The Society for Acute Medicine has made a submission to the Health and Social Care Committee’s ‘Delivering Core NHS and Care Services during the Pandemic and Beyond’ inquiry ahead of its latest evidence session today (Tuesday, 16 June).
In the letter, available to download here (Health and Social Care Committee submission), Dr Susan Crossland, president of SAM, and Dr Nick Scriven, immediate past president of SAM, state:
• During the current pandemic we suspect we have seen and treated far more patients with proven Covid-19, alongside our usual non-Covid patients, than either emergency medicine or intensive care medicine, and face equally urgent and daunting issues in providing a return to ‘normal’ working.
• Our three main areas of concern moving forward are the staffing we need to function safely, the bed capacity we have to provide the care we need to and how to safely restart the Same Day Emergency Care activities crucial to keeping patients out of hospital.
• Over the course of the pandemic much SDEC activity has been displaced or is not presenting at all and we now need to try to restart services catering for those without Covid as well as those who may have Covid or are asymptomatic. This will need major revisions in estate, staffing, diagnostic service availability and protocols.
• We are very aware of the problems we face with those who need an inpatient assessment bed. There needs to be significant work to try to prevent a return to the issues we have all seen in emergency departments with crowding.
• Like emergency departments, our units will need to be configured to allow safe and timely admission of patients not only from ED but also direct from primary care with routes disadvantaging neither. With the constant focus on ED there is a significant risk to those from other sources of referral (up to 40% of patients from our SAMBA audit 2019) being disadvantaged.
• We all need to work together for the best interests of patients and ensure that patient care is always considered above any arbitrary time based target or ‘date stamp’ saying that one area has ‘completed what they need to’ and to move the patient onwards regardless of the receiving areas’ pressures.
• Staffing for us moving forwards is a real and ongoing worry. As a highly skilled workforce in terms of acute care skills, our established teams have often been seen as a source of help for other areas and many of our nurses have been redeployed to ICU, ED and respiratory units to bolster those areas. This meant our teams not only having to cope with Covid patients but also to train up teams of nurses deployed into our acute areas from their normal jobs in areas such as outpatients or cancer screening.
• Our remaining teams have worked wonders, often in the same physically draining PPE as ED and ICU over the last months and now need help. We are acutely aware that winter is not too far away and senior figures are already warning us how ‘bad’ it will be. We urgently need our staff to be returned to us so that we all have enough time over the next few weeks to give everyone a chance to draw breath and recharge our batteries.
They concluded: “We recognise the immense effort that the whole of the NHS has achieved over the last few weeks and this should not be forgotten as we head towards the ’new normal’. As experts in acute care we feel that our contribution going forwards will be invaluable.”