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Emergency medicine at the brink of collapse

Doctors and managers call for A&E shake-up

Jo Carlowe

Wednesday, 15 May 2013

Emergency medicine requires a major overhaul if it’s not to collapse.

So worried are they about the future of A&E units in the UK, that both The College of Emergency Medicine and the Foundation Trust Network have produced proposals on how the system should be reorganised.

And Chris Hopson, chief executive of the Foundation Trust Network (FTN) warned today that without changes the system faced a complete failure.

“A&E services have been under huge pressure and although performance is now stabilising, there is a danger the system will fall over in six months’ time unless we plan effectively for next Winter.”

The College meanwhile has stated that emergency care systems in the UK and Ireland are facing their biggest challenge in well over a decade as they aim to cope with “unsustainable workloads and a lack of sufficient numbers of middle grade doctors and Consultants in Emergency Medicine to deliver consistent quality care”.

In its report, The College calls for fundamental change in the way emergency care systems are designed, funded and run.

The report contains ten recommendations across four domains, based upon the results of a comprehensive survey of 131 Emergency Departments (EDs) in the UK between 2011 and 2012.

Included in the recommendations is a call for:

  • a system redesign to manage workloads and decongest the ED
  • expansion and sustainable working practices for staff
  • a radical change to the way in which emergency care is funded
  • a better system to measure the success of improvement rather than 4 hour system performance alone.

The authors state that all parts of the urgent and emergency care system need to participate and radical overhaul to the way work is recognised and funded is needed.

Meanwhile, the Foundation Trust Network said that due to the difficulty patients have in accessing GP appointments and out-of-hours care, up to 30% of people in A&E should not be there.

Moreover, the FTN said the funding system was wrong and left trusts out of pocket.

“The way the NHS pays hospitals for admitted A&E patients is broken,” said chief exec Hopson, “Under current rules, if a hospital admits more A&E patients than it did five years ago, they only get paid 30% of the cost of treating those patients. Two thirds of hospitals are admitting more patients than they did five years ago, some as many as 40% more. This means re-opening wards and employing more staff to cope with this extra demand. Yet hospitals only get paid 30% of these costs. Some are losing more than £5 million a year as a result, on top of the 5% savings they’re already being required to make. This can’t be right.”

NHS England has agreed to redirect some of the money saved through these rules to support struggling A&E units in the short-term. A review, led by medical director Sir Bruce Keogh, is under way to address the issues in the long-term.

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