Crisis mitigation plan needs political will

“NHS England‘s crisis mitigation plan can only succeed if there is political will to tackle the crisis….” RCEM says

Responding to NHS England’s letter ‘Next steps in increasing capacity and operational resilience in urgent and emergency care ahead of winter’, Dr Adrian Boyle, Vice President of the Royal College of Emergency Medicine said:

“We are pleased to see NHS England recognise the significant pressure that Urgent and Emergency Care is under and welcome the planning for winter, which we know will bring further severe pressures on a system already in crisis.

“It is right for NHS England to focus on discharge, reducing bed occupancy, increasing capacity (where safely possible) and boosting the directory of services. Achieving flow throughout the hospital, by ensuring the timely discharge of patients, is the single most important factor for reducing dangerously long waiting times for patients.

“Emergency Departments have long been stuck in a performance vacuum as targets shifted away from the four-hour standard and began to move towards the basket of measures in Clinically-led Review of Standards which remains on hold. We are pleased NHS England confirm that ‘current standards remain for Emergency Department performance and flow’ and so we urge all Trusts and Emergency Departments to renew their focus on working towards the 95% target for four-hour performance. While this will be a serious challenge, it is especially critical given July’s performance figures published yesterday showed the lowest ever four-hour performance on record at 57% and the highest number of 12-hour DTA waits reaching nearly 30,000.

“We must exit the performance vacuum and continue working towards improving performance thereby improving patient care. However, we stand by our position that the 12-hour data measured from decision to admit to admission is highly misleading and we continue to urge NHS England to regularly publish the 12-hour data measured from time of arrival. As a matter of transparency and honesty, it is crucial to see this data ahead of winter so we can begin to see the crisis in its full scale and tackle it fully.

“We are pleased to see a renewed focus on opening more beds, but NHS England do not go far enough. From our own research, we know that we need at least 13,000 beds across the UK to drive meaningful change and to operate at safe levels. We understand NHS England are constrained by the lack of staff and recognise how difficult achieving 7,000 beds alone will be. Similarly, virtual wards could only be effective with adequate staffing numbers to monitor them. Given how thinly existing staff are spread in their own Emergency Departments and with NHS England’s ambition to open 7,000 extra beds – that also need to be staffed – virtual wards are wishful thinking.

“NHS 111 can also be an effective service but only with greater clinical input, recruiting non-clinical staff to answer calls will not improve the service or help. We also argue that the focus should not be on demand management but on discharge from and flow through the hospital.

“We recognise the constraints that NHS England operate under, this is by no means a recovery plan; it is a crisis mitigation plan. We welcome the measures that NHS England propose, but argue they do not go far enough. Nonetheless, neither what NHS England propose nor what we argue they should propose are possible by any stretch without the political will from the government, the leadership candidates and the Department for Health and Social Care.

“Ultimately, this government have so far failed to deliver the fully funded long-term workforce plan they pledged to deliver, and they have failed to meaningfully tackle the crisis in social care – these are the constraints that NHS England operate under which fall upon our hard working and dedicated NHS health workers who are now expected to do more with less in the worst crisis the NHS has ever faced. Without the political will to address the staffing crisis by recruiting more staff and retaining existing staff, and tackle the social care crisis by bolstering the social care workforce – this winter the Urgent and Emergency Care system will once again be on its knees on the verge of collapse.”