Tag: Royal College of Emergency Medicine

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.”

RCEM launches public appeal to support A&E staff facing stress and burnout

The Royal College of Emergency Medicine is launching a public appeal  to support the mental health and wellbeing of A&E staff after data show that many have struggled with burnout, distress, and other psychological conditions resulting from the stress of the pandemic, further to the continued pressures of their day-to-day work in Emergency Departments.

The NHS entered the pandemic underfunded, under-resourced and understaffed. This meant the severe demands of the ensuing pandemic were faced by the existing but understaffed workforce.

The shortage of health care workers has meant these existing staff have been continually pushed to their limits and beyond. And throughout the pandemic these health care workers have been physically, mentally, and emotionally challenged. Staff have been working with little or no respite in challenging conditions while facing ever increasing pressures.

The Health and Social Care Committee report “Workforce burnout and resilience in the NHS and social care” cites data from NHS Providers that show 92% of trusts raised “concerns about staff wellbeing, stress and burnout following the pandemic”.

A study published in January 2021 found that nearly half of frontline doctors, including those working in Emergency Medicine, suffered psychological distress during the first wave of the pandemic with others suffering from trauma, PTSD and other psychological conditions.

A study from 2019 found that working as an emergency physician is one of the most fatiguing and stress-inducing professions, a result of regularly working shifts longer than 12-hours, struggling to find work-life balance, and burnout. This was recorded prior to the pandemic, during which the pressures on Emergency Medicine staff significantly increased.

Dr John Heyworth, Consultant in Emergency Medicine in Southampton and Chair of RCEM Fundraising, said: “We know that many Emergency Medicine staff are exhausted and facing burnout.

“After 15 months of this pandemic, with waves of Covid causing intense pressures on our overstretched emergency departments, and now a return to high pre-pandemic levels of hospital activity, added to the stress of the threat of a further wave of covid – this is not surprising. But it is deeply worrying.

“We must do all we can to protect and support our frontline Emergency Department staff. Their hard work and dedication throughout this extremely challenging time has been incredible. As ever, they have been on the frontline throughout the pandemic risking their personal health and dedicating themselves to the care of others.

“The public have shown their remarkable support and respect for the health service. And now, we want to appeal to them to support our A&E staff who work 24/7 in Emergency Departments, ready to treat anyone who seeks care.

“When we know that our Emergency Medicine workforce is struggling with exhaustion, burnout, stress and other psychological conditions then we must take action, and they deserve our support.

“RCEM’s Public Mental Health and Wellbeing Appeal aims to raise money to develop and expand the support services offered to A&E staff who may be struggling with mental health conditions including PTSD, stress, burnout and exhaustion.

“The support offered will be guided and dictated by what A&E staff need most so that we can help them in the best way possible.

“RCEM’s goal is to ensure the services and support provided have a positive and lasting impact on the mental health and wellbeing of our frontline A&E workers.”

RCEM Appeal:

 https://www.rcem.ac.uk/RCEM/Get_Involved/Wellbeing_Appeal.aspx

Donate here:

http://www.rcem.ac.uk/RCEM/Get_Involved/Sign_in_for_donations.aspx?f=SPRW

Prepare Emergency Departments now for the next phase of challenges, says RCEM Scotland

The latest data released today by the Scottish Government for March 2021 show that attendances at Emergency Departments are beginning to return to pre-pandemic levels.

In March 2021 there were 90,833 attendances to major Emergency Departments across Scotland. This is a 30% increase compared to February 2021 and a 7% increase when compared to March 2020.

Despite this increase, 87.5% of attendances to major Emergency Departments in Scotland were seen within 4 hours, meaning one in eight patients are waiting for four hours or more before being seen. Although, this represents an increase of 1.6 percentage points compared to February 2021.

In March 2021, 315 patients spent 12 hours or more in an Emergency Department, this is down by one third compared to February 2021 and down by over one quarter compared to March 2020.

Data also show that 1,358 patients spent eight hours or more in a major Emergency Department, this is down by over 22% compared to the previous month and down six percentage points on the previous year.

Dr John Thomson, Vice President of the Royal College of Emergency Medicine, said: “We are beginning to reach pre-pandemic levels of hospital activity and demand for urgent and emergency care services. We fear a return of the pre-pandemic crowding that put patient safety at risk.

“The health service is in recovery, elective care waiting lists are growing, attendances at Emergency Departments are increasing, and the already depleted workforce is exhausted.

“As a result, some hospitals are beginning to face pressures with patients delayed for hours. We must rapidly assess and address our resources, capacity, and the way we deliver care.

“The College launched its campaign Summer to Recover: Winter Proofing the Urgent and Emergency Care system for 2021 which presents a series of actions the Scottish Government, NHS Boards and ED Leadership Teams can take to prepare their departments for the challenges ahead.

“There are threats of a further wave of covid in the late summer and a potentially gruelling winter with seasonal flu in the community. We saw how the NHS in Scotland was underprepared and under-resourced for the pandemic and the brutal winter which followed, now we have a chance to learn and do what we can to ready ourselves for the next phase.

“Staff are exhausted after a difficult year and are facing new challenges on every front, by preparing now and ensuring that departments are ready for this next phase, we may be able to manage demand and cope with system pressures.”

RCEM: To prevent another crippling winter, we must use the summer to prepare our hospitals and Emergency Departments

The Royal College of Emergency Medicine has launched a new campaign Summer to Recover: Winter-Proofing Urgent and Emergency Care for 2021.

The campaign outlines a series of important actions, recommendations, and guidance that four-nation Governments, NHS bodies, NHS Trusts and Boards, and Emergency Department Leadership Teams can take to ‘winter-proof’ the Urgent and Emergency Care system.

The campaign comes following the intense pressures faced by hospitals and Emergency Departments across the UK as a result of the pandemic and the gruelling winter the health service has just experienced.

Dr Katherine Henderson, President of the Royal College of Emergency Medicine, said: “This year has been like no other for health care workers and Emergency Medicine staff. We have all had to adapt quickly to face the intense pressures of the pandemic and in many ways, we have changed the way we deliver care.

“Every winter our hospitals near capacity, our Emergency Departments become crowded, and staff are stretched thinly, sometimes having to administer care in corridors.

“This winter, with the severely high-risk of covid, patient safety was at the forefront of our minds. We could not have crowded Emergency Departments and we could not allow for corridor care. Prevention of hospital acquired infection, enforcing strict infection prevention control measures and social distancing were vital tools to keeping our patients and staff safe.

“Winter saw intense pressures in our Emergency Departments: the ambulances waiting to admit patients into hospital were pictured and widely reported; there were long-delays for some patients in Emergency Departments; staff severely struggled to move patients through the system; and there were huge issues with capacity. It was incredibly tough for staff and patients alike and for many, it will be unforgettable.

“Now, we are seeing a return of our community patients and demand for urgent and emergency care services is beginning to increase, as we return to ‘normal’ we cannot allow our old practices to make a comeback. Crowding and corridor care presented a huge challenge to staff and put patient safety at risk.

“We currently have an opportunity to transform the urgent and emergency care pathway. So, we are launching a new campaign, Summer to Recover: Winter-proofing Urgent and Emergency Care for 2021 outlines a series of recommendations the College is making to the four-nation Governments and NHS bodies, to NHS Trusts and Boards, and to ED Leadership Teams.

“We know there is a challenge ahead with tackling the backlog of elective care, but we must use the time we have and use the Summer to Recover and prepare our hospitals and staff for Winter 2021.

“NHS England 2021/22 priorities and operational planning guidance for the year ahead, together with the recommendations outlined in the consultation on the clinical review of standards are welcome and are aligned with the College’s own recommendations in our new campaign.

“The implementation of the metrics proposed in the consultation on the Clinical Review of Standards, particularly measuring 12-hours from arrival, are welcome and will help identify areas of improvement quicker, but without the ability to resolve these issues with adequate capacity, resources, staff or alternative care there will be little we can do in the Emergency Department.

“Expanding capacity, ensuring there is adequate alternative care that patients have access to, and working with local health systems, are all tools that will be crucial to ensuring our Emergency Departments are not crowded again.

“We have said it before; we must not let Emergency Departments become the safety-net of the system. What happens in the Emergency Department ripples throughout the hospital and the health and social care network. We must work together to prevent crowding, to maximise the safety of our patients and to reduce long and high-risk delays.

“Next Winter may seem like a long way off but to prevent another crippling winter, like the one we have just experienced, we must learn, and recognise the shortages and lack of preparation we faced and absolutely guarantee that this winter, we are ready, and we are prepared.”

As patient demand increases we must be ready for a new phase of challenges, says RCEM

The latest data from RCEM’s Winter Flow Project show that increasing numbers of patients are beginning to return to EDs, with 71,722 attendances recorded in the third week of March – exceeding the previous highest total set in week one of the Project in October 2020.

Throughout the pandemic demand at Emergency Departments (EDs) has been significantly lower than previous years. Lockdowns have also meant that the public were at less risk of accidents that might require attendance at an ED, while the use of masks and increased hygiene practices minimised the spread of other seasonal illnesses, such as flu.

Now as attendances have risen 12-hour stays have also increased once again. However, as a proportion, 12-hour stays remain low suggesting that the rise in attendances has not led to an increase in very long waits as yet.

Even as patients begin to attend EDs in larger numbers, the level of available beds continues to be largely static, partly due to the practical difficulties of opening additional beds while maintaining infection prevention protocols.

Commenting on RCEM’s latest Winter Flow Project report Vice President of the Royal College of Emergency Medicine, Dr Adrian Boyle, said: “While the NHS is manifestly in need of a recovery period, there are already indications that there may be little respite. We expect hospital activity to increase in the coming weeks and months as NHS services return to normal.

“Despite the ongoing success of the vaccine rollout, we know that we are not out of this yet. One trust has forecasted that June could see a surge in Covid patients on a par with the April 2020 peak.

“We are worried about this prospect and we are worried about potential variants coming into the country and spreading through the community. We would like everyone to continue to follow the rules and not become complacent. Unfortunately, without any time to recover and rest, NHS staff must once again be ready to face this if it comes.

“The College has consistently outlined the need for more staff, more beds and more resourcing for EDs, all of which may be needed as never before as Emergency Departments potentially attempt to juggle another wave of covid in addition to returning NHS services and activity to normal, all while maintaining proper infection prevention control measures.

“EDs have proved astoundingly resilient but that resilience will be stretched incredibly thin unless they receive the support they will undoubtedly need in the next few months.

“That being said NHS England’s operational planning guidance is most welcome. This outlines the top priorities for the year ahead and includes sufficient focus on the urgent and emergency care pathway. We particularly welcome the plans to expand capacity, introduce the collection of new data and ensure expansion of alternative care including SDEC and NHS 111.

“We have no doubt that we are once again facing an incredibly challenging phase, but NHS England’s latest guidance will be a welcome relief to many healthcare workers.”

England’s A&E doctors urge public to stay safe ahead of ‘Super Saturday’

Ahead of what is being dubbed ‘Super Saturday’ – when bars, pubs and restaurants reopen in England – The Royal College of Emergency Medicine is urging the public to act sensibly to not risk overwhelming A&Es.

Scots, of course, must wait a wee while longer for the hospitality industry to fully open but there are widespread concerns that tomorrow could see irresponsible behaviour put the UK’s gradual recovery from the coronavirus crisis in jeopardy.

President of the Royal College of Emergency Medicine, Dr Katherine Henderson said: “To many Saturday will come as a welcome release from an unprecedented nationwide lockdown and it is understandable that people want to let off steam.

“But we urge the public to be careful and use common sense. The NHS has coped admirably during this period, but staff are exhausted, and the system is very fragile. After seeing all of the goodwill, all of the clapping for the NHS, it would be heartbreaking to see A&Es overwhelmed on the first post-lockdown evening by people who have gotten too drunk or been in a fight.

“If you go to A&E because you’re plastered, you end up stretching the health service further and potentially put others at risk. Not only do you risk accidentally infecting someone with coronavirus because you don’t know you have it, but you are taking up the time of doctors who could be treating patients whose lives are in danger.

“It has never been more important that our Emergency Departments are for absolute emergencies only, and it has never been more important that people drink responsibly.

“While social distancing measures may have been relaxed, the threat of coronavirus has not gone away; it is still very real, it is still very dangerous.

“We need the public to help; act responsibly, drink responsibly and do maintain social distancing. It is also really important that people choose the care service that is most appropriate for their needs. If it is not an emergency, call 111, see a pharmacist, book a GP appointment. If you are seriously injured or sick, go to your A&E – you will be treated.

“We cannot go back to a pre-covid world where everyone turns up at a crowded A&E for treatment. We need patients to choose wisely and we need proper provision of alternative care services. Without both, A&Es risk becoming hubs of infection and we will end up back at square one.”

Prime Minister Boris Johnson will make an appeal to the public to stick to guidelines at a press conference later today. Whether the public will listen or not we’ll find out tomorrow.

WHAT COULD POSSIBLY GO WRONG? Private Eye’s view …