Senior medics warn unprecedented summer pressures like “worst winters we can recall”

Senior medics have warned the current unprecedented summer workload being seen across the NHS “feels like the worst winters most of us can recall”.

Dr Nick Scriven, immediate past president of the Society for Acute Medicine (SAM), said clinicians were seeing “vast numbers” of patients with non-Covid illness alongside those “still very poorly” with Covid.

He said many patients were suffering from illnesses typically seen in winter such as respiratory infections – particularly in children – but also large numbers of patients who have seen their health deteriorate over the past 18 months.

“I think it is fair to say we are currently facing an unprecedented summer workload that feels more like the worst winter pressures most of us can recall,” explained Dr Scriven.

“We are seeing vast numbers of patients with non-Covid illness alongside the steady admission rates of those still very poorly with Covid.

“The types of illnesses we are seeing are typical of winter weather as in a lot of respiratory infections, especially in paediatrics, but also a lot of people where the lack of access to primary and secondary care during the last 18 months could now be contributing to them needing hospital admission.”

Dr Scriven added this included conditions that are known to chronically worsen and require community care, such as heart failure, COPD and diabetes-related problems, but also mental health issues and alcohol-related illness. 

“We are also noticing frailer people who have deconditioned over lockdowns so that any illness that previously might have been fairly minor now needs an extended stay in hospital with periods of rehabilitation,” he said.

Dr Susan Crossland, president of SAM, said there was major concern about the fact hospitals are contending with this pressure while running on 10% less beds with all Covid infection control precautions in place.

She also warned staff were exhausted and staffing levels were being hit hard by multiple issues including stress and self-isolation as well as Covid infection – exposing the “gaping holes” which already existed in the workforce.

“This is a deeply concerning time as we are in uncharted territory here with a summer crisis consisting of so many different problems with no end in sight and the daunting prospect of an extremely busy and difficult winter,” she said.

“We know many hospitals are at bed occupancy levels well over the safe limit of 85%, with some at more than 95%, at this point of the year and we know we have worse to come with a system that just isn’t currently fit for purpose.”

Dr Crossland said it was “absolutely essential” politicians and NHS bosses started thinking about acute medicine as the solution to help the health service weather the storm ahead before it is too late.

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.

Dr Crossland said the recent announcement of the warning issued by the Care Quality Commission regarding patient safety in the emergency departments at Aintree and the Royal Liverpool University Hospital highlighted the fragility of the system.

“Liverpool is suffering worse than most as it has been hit really hard by each wave of the pandemic and the pressures on emergency departments have been extreme – but these hospitals certainly aren’t the only ones in this situation.

“We are thinking of our colleagues in Liverpool and across the NHS who are doing their best for patients under such difficult conditions but the question we must ask of our leaders is why we are unable to recognise the knock-on effects of mismanagement.  

“Much time, effort and money has been spent trying to sort out emergency departments yet they continue to struggle and if one part of the system fails then the whole thing buckles, yet there is little accountability for so much focus on the wrong things. 

Dr Crossland said that despite acute medical units being integral to the management of emergency departments and the flow of patients, the specialty has been “misused” to the detriment of the system.

“It is so extremely frustrating to us as we know acute medicine holds the key to solving many of the system pressures in the NHS but that is not feasible when it becomes the “go to” solution for helping out in emergency departments, giving up beds for extra capacity or working in sub-standard facilities.

“We need to start thinking about acute medical units as different to the rest of the hospital bed base and take into account that if our AMUs are full, neither the front door (ED) nor the back door (hospital wards and discharge) will work. 

“All this time we have spent trying to sort out ED when we should have been sorting out AMUs with more staff, purpose-built units and better training of the whole team of staff.”

She added: “These are the real issues which could make a tangible difference to the way we run the health service and deliver care for patients, not misleading claims about supposed “new” hospitals or gimmicks to avoid taking the right action. 

“The government has a real opportunity to work with NHS leaders and make a real difference by ensuring it delivers appropriate funding for the remainder of the year and beyond and listens to the needs of experts.”