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Emergency departments veer towards collapse

Doctors leaders have demanded urgent action to address the pressures on emergency departments after revelations of a system on the brink of failure.

emergencyBMA council chair Mark Porter urged the government to tackle the crisis after a letter copied to the association shows an alarming picture of a service veering towards collapse.

The letter sent by service leads in the West Midlands, including those at Mid Staffordshire NHS Foundation Trust, which was the subject of a damning inquiry into emergency care standards, says the region’s emergency departments are now in a ‘state of crisis’ as a result of ‘toxic overcrowding’ which has become the norm.

They say they can ‘no longer guarantee the provision of safe and high-quality medical and nursing care in our [emergency departments]’.

Dr Porter said: ‘[This letter] paints an alarming picture of a system on the brink of failure. The crisis has developed because the increased demand on emergency departments has not been properly addressed.

‘It is telling that doctors working in emergency medicine feel that recent developments, such as the introduction of NHS 111 and the financial penalties for holding ambulance crews, have made the situation worse not better.’

Breaking point

There has been mounting evidence of increasing pressure on the health service, including in both emergency care and general practice.

The BMA has said the government must stop trying to blame GPs for the problems which have complex and interconnected causes, including reductions in bed numbers, staff shortages in key departments, and the impact of NHS 111’s botched roll-out on already over-stretched services.

BMA GPs committee chair Laurence Buckman (pictured below) said GPs were struggling to cope with rising patient demand and a proliferation of box-ticking at a time of reduced funding in general practice.

The issues were set to be debated at the BMA annual local medical committees conference this week, while health secretary Jeremy Hunt was due to announce plans for general practice, including a new chief inspector of primary care.Laurence Buckman

Dr Porter added: ‘The government has done little to address the pressures on emergency departments; indeed by forcing through a pointless reorganisation of the NHS in England it has more than likely made the pressures worse.’

Dr Buckman said: ‘The BMA believes that much can be done to better integrate GP services with out-of-hours care, NHS 111 and emergency hospital services. Clinical commissioning groups have just taken over responsibility for commissioning out-of-hours care and their pivotal role could find a way forward. We hope the government will work with doctors and other healthcare staff to find a solution that helps the NHS tackle these challenges. Recent attacks on hard-working NHS staff and specific services have been neither helpful nor productive.’

'Herculean' workload

The letter from chief executives of acute NHS trusts and heads of CCGs in the West Midlands warns of the ‘Herculean’ workload of emergency departments which has caused ‘institutional exhaustion’ among staff who are carrying a huge burden of clinical risk.

‘There is toxic [emergency department] overcrowding, the likes of which we have never seen before. Nurses and doctors are forced to deliver care in corridors and inappropriate areas within the [emergency department], routinely sacrificing patient privacy and dignity and frequently operating at the absolute margins of clinical safety,’ the letter says.

The service leaders say their trusts are seeing unsurprising increases in serious clinical incidents and complaints, adding: ‘And for every incident reported, we know there are multiple examples of substandard care that go under the radar … The position is such that we can no longer guarantee the provision of safe and high-quality medical and nursing care in our [emergency departments].’

The West Midlands letter also highlights the staffing problems that need addressing saying: ‘The Herculean burden of work, responsibility and clinical risk is so obvious to junior doctors that they are unwilling to join us in the practice of what we once considered the most rewarding areas of clinical medicine, and instead opt for more attractive and sustainable careers.’

It adds: ‘Recruitment is almost impossible, and retention is becoming hugely challenging.’

They accept there is no simple answer to the conundrum but say it cannot be allowed to escalate further and a collaborative approach is needed.

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