Royal College of Emergency Medicine – Page 6 – The NEN

Health and Social Care: Johnson bites the bullet

Prime Minister Boris Johnson’s statement at yesterday’s press conference on health and social care:

Good afternoon, I’m joined by the Chancellor of the Exchequer and the Secretary of State for Health and Social Care, because today we’re setting out our plan to help our NHS recover from the pandemic and build back better by fixing the problems in health and social care that governments have avoided for decades.

We all know someone whose test, scan or hip replacement was delayed or who helped to protect the NHS amid the immense pressures of Covid by putting off treatment for a new medical condition.

And now, as people come forward again, we need to pay for those missed operations and treatments; we need to pay good wages for the 50,000 extra nurses we are recruiting, we need to go beyond the record funding we’ve already provided to the NHS, and that means going further than the 48 hospitals and 50 million more GP appointments.

So today, following the most successful vaccine programme in the world, we’re beginning the biggest catch-up programme in the history of the NHS, increasing hospital capacity by 110 per cent, and enabling 9 million more appointments, scans and operations.

I have to level with people – waiting lists will get worse before they get better, but compared with before Covid, by 2024/25 our plan will allow the NHS to aim to treat 30 per cent more patients who need elective care – like knee replacements or cancer screening.

A recovery on this scale cannot be delivered by cheese-paring budgets elsewhere and it would be irresponsible to cover a permanent increase in health and social care spending with higher day to day borrowing.

For more than 70 years, we’ve lived by the principle that everyone pays for the NHS through our taxes, so it’s there for all of us when we need it.

In that spirit, from April we will have a new UK-wide 1.25 per cent Health and Social Care Levy on earned income, with the money required by law to go directly to health and social care across the whole of our United Kingdom, and with dividends rates increasing by the same amount.

This will raise almost £36 billion over the next three years, not just funding more care but better care, including better screening equipment to diagnose cancer earlier and digital technologies allowing doctors to monitor patients in their homes.

The levy will share the cost as fairly as possible between people and businesses: because we all benefit from a well-supported NHS and all businesses benefit from a healthy workforce.

And those who earn more will pay more, including those who continue to work over the State Pension Age.

The highest earning 14 per cent of the population will pay around half of the revenue raised; no-one earning less than £9,568 will pay a penny, and most small businesses will be protected, with 40 per cent paying nothing extra at all.

And this new investment will go alongside vital reform, because we learned from the pandemic that we can’t fix the NHS unless we also fix social care.

When Covid struck, there were 30,000 hospital beds in England occupied by people who would have been better cared for elsewhere, and the inevitable consequence was that patients could not get the hip operations or cancer treatment or whatever other help they needed.

And those people were often in hospital because they feared the costs of care in a residential home.

If you suffer from cancer or heart disease, the NHS will cover the costs of your treatment in full.

But if you develop Alzheimer’s or Parkinson’s, then you have to pay for everything above a very low threshold.

Today, 1 in 7 of us can expect to face care costs exceeding £100,000 in our later years, and millions more live in fear that they could be among that 1 in 7.

Suppose you have a house worth £250,000 and you’re in a care home for eight years, then once you’ve paid your bills, you could be left with just £14,000 after a lifetime of work, effort and saving – having sacrificed everything else – everything that you would otherwise have passed on to your children – simply to avoid the indignity of suffering.

So we are doing something that, frankly, should have been done a long time ago, and share the risk of these catastrophic care costs, so everyone is relieved of that fear of financial ruin.

We’re setting a limit to what people will ever have to pay, regardless of assets or income.

In England, from October 2023, no-one starting care will pay more than £86,000 over their lifetime.

Nobody with assets of less than £20,000 will have to pay anything at all, and anyone with assets between £20,000 and £100,000 will be eligible for means-tested support.

And we’ll also address the fear many have about how their parents or grandparents will be looked after.

We’ll invest in the quality of care, and in carers themselves, with £500 million going to hundreds of thousands of new training places, mental health support for carers and improved recruitment, making sure that caring is a properly respected profession in its own right.

And we’ll integrate health and social care in England so that all elderly and disabled people are looked after with the dignity they deserve.

No Conservative Government wants to raise taxes, but nor could we in good conscience meet the cost of this plan simply by borrowing the money and imposing the burden on future generations.

So I will be absolutely frank with you: this new levy will break our manifesto commitment, but a global pandemic wasn’t in our manifesto either, and everyone knows in their bones that after everything we’ve spent to protect people through that crisis, we cannot now shirk the challenge of putting the NHS back on its feet, which requires fixing the problem of social care, and investing the money needed.

So we will do what is right, reasonable and fair, we’ll make up the Covid backlogs, we’ll fund more nurses and, I hope, we will remove the anxiety of millions of families up and down the land by taking forward reforms that have been delayed for far too long.

Chancellor Rishi Sunak’s statement on health and social care, delivered on 7 September 2021

Good afternoon.

I want to address straight away the following question:

Why do we need to raise taxes?

Three reasons.

First, we need to properly fund the NHS as we recover from the pandemic.

Senior NHS leaders have made clear that without more funding we will not properly be able to address the significant backlog…

…in people’s cancelled operations, delayed treatments, or missed diagnoses.

To get everyone the care they need is going to take time – and it is going to take money.

The second reason is that social care plans announced today have created an expanded safety net.

Instead of individuals having to bear the financial risks of catastrophic care costs themselves, we as a country are deciding to share more of that risk collectively.

This is a permanent, new role for the Government.

And as such we need a permanent, new way to fund it.

The only alternative would be to borrow more indefinitely.

But that would be irresponsible at a time when our national debt is already the highest it has been in peacetime.

And it would be dishonest – borrowing more today just means higher taxes tomorrow.

The third reason we need to raise taxes is to fund the Government’s vision for the future of health and social care.

Properly funded, we can tackle not just the NHS backlog and expand the social care safety net, we can afford the nurses pay rise;

Invest in the newest, most modern equipment;

Prepare for the next pandemic;

And provide one of the largest investments ever to upskill social care workers.

In other words, we can build the modern, more efficient health and social care services the British public deserves.

To fund this vital spending, we will introduce a new UK-wide Health and Social Care Levy.

From next April, we will ask businesses, employees and the self-employed to pay an extra 1.25% on earnings.

All the money we raise will be legally ringfenced, which means every pound from the Levy will go directly to health and social care.

The Levy is the best way to raise the funds we need.

It is fair: the more you earn, the more you pay.

It is honest: it is not a stealth tax or borrowed – the Levy will be there in black and white on people’s payslips.

And it is UK-wide, so people in England, Scotland, Wales and Northern Ireland will all pay the same amount.

To make sure everyone pays their fair share, we will also increase dividend tax rates by the same amount.

And, from 2023, people over the age of 66 will be asked to pay the Levy on their earnings too.

No Government wants to have to raise taxes.

But these are extraordinary times and we face extraordinary circumstances.

For more than 70 years, it has been an article of faith in this country that our national health service should be free at the point of use, funded by general taxation.

If we are serious about defending this principle in a post-Covid world …

… we have to be honest with ourselves about the costs that brings …

… and be prepared to take the difficult and responsible decisions to meet them.

Thank you.

PM Boris Johnson’s letter to the First Ministers of Scotland, Wales and Northern Ireland and Deputy First Minister of Northern Ireland on the new health and social care reform:

National Insurance Contributions increase ‘adds insult to injury’ for families facing devastating cut to Universal Credit

New Joseph Rowntree Foundation analysis estimates that around 2 million families on low incomes who receive Universal Credit or Working Tax Credit will pay on average around an extra £100 per year in National Insurance contributions under the Government’s proposed changes.

Peter Matejic, Deputy Director of Evidence & Impact at JRF said: “We are concerned that around two million families on low incomes who receive Universal Credit or Working Tax Credit will pay on average around an extra £100 per year in national insurance contributions under the Government’s proposal.

“This extra cost adds insult to injury for these families who are facing a historic £1,040 cut to their annual incomes when Universal Credit and Working Tax Credit are reduced in less than a month on 6 October. If it presses ahead, this Government will be responsible for the single biggest overnight cut to social security ever.

“With inflation rising, the cost of living going up and an energy price rise coming in October, many struggling families are wondering how on earth they will be expected to make ends meet from next month.

“The Chancellor is in denial if he seriously believes this cut will not impose unnecessary hardship on millions of families – the majority of whom are in low-paid work.

“Any MP who is concerned about families on low incomes must urge the Prime Minister and Chancellor to reverse this damaging cut, which will have an immediate and devastating impact on their constituents’ living standards in just a few weeks’ time.”

RCEM welcomes Government funding, but warns it won’t be enough

Responding to the announcement of an extra £5.4 billion of funding for the NHS, Dr Katherine Henderson, President of the Royal College of Emergency Medicine, said: “The announcement of this additional funding for the NHS over the next six months is very welcome.

“It comes at a crucial time when the health service enters what will likely be its most challenging winter ever, as it exits the pandemic, seeks to recover the elective backlog and faces the worst ever levels of performance in the summer.

“It is particularly welcome to see the investment in improving infection prevention control measures in hospitals, as this will continue to be of the utmost importance in the coming months. It is also pleasing to see funding to continue to improve the timely discharge of hospital patients. It is vital for Emergency Care that there is good flow throughout the hospital, which includes making sure patients have a smooth discharge from the hospital.

“While this short-term funding is appreciated, there must also be an adequate response to the sharp increase in demand and equivalent deterioration in performance. It is unlikely that this funding will be enough to help enable longer term recovery.

“The challenges that our Emergency Departments face stem from workforce shortages and capacity issues. A shortage of beds can lead to crowding, corridor care and poor flow through the hospital. Workforce shortages spread existing staff thinly and put them under severe pressure.

“These are long term issues and the only way to tackle them will be via a long-term funding plan for the health service, including a workforce plan to recruit nurses and doctors by expanding student medical and nursing places and training places.”

Dr Katherine Henderson, commenting on the announcement of a three-year settlement for health and social care, continued: “The three-year funding settlement announced for health and social care is welcome.

“But the scale of the challenges faced across the health and social care service at a crucial time of recovery mean this will likely not be enough – and the government must be realistic in the colossal task ahead for the health and social care service. It is essential that a plan to address the workforce crisis is prioritised.

“It is also welcome to see the long overdue the first steps towards a plan for social care. There has been a crisis within social care for some time, so it will be good to see the government fulfil its pledge to reform and tackle the social care crisis.

“For that to happen, it is vital that an adequate proportion of the settlement is allocated to social care.”

Commenting on Tuesday’s social care announcement by the Prime Minister, TUC General Secretary Frances O’Grady said: “We need a social care system that delivers high-quality care and high-quality employment.

“New funding for social care is long overdue. But today’s announcement will have been deeply disappointing both to those who use care, and to those who provide it.

“The Prime Minister promised us a real plan for social care services, but what we got was vague promises of money tomorrow.

“Care workers need to see more pay in their pockets now. Nothing today delivered that. Instead, the only difference it will make to low-paid care staff is to push up their taxes.

“This is so disappointing after the dedication care workers have shown during this pandemic keeping services running and looking after our loved ones.

“Proposals to tax dividends should have been just once piece in a plan to tax wealth, not an afterthought to a plan to tax the low-paid workers who’ve got us through the pandemic.

“We know social care needs extra funding. But the prime minister is raiding the pockets of low-paid workers, while leaving the wealthy barely touched.

“We need a genuine plan that will urgently tackle the endemic low pay and job insecurity that blights the social care sector – and is causing huge staff shortages and undermining the quality of care people receive.”

The TUC published proposals on Sunday to fund social care and a pay rise for the workforce by increasing Capital Gains Tax.

The union body says increasing tax on dividends is a welcome first step to reforming the way we tax wealth, but that it won’t generate the revenue needed to deliver a social care system this country deserves.

Instead, by taxing wealth and assets at the same level as income tax, the government could raise up to £17bn a year to invest in services and give all care staff a minimum wage of £10 an hour.

TUC analysis shows that seven in 10 social care workers earn less than £10 an hour and one in four are on zero-hours contracts.

Polling published on Sunday by the TUC showed that eight in 10 working adults – including seven in 10 Conservative voters – support a £10 minimum wage for care workers.

“Shocking”: Ambulance handover delays are threatening patient safety, experts warn

A new snapshot survey by the Royal College of Emergency Medicine has found that in August 2021 half of respondents stated that their Emergency Department had been forced to hold patients outside in ambulances every day, compared to just over a quarter in October 2020 and less than one-fifth in March 2020.

The survey, sent out to Emergency Department Clinical Leads across the UK, also found that half of respondents described how their Emergency Department had been forced to provide care for patients in corridors every day, while nearly three-quarters said their department was unable to maintain social distancing every day.

One-third said that the longest patient stay they had had in their Emergency Department was between 24 and 48 hours, with seven per cent reporting the longest stay to be more than 48 hours.

Dr Ian Higginson, Vice President of the Royal College of Emergency Medicine, said: “It is shocking to see the extent of the challenges faced by Emergency Departments across the UK.

“Holding ambulances, corridor care, long stays – these are all unconscionable practices that cause harm to patients. But the scale of the pressures right now leaves doctors and nurses no options.

“We are doing all we can to maintain flow, maximise infection prevention control measures, and maintain social distancing. Our priority is to keep patients safe, and ensure we deliver effective care quickly and efficiently, but it is extremely difficult right now.

“The data is stark, and this is August. Our members are really worried about what may come in autumn and winter. We have a duty to our patients and staff. Currently there is extremely high demand – for a number of reasons – but demand is not the whole picture.

“Demand presents a challenge because of the limitations of hospital space, workforce shortages, difficulties arranging quick ambulance handovers, smooth care and safe discharge of patients from wards, and a lack of services and alternatives to admission, particularly in the evenings and at weekends.

“The health service entered the pandemic short of staff, with less beds, and underprepared. Throughout the pandemic these shortages have been felt, but with demand higher than ever before, and with a workforce that is burned out, these shortages are felt more acutely than ever.”

Commenting on the increase in ambulance handover delays, Tracy Nicholls, Chief Executive of the College of Paramedics, said: “The College of Paramedics’ members also speak passionately about the potential for harm to those patients who, as a consequence of these lengthy ambulance handover delays, can wait an unacceptably long time for help. It is deeply concerning.

“Like the Royal College of Emergency Medicine, we recognise that all partners are working exceptionally hard to manage this situation and current demand. The reality is, however, that unless effective actions are taken now to ease the system pressures, more and more patients will face these delays as we head into another difficult winter, and both paramedics and ambulance clinicians across the UK will face the brunt of any further increase in demand.

“We urge NHS leadership to take action now to mitigate this risk wherever possible and protect both patients and our collective workforce from the inevitable pressure that we face if nothing is done.”

The survey also found that over 80% of respondents had little or no confidence in their organisation’s ability to safely and effectively manage the current or predicted combination of pressures as we head into winter.

Dr Higginson continued: “The final response that found an overwhelming lack of confidence signals something deeply troubling.

“The College has consistently warned of the upcoming winter and ongoing pressures. It is time we saw leadership and an equivalent response. There must be a comprehensive plan for the current demand and upcoming winter that include short- and long-term solutions to tackle these serious challenges.

“If ambulance services and Emergency Departments cannot cope with ongoing pressures, then it is patients and the workforce looking after them who will suffer. The winter could lead the health service into a serious crisis. Patients and staff must have assurance that they, their Emergency Department and their hospital will get what they need to manage.”

Lowest ever levels of A&E performance show NHS ‘near boiling point’

‘the reality is that the NHS is really struggling’

Responding to the latest set of performance figures released by NHS England for July 2021, President of the Royal College of Emergency Medicine, Dr Katherine Henderson, said: “The NHS has been running hot for months now and these figures show we are nearly at boiling point.

“We are worried that the public think that things are getting back to normal on the virtual eve of a further reduction in restrictions, and messages from the centre that says things are OK are disingenuous – the reality is that the health service is really struggling.

“Four-hour performance has sunk to its lowest ever level, we have levels of 12 hour waits we would usually associate with winter, and July saw the second highest ever number of attendances across emergency care units. Yet there is no sign of rescue ahead of winter. Despite our calls for action, crowding is back with us and is compromising patient care.”

Performance figures for Emergency Care for the NHS in England in July 2021 showed that:

there were 1,431,499 attendances at major Emergency Departments – the second highest on record
67.7% of patients waited less than four hours from arrival to admission, transfer, or discharge in Type 1 EDs – the lowest percentage on record
the number of patients waiting more than four hours after a decision to admit them stood at 89,768 – this is a 30% increase compared to June 2021 (66,619) and is the third highest ever
the number of patients waiting more than 12 hours after a decision to admit them stood at 2,215 – by far the highest July figure on record (second highest is 451 from July 2019).

Dr Henderson said: “The NHS was in a pretty dreadful state going into the pandemic – we were seeing record waits across the board, due to insufficient resourcing – but the sheer determination of an overstretched workforce, combined with a ‘whatever it takes’ approach, got us through.

“The problems that were with us before the pandemic have not gone away. Not only do they remain but are now much worse due to the impact of Covid, as these figures make crystal clear.

“The ambulance service saw thehighest ever number of ambulance callouts for life threatening conditions in July, and we saw ‘trolley waits’ in hospitals go up by 30% on the previous month. This means there have been delays offloading ambulances and patients have experienced long waits to be seen and moved to a bed if they need admission.

“Emergency Departments are very, very busy.

“There has also been a steady rise in Covid presentations and even though numbers are still low all the infection risk concerns remain in hospitals, further depleting capacity. Staff have had no let up and are worried about what the winter will be like if this is where we are in the summer.

“Demand is driven by multiple factors – difficulties accessing primary care, complications of chronic conditions, new presentations of significant illness and waiting list patients with on-going symptoms and no sign of getting their care sorted any time soon.

“NHSE recommends patients to access help via 111 but unless the system is responsive and clinically supported and other options available that advice too often defaults to go to the Emergency Department. Local health systems must ensure adequate urgent care facilities for their communities, letting Emergency Department have capacity to treat the seriously ill and injured.

“The other side of this is problems with supply – we do not have enough staff, beds, or equipment. There is still no plan for social care, which has a huge impact on the NHS. These have been issues for some time, but on top of this is the growing waiting list for elective care, staff absence due to a combination of leave and necessary self-isolation, and an even lower bed capacity due to infection prevention control measures.

“We fear for what winter may hold; we know it will be worse than now but a heavy flu season, another potential Covid surge and an understandable desire not to cancel elective care this winter could cripple us and put patient safety at risk.

“NHS Trusts must do all that they can to wring out every drop of capacity ahead of winter and the Department of Health and Social Care must extend ‘discharge to assess’, which made a significant difference freeing up beds during the pandemic. There has been a sustained rise in the number of patients experience long stays in hospital, and this funding is critical to freeing beds and maintaining flow in hospitals.

“We also need clarity in terms of performance – we are currently in a performance vacuum with Trusts uncertain about what they need to focus on. Implementing some of the metrics proposed by the Clinical Review of Standards is vital ahead of winter. We need to operationalise the metric of a maximum of a 12 hour stay from point of arrival. This will be a small step to reducing exit block, and allow timely ambulance offloads.

“While the NHS rollout of the vaccine has been an incredible success, parliament must not take its eyes off the ball regarding the state of the NHS. This autumn’s spending review – one which has not been put out to consultation – is an opportunity for the government to further signal it’s ‘peace time’ commitment to NHS funding and help prevent the NHS from boiling over this winter.”

The situation in Scotland is also giving cause for alarm. Lothian MSP, Miles Briggs is ‘very concerned’ A&E waiting times aren’t showing signs of improvement.

Miles Briggs MSP said: “NHS Lothian is in desperate need of an injection of funds to alleviate pressure on services.

“Years of chronic underfunding and a global pandemic has left staff on their knees, struggling to meet the increased numbers of patients attending A&E.

“SNP Ministers must take responsibility for allowing the situation to get to this point and immediately fund NHS Lothian properly to start getting services back to normal.”

https://www.publichealthscotland.scot/publications/nhs-performs-weekly-update-of-emergency-department-activity-and-waiting-time-statistics/nhs-performs-weekly-update-of-emergency-department-activity-and-waiting-time-statistics-week-ending-1-august-2021/

RCEM: ‘It is absolutely essential that masks are worn by everyone in A&Es’

Dr Katherine Henderson, President of the Royal College of Emergency Medicine has stated that it is absolutely essential that patients and visitors in Emergency Departments continue to protect themselves and others with face masks, hand washing and social distancing.

Dr Katherine Henderson said: “While restrictions have been eased, it is absolutely essential that we continue to keep everyone safe in hospital settings and in Emergency Departments. Patients and visitors must therefore expect to wear a mask and maintain social distancing.

“Emergency Departments regularly see vulnerable patients. We must do all we can to keep those patients safe, but also to ensure that these patients feel safe coming to the hospital and the Emergency Department if, and when, they need help.

“We ask patients and visitors to kindly respect and co-operate with this guidance and help to keep everyone safe. Staff will not tolerate any abuse whatsoever. They absolutely do not deserve it, but it is a sad reality that we are already hearing and seeing abusive behaviour towards staff. It is clear these measures will help protect the most vulnerable patients, so it is right that all patients and visitors follow them.

“Staff will request all patients and visitors to put a mask on when in an Emergency Department and they will not be engaging in any debate on the guidance.

“It is a matter of public health and infection prevention control to keep all our patients safe.”

Burnout: RCEM calls for urgent increase in staffing levels

The Royal College of Emergency Medicine is calling for UK governments to act now to achieve safe staffing levels in Emergency Departments after a workforce survey found that three in five Emergency Medicine staff say they have experienced high levels of burnout, stress, and exhaustion.

The survey found:

73% of respondents indicated workforce pressures in their Emergency Department impacted patient safety before the pandemic.
59% of respondents experienced burnout during the second wave of the pandemic.
59% described their levels of stress and exhaustion from having worked the second wave as higher than normal.
In the next two years, 50% are considering reducing their working hours and 26% are considering taking a career break or sabbatical. When asked what prompted them to make this decision, 32% selected workload pressures and 35% selected burnout.
In the next six years, trainee emergency physicians are considering reducing working hours (57%), taking a career break or sabbatical (45%), working abroad (36%), and changing specialty (25%).
69% of clinical leads revealed that locums were being used in their Emergency Department to fill permanent posts.

Dr Katherine Henderson, President of the Royal College of Emergency Medicine, said: “The workforce survey reveals the scale of the problem in the Emergency Medicine specialty with burnout and retention of staff.

“The fact that half of Emergency Medicine staff are considering reducing their hours in the near future and over one quarter are considering taking a career break, is deeply worrying.

“Emergency Medicine has always been an exciting yet challenging career, but the intensity of the pandemic and the current severity of the pressures has exacerbated these challenges vastly and increased burnout and exhaustion among staff, and ultimately discouraged existing staff from continuing their career in the specialty.

“The response from the survey clearly show that operational pressures are seen by staff as the most significant reason for considering reducing hours, changing careers, or retiring early. Therefore, we must make Emergency Medicine a sustainable career and improve staff retention.

“Demand for urgent and emergency care has increased significantly over the past few years, but the workforce has not grown adequately to keep up with this demand. The result has led to an increase in crowding and corridor care, with more delays and more long stays for patients in Emergency Departments, while staff have been spread more and more thinly trying to cope with intense pressures. These factors put huge strains on staff and put patient safety at risk.

“This is not sustainable for staff, and if Emergency Departments must be the safety-net of the system and the place where people go when they have nowhere else to seek treatment, we must be staffed appropriately to deal with that. Our fear is that we are on the brink of a crisis in urgent and emergency care, and fewer staff will be inclined to work in Emergency Medicine and a depleted workforce will be facing higher demand.”

The College is calling for a workforce plan that achieves safe-staffing levels in Emergency Departments; currently the College estimates there is a shortage of between 2000-2500 Emergency Medicine Whole Time Equivalent consultants across the UK.

Dr Henderson continued: “Governments must acknowledge the data and reports that show Emergency Departments across all four-nations are struggling to cope, struggling with performance, and struggling to deliver quick, effective and high-quality care, and take the necessary action to address it.

“We urgently need decisive action and leadership, we must achieve safe-staffing levels in Emergency Departments across the UK, and this workforce must be formed of staff trained and qualified in Emergency Medicine.

“We must see a long-term Health and Social Care strategy that recognises the value of urgent and emergency care and enables high-quality care and performance – this should be done by funding Same Day Emergency Care and Ambulatory Emergency Care, through expanding capacity, funding local health systems, and rigorously determining the effectiveness of NHS 111 and maximising its potential – all these steps must be taken to address the problems facing emergency care.

“We hope that the new Health Secretary will hear our urgent calls for decisive leadership and take swift action to address the challenges facing the Urgent and Emergency Care system and enact our recommendations.”

RCEM: We have a serious problem in Urgent & Emergency Care

Emergency Department performance figures published by NHS England for June 2021 show the highest number of Type 1 attendances ever recorded, the worst four-hour performance for the month of June, and the highest ever number of total emergency admissions for the month of June.

The data show that in June 2021 1,436,613 patients attended Type 1 Emergency Departments, the highest ever figure since records began.

A total of 400,826 patients were admitted via Type 1 Emergency Departments, the highest ever recorded figure for the month of June.

Four-hour performance in Type 1 departments was 73.2% which is by far the lowest June percentage on record.

1,289 patients were delayed by 12-hours or more in an Emergency Department – almost double the figure of the previous month. It is also the highest ever recorded figure for the month of June, and almost triple the previous highest figure for June recorded in 2019.

Dr Katherine Henderson, President of the Royal College of Emergency Medicine, said: “We have a serious problem in urgent and emergency care. We are deeply concerned. We are facing record breaking figures in the high summer. We can only begin to imagine what this winter may bring.

“We are facing record breaking attendances with a tired workforce and fewer beds; it is seriously challenging. Busy departments are a threat to patient safety, it increases the chance of crowding and corridor care, this risk is significantly increased if covid and non-covid patients are sharing the space for long periods of time.

“We ask that there is a transparent discussion about how the whole of the health service deals with the current levels of demand. Emergency care does not happen in a vacuum but is often the canary of the system. Managing demand in Primary care, the elective backlog and what is happening at the front doors of hospitals is all connected and there is urgent need for a plan that balances these needs in a way everyone can understand.

“The data show what is happening on the ground, and it is likely that things will worsen in the coming months, especially as we enter the winter. The government must realize there is a looming crisis and take swift and urgent action – this is critical ahead of Winter.

“Hospitals can only do all they can to boost capacity, in the face of serious resourcing constraints. And we would ask patients to only attend Emergency Department if they need urgent and emergency care, and seek alternative care, like from their GP or NHS 111, if they have a minor injury or mild condition.

“Despite now being in the middle of summer, our Summer to Recover: Winter-Proofing Urgent and Emergency Care for 2021 contains the necessary actions the government and the NHS can take ahead of Winter.

“If no action is taken, we may soon be in the middle of a crisis worse than any previous winter.”

Scotland’s Emergency Departments experience worst ever May performance

The latest data released yesterday by the Scottish Government for May 2021 show that attendances at Emergency Departments have risen significantly.

In May 2021 there were 112,563 attendances to major Emergency Departments across Scotland. This is a 12% increase compared to April 2021, a 24% increase when compared to March 2021, and a 45% increase compared to May 2020.

Following this increase, four-hour performance deteriorated, 86% of attendances to major Emergency Departments in Scotland were seen within four hours. 15,706 patients were delayed by four-hours or more in an Emergency Department, this is the highest figure since January 2020, and it is the highest figure ever recorded for the month of May. This means one in seven patients were delayed by four hours or more before being seen.

In May 2021, 393 patients spent 12 hours or more in an Emergency Department, this is double the figure for April 2021. This is the highest number of 12-hour delays for the month of May ever recorded, and it is more than double the previous highest May figure of 189 12-hour delays that was recorded in 2019.

Data also show that 1,680 patients spent eight hours or more in a major Emergency Department, this is an increase of nearly 50% compared to April 2021 and it is the highest figure ever recorded for the month of May.

Dr John Thomson, Vice President of the Royal College of Emergency Medicine, said: “The data is deeply concerning and very much reflects what is happening on the ground. Departments are busier than ever, especially for the summer period with some record-breaking figures for the month of May, and it is becoming increasingly challenging.

“These figures come at a time when reports suggest Scotland has the highest covid infection rate in Europe. We are battling community admissions, elective care patients seeking treatment, as well as increasing covid patients attending our departments, all within the context of reduced bed-stock.

“Departments are filled with patients, some who may have covid, waiting to be seen. While long-stays alone can put patient safety at risk. This risk is increased as some patients could contract the disease in a busy Emergency Department.

“The College’s recent Emergency Medicine workforce census in Scotland revealed an Emergency Medicine workforce that was not adequately staffed to deliver the highest quality patient care in Emergency Departments in Scotland.

“We have shortages across the board, but particularly among consultants and senior decision-making clinicians. These shortages are currently exacerbated by the soaring covid infection rate, meaning there are a large number of absent NHS staff due to covid in Scotland.

“We are doing all we can to maintain flow and maximise patient safety, but the pressures are increasingly intense and are faced by the existing but short-staffed workforce that are facing continued burnout and exhaustion.

“The data show the growing demand for urgent and emergency care, Emergency Departments are where people turn to for treatment when there is nowhere else to go, so they must be adequately staffed with trained Emergency Medicine staff, properly funded, and equipped with enough capacity and resources to cope with severe demand.”

“We urgently need the Scottish Government to support the urgent and emergency care system to cope with these pressures.”

Two NHS Grampian hospitals have announced this week that they are at capacity as Covid cases rise.

Scotland was expected to move to level zero on 19 July, with remaining legal restrictions lifted on 9 August, but First Minister Nicola Sturgeon conceded yesterday that th planned dates are not “set in stone”.

She will be holding a media briefing at lunchtime today:

Emergency! Key staff shortages are increasing the pressure on struggling ED workforce

Census by RCEM Scotland shows a shortage of key senior decision-making clinicians and a workforce below adequate staffing levels

A census of the Emergency Medicine workforce in Scotland by the Royal College of Emergency has found shortages of key senior decision-makers, and a workforce that is below adequate staffing levels to deliver the best and most effective care to patients.

When asked for immediate staffing needs, Emergency Departments across Scotland reported they needed an increase of:

25% in consultants
45% in Advanced Clinical Practitioners/Advanced Nursing Practitioners/Physician Associates
16% in Emergency Nurse Practitioners
22% in Higher Specialist Trainees/Non-consultant Senior Decision-Makers
21% in Junior Doctors

RCEM analysis shows that to resolve the shortages of senior decision-makers and to achieve adequate staffing and aspirational staffing levels by 2026 the current workforce in Scotland needs a total of 405 more health care staff broken down as:

113 more consultants
74 more Higher Specialist Trainees/Non-consultant Senior Decision-Makers
38 more Advanced Clinical Practitioners/Advanced Nursing Practitioners/Physician Associates
180 more Junior Doctors

RCEM’s Scotland workforce census consisted of a 64-question survey and was sent to Emergency Department Clinical Leads across Scotland.

Responses were received from 24 Emergency Departments, including all 20 consultant-led Emergency Departments, one Minor Injury Unit, and three Remote and Rural Hospitals.

Commenting on RCEM’s Scotland workforce census, Dr John Thomson, Vice President (Scotland) of the Royal College of Emergency Medicine, said: “The census clearly shows that the Emergency Medicine workforce in Scotland is not adequately staffed to deliver the highest quality patient care.

“This has led to an increase in intense pressures on the existing workforce and is very likely to be a contributing factor to the continued deterioration in performance.

“We have always been proud of Scotland’s performance in Emergency Medicine, ensuring quick and effective care that outperformed the rest of the United Kingdom. But, even before the pandemic, the increase in demand put severe pressure on staff, and departments began to struggle to meet the four-hour access standard, but more seriously began to struggle to deliver appropriate treatment to patients, resulting in more delays and longer stays.

“The pandemic certainly exacerbated these issues and now there are some major challenges that face Emergency Medicine in Scotland. Emergency Medicine can be relentless; a service delivered 24 hours a day, seven days a week, will always take its toll, and the pandemic has highlighted the severe burnout that Emergency Medicine staff, especially face.

“Departments must be staffed with a workforce trained and qualified in Emergency Medicine. Shortages in senior decision-making staff groups can lead to Emergency Departments over-depending on junior staff. The census shows that we need considerable expansion of funded consultant and senior decision-maker posts in order to prioritise patient safety and quality of care.

“We managed to survive the first two waves of pandemic with an insufficient workforce, but now these existing staff are facing burnout and exhaustion – with some clinicians reporting they are planning on retiring early. This census clearly shows that we must act and address these problems without delay.

“The Scottish Government must work with the specialty to devise an adequate workforce plan for the emergency care system, taking into account population needs and rising demand on the service. Plans must ensure sustainable and fulfilling careers for all staff, allowing for the delivery of quick, safe, and effective care for patients.

“Without a sufficient workforce plan that addresses the findings of the census, it is likely that there will be continued deterioration in Emergency Department performance and rates of burnout will continue to increase amongst Emergency Medicine staff.”

Royal College of Emergency Medicine: Winter crisis looming?

16,000 additional beds may be needed for the NHS to cope this winter

The NHS urgently needs a rapid increase in bed numbers if it is to meet potential demand this winter according to new analysis from the Royal College of Emergency Medicine.

The College’s new briefing document ‘RCEM Explains: Hospital Beds’ looks at how bed numbers have declined in the past decade, the impact of covid, and the potential number of beds needed this winter, based on previous levels of demand.

The briefing uses the ratio of emergency admissions to beds to model the numbers of beds that will likely be needed, based on the levels of demand seen each winter prior to the pandemic.

In the last five years in England this figure has fluctuated between 11.07 admissions per bed (winter 2015/16) and 12.50 (winter 2018/19). Excluding the most recent winters (both of which saw demand and capacity fall due to the pandemic), there was an average of 11.77 admissions per bed.

If the NHS is to achieve a similar ratio this winter, and there are a similar number of admissions as in the winter of 2017/18, the NHS will need just over 7,500 additional beds. If demand is similar to 2018/19, then this figure rises to 15,788 extra beds.

President of the Royal College of Emergency Medicine, Dr Katherine Henderson said: “We are currently seeing record levels of attendances at Emergency Departments and if this continues into winter – an extremely likely situation – the NHS will have too few beds to be able to cope.

“The consequences of having too few beds could be dire. If we do not have the capacity to admit patients into hospitals, then A&E waiting times will go up, patients will end up being treated in corridors – a very real threat to their safety before the pandemic, but now with the added risk of hospital acquired infection – and the elective backlog will grow further as beds earmarked for surgeries will be used for emergency patients.”

The briefing also makes clear the relationship between high bed occupancy and an increased rate of cancelled elective operations.

Dr Henderson said: “Too few beds means higher rates of occupancy, which in itself puts patient safety at risk, but it is clear that this has a huge knock-on effect on elective care. Lack of beds is one of the top reasons for cancellation of surgeries and if we do not address the shortage now, before winter, the elective recovery will fail.

“We know that access to services is an issue throughout the NHS at the moment with resources short all-round, but Emergency Departments act as the safety net for the NHS – if they cannot function properly the entire system stalls – so it is vital that the new Secretary of State does all he can to enable the NHS to expand hospital capacity.

“The safe restoration of bed capacity to pre-pandemic levels is no easy fix though – as we’ve seen with the Nightingale initiative, capacity cannot be expanded if we do not have enough doctors, nurses, and clinicians.

“The capacity and staffing issues we face now have been over a decade in the making. Social care is still unfixed. Waiting lists are growing. Structural reconfiguration is in progress. Covid is less of an immediate threat but is unlikely to disappear. The Secretary of State has much to do, but he must start by making the beds.”

NHS Trusts grappling with challenges on ‘multiple fronts’

Survey by NHS Providers reveals fears over waiting lists, COVID-19 and winter pressures

A survey by NHS Providers sets out in stark detail how NHS leaders are grappling with challenges on multiple fronts as they seek to meet rising demand for health services alongside a rapidly growing waiting list and a worrying surge of COVID-19.

The health service is coming under concerted pressure with recent figures revealing a record 5.1 million people on waiting lists, over 2 million A&E attendances in the last month and a steep increase in demand for mental health services.

Trusts and frontline staff are working at full pelt to clear the backlog of care that has built up during the pandemic, with 90% of pre-pandemic levels of operations now being carried out and a small, but welcome fall in the number of people now waiting over 52 weeks for treatment to begin.

But our survey reveals widespread concerns amongst trust leaders that winter pressures and further surges of COVID-19 will derail plans to deal with the backlog of care and undermine hard-won progress.

These findings come just days after the chief medical officer warned of a further wave of COVID-19 this winter and the prime minister was forced to delay plans to further ease restrictions following a sharp rise in infections and hospital admissions because of the Delta variant.

The survey responses reveal:

A large majority of leaders (88%) said it was likely that another surge in COVID-19 cases would place additional pressures on their services.
89% said they were worried these additional pressures would come during the challenging winter months.
Almost three quarters (73%) of respondents raised concerns that plans to clear the backlog of care over winter risked being disrupted because of the need to prioritise demand for urgent and emergency care.
Almost half (48%) of respondents said they have seen evidence of staff leaving their organisation due to early retirement, COVID-19 burnout, or other effects from working in the pandemic. Respondents are concerned that juggling winter, flu, COVID-19 and ambitious recovery plans will once again put pressure on the workforce.

Commenting on the survey results, the deputy chief executive of NHS Providers, Saffron Cordery said: “Our survey reveals the sheer scale of the challenge facing trusts right now. They are battling on multiple fronts as they try to recover care backlogs, deal with increased demand for emergency care and treat patients with COVID-19.

“This is difficult at the best of times but as we saw last year, could become even more challenging during the hard winter months, particularly with the expectation that flu will return and there will be increased respiratory viruses among children.

“Trusts are committed to clearing the backlog of care that built up during the pandemic. We are confident vaccines are breaking the chain between infections and hospital admissions, but the reality on the frontline is that even a small increase in COVID-19 admissions or emergency care pressures could affect our ability to deliver non-COVID services.

“Trust leaders are doing all they can, but there are three steps the government can take immediately to ease the current pressure trusts are facing.

The government must provide much needed short-term capital funding so trusts can direct it to the services that need it most. Saffron Cordery DEPUTY CHIEF EXECUTIVE

“First, the government must provide much needed short-term capital funding so trusts can direct it to the services that need it most. Trusts tell us they need capital quickly to expand intensive care units, to invest in digital to transform pathways to see patients more quickly, and to adapt estates to create more capacity.

“Second, trusts need to maintain patient flow and maximise their capacity. We’re urging the government to commit to permanent, dedicated funding for the discharge to assess programme, which ensures patients who are ready to leave hospital are placed in a more appropriate setting freeing up hospital beds.

“Third, we need national bodies to work with NHS leaders to get the planning for winter pressures right to help manage the risk ahead. We know the NHS faces a perfect storm of COVID-19, flu and other respiratory illnesses as well as a growing backlog of care. We must act now.”

‘The threat of winter is tangible’

RCEM supports NHS Providers call for action

Responding to the latest survey from NHS Providers about the challenges facing Trusts, Dr Adrian Boyle, Vice President of the Royal College of Emergency Medicine, said:

“The health service is facing serious pressures: with the backlog of elective care reaching 5.1 million patients; and the urgent and emergency care system facing record breaking attendances.

“It is an incredibly challenging time, but we support our Trust Leaders and recognise that they are doing what they can to manage the current situation.

“We support NHS Providers and their three steps the government can take to ease pressures currently facing Trusts. We particularly welcome NHS Providers call for action ahead of winter and the likely increase of pressures that covid, flu and respiratory illnesses will bring, in tandem with the urgent tackling of elective care.

“Since April 2021, the College has warned of the threat of winter and the need to prepare the health service and ready Emergency Departments. It is absolutely essential that we ensure there is adequate capacity, adequate access to alternative care, departments have the right resources, and that staff are prepared.

“Our Summer to Recover: Winter-proofing Urgent and Emergency Care for 2021 outlines the steps the government, NHS Trusts and Boards, and ED Leadership Teams can take to prepare ahead of winter.

“We welcome the recognition from NHS Providers of this threat ahead, now we wait for the urgent action and leadership from government that is desperately needed.”