Last updated on August 29th, 2017 at 10:50 am
But inadequate staffing levels (over 50% of senior medical posts in A & E departments have been unfilled for four years) and complex factors have contributed towards significant delays in our already overstretched emergency services.
Emergency services under pressure
Nearly one in four of us are spending more than four hours in an emergency department.
This is because the number of people attending A & E has increased. Surveys indicate that up to 20% of those attendances could have been treated within the community, and many are repeat attendances by people with complex long term health conditions. Poor out of hours GP services that are inaccessible, fragmented and confusing contribute to these additional A&E attendances. Although, in response, the NHS Five Year Forward View says that it will look at reorganising and simplifying the system, by
“making more appropriate use of primary care, community mental health teams, ambulance services and community pharmacies”.
Social care provision is another significant factor in the delays in emergency care as the cut in social care budgets means that there is a lack of facilities to transfer the ever increasing elderly and vulnerable population back into the community following admission, which of course results in the additional strain of bed-blocking.
The Royal College of Emergency Medicine has considered the current issues facing emergency care and has launched the STEP campaign to address those challenges facing A&E departments in order to provide a safe and efficient service.
The STEP campaign for emergency services
To rebuild the emergency medicine service the college is calling for four steps to be taken:
Step 1: staffing levels for urgent and emergency care that are safe and sustainable must be achieved.
The RCEM points out that staff suffer burn-out as a result of working in “overcrowded departments, where care is constantly impaired as a consequence and saps morale”, resulting in many doctors leaving the NHS and in some instances emigrating. This has a knock on effect as the financial impact is significant. The RCEM estimates that not only is there a cost to the British taxpayer of training doctors who emigrate to work in emergency medicine in Australia which is in excess of £250 million but that over £150 million is spent on A & E locum doctors each year.
Step 2: tariffs and funding for urgent and emergency care must be fair and effective, thus helping to promote better systems.
The RCEM states that hospitals are penalised for every non-elective admission (where a patient is seen in A & E, for example, and admitted to hospital), which means that hospitals lose money by providing the emergency care that we need. Hospitals have to subsidise this service by increasing their amount of elective admissions (admissions where a bed has been pre-arranged). This has a significant impact because it means hospitals continuously have dangerously high occupancy levels. Therefore they are not able to cope with additional pressures such as the increased demands associated with seasonal pressures and wider demographic change or continued population growth.
Step 3: exit block and overcrowding in A&E departments must be eliminated.
People are put at “risk by long waits on trolleys or wheelchairs in crowded A&E departments” and the RCEM states that this is a hospital problem that causes “more than 500 avoidable deaths every year”.
Step 4: Primary care facilities must be co-located with A & E services wherever possible.
The RCEM supports on site primary-care facilities located beside the emergency departments to tackle the current difficulties of inaccessible GP services and to prevent duplication of services, as many people are advised to attend the emergency department by other health care providers. Co-located services would reduce cost and inefficiency and provide a fully integrated and joined up system which would also ease the pressure on staff working in emergency departments.
