Where are we now?
During the Autumn of 2017 the challenges facing NHS Emergency Departments (EDs) are less in the news, but the problems they face have not gone away. In our view, presently, the system is just coping after a terrible winter performance in many parts of the UK: there is an urgent need for action to tackle the problems facing Emergency Care.
There is a myth that patients are choosing to come to Emergency Departments instead of other services whereas the facts show that the growth is in step with the rising population in the UK. Since 2010/11 attendances in England have increased by 1,031,164 (7.4%) – equivalent to the workload of 10 medium sized departments – and this number is set to rise.
Patients rightly expect to be seen, treated, and admitted or discharged in under four hours – the national standard. But the workforce and resources are not growing to meet this demand — demand which has historically defied all attempts to reduce it. As a result, emergency care staff are working to the very limits of their abilities, 12-hour patient waits have increased, performance has declined to the worst for 15 years and safety is increasingly compromised.
The NHS’s emergency medical workforce is simply not large enough and so faces a significant challenge to meet the health needs of a growing and ageing population with increasingly complex needs. Emergency Departments are at the very heart of our emergency care systems and, as one of the few places in the NHS to offer a 24-hours a day, 7 days a week service, there is an increasing demand from patients to access them in their times of need.
What is needed?
- 2,200 extra Emergency Medicine consultants in England alone to achieve safe, sustainable staffing levels
Posts must be structured to allow good recruitment, retention and prevent career ‘burnout’.
- 100 extra training places per annum for at least four years
- More hospital beds
We estimate that we have a shortfall of at least 5,065 hospital beds in England alone to get occupancy rates back to safe levels (85% of all beds - a level we are consistently over). More beds are vital to tackle ‘exit block’ and overcrowding. Better social care provision and community care will also help maintain flow in the hospital system.
- Co-location of services
Locating and integrating other vital care services, including frailty teams, pharmacists, mental health specialists, ambulatory emergency care and GPs, around Emergency Departments is cost effective and helps reduce pressure.
- Emergency Care Transformation Programme
To achieve all of the above will require a robust and practical workforce plan that over a four-year period will help reduce the £1.3m being spent each day on locum agency staff.
Priorities for 2017 to 2020
To improve emergency medicine and deliver what is needed, over a three year period we will focus our resources and activities on three strategic aims:
"There must be a sustainable workforce to allow safe, effective and compassionate care of patients."
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"There must be systems, processes and setup of services within the NHS that allow for the timely care of patients and prevents Exit Block."
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"All staff should feel supported and enabled to deliver patient care and best practice through continuous quality improvement"
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