Hospital Dr News

Plan to tackle acute and emergency care crisis

An action plan to help hospitals tackle the increasing pressure on urgent and emergency care services has been drawn up by organisations representing doctors and other healthcare professionals involved in acute care.

Urgent action is needed before the stresses on hospitals and clinicians build up again next winter, said the Royal College of Physicians (RCP), the College of Emergency Medicine, the Society for Acute Medicine (SAM) and the NHS Confederation organisations which worked together to produce the document.

The 10-point plan addresses rising demand and the changing needs of an ageing population, a lack of comprehensive, effective alternatives to hospital admission, complex discharge issues, handover and flow and recruitment into emergency and acute medicine.

Sir Richard Thompson, president of the RCP, said: “These ten priorities are the product of two multidisciplinary conferences held earlier this year, and summarise some of the actions that are urgently needed to help primary and secondary care cope with the rapid changes in health care that derive both from the success of medical treatments and the increasing age and changing nature of the population. Unless some of these actions are carried out quickly, the quality of NHS care will fall.”

Chris Roseveare, president of SAM, said: “The recent pressures on acute services within the NHS have been unprecedented. Urgent action is required if we are going to prevent a further deterioration in the quality of care for patients admitted to hospital in an emergency. Clinicians must continue to work closely with managers, patient representatives and politicians and ensure that these actions are implemented urgently, before the demands inevitably rise again next winter.”

The plan says acute care must:

Develop effective alternatives to hospital admission across seven days.

Adjust financial incentives so that they support effective management of demand for unscheduled care.

Focus on supporting patients to leave hospital seven days a week.

Provide consultant-led hospital services across seven days. A consultant physician should always be available on call and should be present in the acute medical unit for at least 12 hours per day, seven days per week with no concurrent duties except the delivery of care to acute admissions.

Promote greater collaboration within the hospital and beyond to manage emergency patients.

Ensure there is sufficient bed and staffing capacity within the hospital and the wider system to meet changing demand.

Focus on ambulatory emergency care where appropriate.

Develop a sustainable workforce, making sure that emergency and acute medicine remain attractive career options. Job planning must take into consideration the intensity of workload as well as the numbers of hours worked to ensure the long-term sustainability of a consultant career in these acute specialties.

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2 Responses to “Plan to tackle acute and emergency care crisis”

  1. Dr D A Kilroy says:

    These are unarguably good points to make. The real issue however is to bring forward a timeline of actual actions to enact these points in real terms based upon a clearer understanding of the role of the A&E in a health economy. Many if not most organisations are already embedded in work-streams around ambulatory care and the like. Nothing there will ease demand – it is an alternative model of supply. The most pressing immediate need is for health economies, led by CCGs, to pin down the clinical identity of A&E and AMU and strip out what services they will NOT provide, rather than create what can come to be constructs to fluff over this, such as CDUs and ACUs. The risk otherwise is that demand management morphs into alternative access models. The latter will not address the former.

  2. Malcolm Morrison says:

    If the NHS cannot provide proper, adequate care for emergencies, it has failed.

    The causes of the present situation are multi-factorial – cultural, historical, clinical, social, managerial, financial and politcal. All these were compounded by the disasterous ‘111’ call system which appeard to be a ‘tick box, telephone, test’ – with the ‘fall back’ position of ‘if in doubt go to A&E’!

    Unless the clinicians, the managers, the Trusts and the CCGs get together with the Social Services and make this their number one priority, there is bound to be a crisis soon – and people will die. They must also work together to educate the public of what constitutes an ’emergency’ – and so who to call and when.

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