RCEM calls for an increase in staffing

RCEM calls for an increase in staffing after survey finds 3 in 5 A&E staff have experienced burnout: The Royal College of Emergency Medicine is calling for UK governments to act now to achieve safe staffing levels in Emergency Departments after a workforce survey found that three in five Emergency Medicine staff say they have experienced high levels of burnout, stress, and exhaustion.

The survey found:

• 73% of respondents indicated workforce pressures in their Emergency Department impacted patient safety before the pandemic.
• 59% of respondents experienced burnout during the second wave of the pandemic.
• 59% described their levels of stress and exhaustion from having worked the second wave as higher than normal.
• In the next two years, 50% are considering reducing their working hours and 26% are considering taking a career break or sabbatical. When asked what prompted them to make this decision, 32% selected workload pressures and 35% selected burnout.
• In the next six years, trainee emergency physicians are considering reducing working hours (57%), taking a career break or sabbatical (45%), working abroad (36%), and changing specialty (25%).
• 69% of clinical leads revealed that locums were being used in their Emergency Department to fill permanent posts.

Dr Katherine Henderson, President of the Royal College of Emergency Medicine, said:

“The workforce survey reveals the scale of the problem in the Emergency Medicine specialty with burnout and retention of staff. The fact that half of Emergency Medicine staff are considering reducing their hours in the near future and over one quarter are considering taking a career break, is deeply worrying.

“Emergency Medicine has always been an exciting yet challenging career, but the intensity of the pandemic and the current severity of the pressures has exacerbated these challenges vastly and increased burnout and exhaustion among staff, and ultimately discouraged existing staff from continuing their career in the specialty.

“The response from the survey clearly show that operational pressures are seen by staff as the most significant reason for considering reducing hours, changing careers, or retiring early. Therefore, we must make Emergency Medicine a sustainable career and improve staff retention.

“Demand for urgent and emergency care has increased significantly over the past few years, but the workforce has not grown adequately to keep up with this demand. The result has led to an increase in crowding and corridor care, with more delays and more long stays for patients in Emergency Departments, while staff have been spread more and more thinly trying to cope with intense pressures. These factors put huge strains on staff and put patient safety at risk.

“This is not sustainable for staff, and if Emergency Departments must be the safety-net of the system and the place where people go when they have nowhere else to seek treatment, we must be staffed appropriately to deal with that. Our fear is that we are on the brink of a crisis in urgent and emergency care, and fewer staff will be inclined to work in Emergency Medicine and a depleted workforce will be facing higher demand.”

The College is calling for a workforce plan that achieves safe-staffing levels in Emergency Departments; currently the College estimates there is a shortage of between 2000-2500 Emergency Medicine Whole Time Equivalent consultants across the UK.

President of the Royal College of Emergency Medicine, Dr Katherine Henderson continued:

“Governments must acknowledge the data and reports that show Emergency Departments across all four-nations are struggling to cope, struggling with performance, and struggling to deliver quick, effective and high-quality care, and take the necessary action to address it.

“We urgently need decisive action and leadership, we must achieve safe-staffing levels in Emergency Departments across the UK, and this workforce must be formed of staff trained and qualified in Emergency Medicine. We must see a long-term Health and Social Care strategy that recognises the value of urgent and emergency care and enables high-quality care and performance – this should be done by funding Same Day Emergency Care and Ambulatory Emergency Care, through expanding capacity, funding local health systems, and rigorously determining the effectiveness of NHS 111 and maximising its potential – all these steps must be taken to address the problems facing emergency care.

“We hope that the new Health Secretary will hear our urgent calls for decisive leadership and take swift action to address the challenges facing the Urgent and Emergency Care system and enact our recommendations.”

RCEM’s workforce survey was administered from 14 May to 14 June 2021. There was a total of 1039 responses from our membership across the United Kingdom. The survey was conducted online and rolled out through a series of emails sent to members and fellows.

The College has published the following recommendations that will help support the retention of Emergency Department staff and improve patient care:

1. Governments must act now to achieve safe staffing levels in Emergency Departments. At present, there is a shortfall of 2,000-2,500 Whole Time Equivalent consultants in the UK. Expansion of the workforce is needed to ensure patients are treated by staff who are trained in Emergency Medicine. This must also include an accompanying increase in Allied Health Professionals, SAS doctors, Emergency Nurses and the faculty to train them.
2. Across the UK, make funding available to support inpatient teams to enable more effective Urgent and Emergency Care, including Same Day Emergency Care and Ambulatory Emergency Care. These services improve the quality of care and staff morale, are cost effective, and reduce avoidable admission into hospital.
3. Previous long term health strategies are now redundant given the disruption to the healthcare system caused by the pandemic. A new, actionable, long term health and social care strategy is now required in all four nations to enable the delivery of high quality Urgent and Emergency Care.
4. Governments must immediately prepare and manage adequate capacity in order to minimise the harm to patients and staff caused by Emergency Department crowding and exit block. This will reduce the risk of emergency demand derailing the elective recovery and improve the working conditions of staff in Emergency Departments. Ahead of Winter, this must include but is not limited to:
   1. Making funding available to local health systems to maintain or expand discharge to assess services so they are available all year round.
   2. Expanding clinical validation of Phone First services to ensure patients receive care in the best setting based on their needs. These services are only effective if there are adequate levels of clinical involvement.

The Royal College of Emergency Medicine: Retain, Recruit, Recover: Our Call for Action to Improve the Urgent and Emergency Care System