The NHS Confederation has just published a report entitled 'Emergency Care – an accident waiting to happen?' which appears to be another good step forward in identifying points of failure – particularly within the emergency care framework. The confederation represents all organisations commissioning and providing NHS services and part of its role is to improve standards of care and input into healthcare policy.
The report is based on surveys carried out across the NHS and analysis of national data and looks at the reality of the issues faced by providers of emergency care services. The report noted that in the last 10 years the number of emergency admissions has risen by 51%. Clearly, this in itself gives a sense of the scale of the resourcing issues.
However, the key thing that has come out of the report is the issue that our ageing population is presenting within the context of emergency care. In the last four years, the rise in admissions within the 85+ age group was 26%. Those responding to the survey were consistent in their view that the biggest cause of pressures on local A&E services is the rising number of frail older people with multiple long term conditions. They further highlighted that the issue is not just about providing emergency care but the great difficulties with discharging patients with ongoing needs to suitable care outside hospital.
Another issue highlighted by the responses was lack of available consultant input on a 24 hour basis. This leads to delays in assessing patients and/or patients being kept in hospital in situations where a more senior doctor would have been confident to discharge them. It is clear from the report that the lack of clinicians generally practising in emergency medicine is having a significant impact on the ability of emergency units to cope with the ever-increasing flow of patients.
The report recognises the current negative publicity about the NHS and how this has been focused to some degree on emergency care. It makes the point that what is really needed is action to improve emergency care rather than a focus on the failings. Much emphasis is put on the fact that, when out of hours services are not available, A&E becomes the default option and this is what needs addressing.
The timing of this report has particular significance given that there is hugely increased demand on A&E services during the winter months and it is clear that many hospitals and trusts have serious concerns about their ability to cope.
It is also clear that there are significant concerns ‘on the ground’ with many of those interviewed believing that the increased pressure will lead to over-worked staff and, in turn, more mistakes. From a patient safety point of view, greater delays and less time available to assess patients may also lead to compromised patient outcomes.
The report makes a number of recommendations regarding solutions and highlights that simply putting additional funding into A&E care (the recent £500 million announced by the government) is not enough. The good points that come out are:
Most of all, the members of the confederation who were interviewed stressed the need to educate the public about what emergency care is and is not for, how they can best access differing types of care and what really does constitute an emergency.
Philippa Luscombe, partner in the clinical negligence team at Penningtons Solicitors LLP, commented: “The recent Keogh report made good progress with identifying key causes of failures and patient safety issues and it is good to see further work being done on this. This report is a very balanced report and gives an insight into the experience of those on the ground. It doesn’t shy away from highlighting problems and failures but comes up with good recommendations for improvements.
“We see increasing numbers of claims against hospitals arising from emergency care where many are based on delays or failures to properly assess patients. We agree with the conclusions of the report that without action patient safety will deteriorate further. However, it is very clear that issues regarding out of hours and social and community care need to be addressed and will be the single biggest thing that could be done to improve emergency care.
“The points made, however, about public awareness and the need to educate the public to help them to use resources correctly and not just get them focused on problems is a very interesting and valid point. We hope that this report receives careful consideration and prompts further action in accordance with its recommendations.”