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BMA warns of ‘toxic overcrowding’ in A&E departments

Real danger of collapse in some emergency departments, says letter

Adrian O'Dowd

Thursday, 23 May 2013

Some emergency departments are heading towards collapse and urgent steps must be taken to prevent them from failing, doctors’ leaders have warned.

The BMA has raised new concerns following a letter copied to the association showing the extent of problems in one part of the country.

The letter sent by service leads in the West Midlands, including those at Mid Staffordshire NHS Foundation Trust – the subject of a highly critical inquiry into care standards – said the region’s emergency departments were now in a “state of crisis” as a result of “toxic overcrowding” which had become the norm.

The letter’s authors – chief executives of acute NHS trusts and heads of CCGs in the West Midlands – said they could “no longer guarantee the provision of safe and high-quality medical and nursing care in our [emergency departments]”.

They warned that the workload of emergency departments was causing “institutional exhaustion” among staff who were carrying a huge burden of clinical risk.

“There is toxic [emergency department] overcrowding, the likes of which we have never seen before,” said the letter.

“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 authors said their trusts were seeing unsurprising increases in serious clinical incidents and complaints, and added: “For every incident reported, we know there are multiple examples of substandard care that go under the radar.”

BMA council chair Dr Mark Porter urged the government to tackle the problem, saying: “[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.

“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.”

The BMA said there was growing evidence of pressure on the health service, including both emergency care and general practice and the government should stop trying to blame GPs for these problems which had complex and interconnected causes.

Possible reasons for increased pressure included reductions in bed numbers, staff shortages in key departments, and the impact of NHS 111’s roll-out across England.

BMA GPs committee chair Dr Laurence Buckman said GPs were struggling to cope with rising patient demand and what he called a “proliferation of box-ticking” at a time of reduced funding for general practice.

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.”

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