Hospital Dr News

Acute hospital care teeters on brink of collapse

Acute hospital services are buckling under the pressure of increasing emergency admissions and the complex needs of an ageing population, warns a new report from the Royal College of Physicians (RCP).

These challenges are being compounded by a looming medical workforce crisis. Three quarters of consultants report being under more pressure than three years ago and over a quarter of medical registrars say they have an unmanageable workload.

The demand on clinical services is increasing to the point where acute care cannot keep pace in its current form says the report Hospitals on the edge? The time for action.

There are a third fewer general and acute beds now than there were 25 years ago but the last decade alone has seen a 37% increase in emergency admissions.

Patients’ needs have also changed. Nearly two thirds (65%) of people admitted to hospital are over 65-years-old and an increasing number are frail or have a diagnosis of dementia. However hospital buildings, services and staff are often not equipped to deal with the people with multiple, complex needs including dementia.

This is having detrimental effects on patient care with continuity of care the main casualty. It is not uncommon for patients, particularly older patients, to be moved four or five times during a hospital stay, often with incomplete notes and no formal handover. Older people are at particular risk as they account for 70% of bed days.

Medical and nursing staff often feel that older patients “shouldn’t be there”. Being perceived as the “wrong patient on the wrong ward” has been shown to reduce the quality of care, building attitudes of resentment from both medical and nursing staff, says the report.

The RCP is also concerned about future medical workforce skills. Recruitment into emergency medicine is becoming increasingly difficult with gaps in training schemes, unfilled consultant posts and increasing reliance on locums. Application rates into training schemes involving general medicine are declining.

In addition fragmentation of acute care services into specialist areas such as stroke, acute myocardial infarction and respiratory failure has removed many consultants from the general medical admitting role. Only one in five consultants report having a formalised acute team in their hospital.

The report says: “It is clear that if we do not act we risk losing the pool of generalist skills so essential to the effective provision of holistic care to patients.”

It is also concerned about the current policy to reduce hospital training numbers and increase GP training numbers. “This may be appropriate if GPs reduce hospital admissions or staff (additional) community-based care facilities.  There is no evidence this is likely to happen,” it says.

The report recommends that clinicians should lead a redesign of acute services which may involve consolidation of hospital services and hospital closures; consultant care should be available seven days a week and out of hours primary care should be more accessible at night and at the weekend to relieve pressure on A&E services.

It also calls for medical education and training to be reviewed to ensure physicians have the right balance of general and specialist skills and that all doctors have the skills and knowledge to care for older patients with complex conditions, frailty and dementia. Emergency and general medicine must remain an attractive career option.

RCP president Sir Richard Thompson said: “One doctor told me that his trust does not function well at night or at the weekend and he is relieved that nothing catastrophic has happened when he arrives at work on Monday morning. This is no way to run a health service. Excellent care must be available to patients at all times of the day and night.”

Dr Chris Roseveare, president of the Society for Acute Medicine, said: “There is increasing evidence that a consultant-led, multi-professional acute medicine team provides better outcomes for patients. It is vital that acute hospitals work to provide this consistently, seven days per week.

“The NHS is being asked to deliver huge financial savings at a time when many hospitals are already buckling under pressure from the rising number of emergency admissions. A coordinated approach is urgently required between hospitals, general practitioners and social care agencies to address the challenges which this report has identified.”

Brush up on your skills at Acute & General Medicine 2012, in London, in November. Click here for the full programme.

Bookmark and Share

2 Responses to “Acute hospital care teeters on brink of collapse”

  1. Malcolm Morrison says:

    These are CLINICAL problems – and they can only be solved by the profession. The care of patients is a CLINICAL matter; and if the ‘configuration of services’ need to be redesigned (as suggested in the recommendations of the report, as in para. 12 above), this must be led by CLINICIANS.

    Clinicians should never allow, knowingly, the proper standards of care of patients to be put in jeopardy.

    If there is a shortage of facilities &/or staff of the appropriate level of responsibility, then emergencies must take precedence – even if a ‘state of emergency’ in the hospital has to be declared which means that all ‘elective’ care has to cease. This might ‘concentrate the minds’ of all concerned!

  2. dpc says:

    one of the reasons for this has got to be the amazing contract the Gp’s negociated for themselves -which has created apartheid in Uk medicine -why , as a trainee would you embark on an intense , anti social hospital career in emergency or acute medicine -when you could become a gp trainee work office hours & recieve a better renumeration ? younger doctors -not suprisingly look at their consultants working unsustainable , anti social hours , look at their pay packets and vote with their feet.
    This situation will not get better until the Gp’s ( the most highly renumerated primary care doctors in the EU ) are paid less and ‘difficult to recruit to posts” have favourable renumeration.If this dosn’t happen -those doctors working in the acute/emergency sector -will ‘burn out” -& patinet care will get worse

Post a Comment

Enter this security code

Submit Comment for Moderation