less resourced than the ED to cope in providing safe and dignified care.

“We also need to remember that although nurses and doctors can work extra hours they are exhausted and, even if they do, other healthcare professionals such as physiotherapists and pharmacists are vital in supporting patients recover and return home. 

He added: “As hospitals open extra beds, as we are seeing in trusts which are at capacity and being forced to squeeze more space, the resource of all staff is stretched even thinner.

“The idea that hospitals can magically open up extra safe capacity currently without slowing down other areas of vital work seems an impossible ‘mirage’.”

Dr Scriven said the only way to cope into the winter will be if a coherent plan across primary, secondary and social care is developed.

“As recently as May the Government rejected calls for an integrated health and social care recovery plan to tackle the effects of the pandemic and an annual independent assessment of workforce numbers, which demonstrates there is still a lack of realisation about the situation we face.

“To enable us to care safely and effectively over the coming months we need coherent thought processes using practices that Re proven to work, not short-term gimmicks which will mask the real problems and divert attention and funding from the genuine issues.”