The emergency crisis was predictable- and partly preventable

The winter crisis experienced across the country was by no means inevitable say two consultant emergency physicians. They explain that in actuality this  winter phenomenon has been building steadily for years as a result of a toxic combination of increasing demand, full hospitals, and inadequate social care capacity which has created a perfect storm centred on under-resourced emergency departments.

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This situation was entirely predictable and partly preventable.  The current difficulties are because of inadequate acute bed  capacity and coordination in hospitals, which in turn is caused  by insufficient social care capacity. This has been made more difficult because of medical, nursing, and other staff shortages,
resulting from the abject failure in NHS workforce planning. There are particular problems in emergency medicine, acute medicine, and geriatric medicine. (BMJ)

The full piece is available for Athens users via the BMJ 

Full reference: Boyle, A. & Higginson, I.| The emergency crisis was predictable- and partly preventable|BMJ | 2018 |360|k64

 

 

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Waiting times in A&E departments

Waiting times in accident and emergency (A&E) departments are a key measure of how the NHS is performing. In recent years, patients have been waiting longer in A&E; this article from the Kings Fund explores the reasons behind this.

The article reports that not only are more people are attending A&E departments each year, but A&E waiting times have also increased substantially over recent years. The NHS has not met the standard at national level in any year since 2013/14, and the standard has been missed in every month since July 2015.

At the same time, longstanding staffing issues and continued reductions in the number of hospital beds have made it more difficult for A&E departments to admit patients.

Full article: What’s going on with A&E waiting times?

Addressing ambulance handover delays

NHS England has written to ambulance trusts setting out actions that need to be embedded as part of normal working practice, and actions to be taken should ambulances begin to queue.

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 ‘Addressing ambulance handover delays: Actions for Local A&E Delivery Boards’ sets out the main points from recent guidance documents, and separates them into actions to be embedded as part of normal working practice, and actions to be taken should ambulances begin to queue.

There are 4 key principles:

  • The patients in the urgent care pathway who are at highest risk of preventable harm are those for whom a high priority 999 emergency call has been received, but no ambulance resource is available for dispatch.
  • Acute Trusts must always accept handover of patients within 15 minutes of an ambulance arriving at the ED or other urgent admission facility (e.g. medical/surgical assessment units, ambulatory care etc.)
  • Leaving patients waiting in ambulances or in a corridor supervised by ambulance personnel is inappropriate.
  • The patient is the responsibility of the ED from the moment that the ambulance arrives outside the ED department, regardless of the exact location of the patient.

Full document:  ‘Addressing ambulance handover delays: Actions for Local A&E Delivery Boards’

A&E waiting times: £360m needed to meet targets

Winter is coming. How much would it cost to keep the pressure down? | The Health Foundation | Story via OnMedica

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New analysis from the Health Foundation suggests that this winter could see the worst performance against the NHS four-hour A&E target since records began in 2004-5.

The analysis uses projected trends in A&E attendances, the number of people waiting over four hours at A&E, and the number of those needing admission but waiting over four hours for a bed. The projections suggest that around 735,000 people will wait longer than four hours in the last quarter of 2017-18 (January – March), equal to a 311% increase on winter 2010-11.

The NHS aims to admit, discharge, or transfer 95% of people within four hours of arriving at A&E. But in a worsening financial climate, hospitals are now struggling to meet this target all year round, not just in winter.

Full analysis: The Health Foundation:  Winter is coming. How much would it cost to keep the pressure down?

See also: OnMedica:  Millions needed to shore up NHS this winter, says think tank

 

Winter pressure in A&E: response to Health Select Committee

The government’s response to the House of Commons Health Select Committee report on winter pressure in accident and emergency departments.

This report responds to each of the 27 conclusions and recommendations in the Health Select Committee’s report, Winter Pressure in A&E Departments . It highlights how the NHS prepares for winter, as part of its year-round operational resilience planning, to ensure the health and social care system in England is fully prepared for the increased pressures at that time of year.

Full document: Government Response to Health Select Committee Report on Winter Pressure in Accident and Emergency Departments

Emergency departments under pressure

The Institute of Health Care Management has published The Winter’s Tale: leadership lessons from emergency departments under pressure.

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Image source: ihm.org.uk/

The report focuses on the processes and behaviours of the emergency teams that are managing to deliver outstanding results despite the ever increasing challenges.

This report highlights the importance of using data to identify and shape solutions to the pressures in emergency departments.  It identifies key lessons for managers working in or with emergency departments.

The full report can be read online here.

Sicker patients the main reason for A&E winter pressures

Sicker patients with more complex conditions are the main reason for worsening performance in A&E departments, according to The King’s Fund’s latest quarterly monitoring report.

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Eighty per cent of NHS finance directors who responded to the latest Kings Fund survey identified higher numbers of patients with severe illnesses and complex health needs as a key reason for the pressures on A&E units, while 70 per cent cited delays in discharging patients from hospital. In contrast, only 27 per cent pointed to poor access to GPs and 20 per cent identified shortages of clinical staff as key factors.

The survey also highlights the effort made by the NHS to prepare for increased pressure on services during the winter. More than 70 per cent of the trusts surveyed increased their staff, while 80 per cent of clinical commissioning groups (CCGs) paid for extra resources in primary care. Other common measures included postponing planned treatment, paying private companies to take on NHS work, and paying higher rates to recruit more agency staff.

Read the full report here