The incompetence that underlies emergency care
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The incompetence that underlies emergency care

Cliff Evans Nurse consultant in emergency medicine, Medway NHS Foundation Trust

Poor political choices have resulted in unprecedented pressure and stress on an overstretched workforce

There is a national emergency in England that is causing harm, indignity and stress to patients and destroying nurses’ morale. Rather than increasing the availability of hospital beds, successive governments have reduced bed numbers and closed emergency departments (EDs), replacing them with efficiency savings and the promise of increasing productivity.

Emergency Nurse. 30, 6, 9-9. doi: 10.7748/en.30.6.9.s3

Published: 01 November 2022

The UK has 2.6 acute beds per 1,000 of population, according to an analysis by think tank the King’s Fund. By comparison, France, Belgium and Poland have double that number and Germany has three times as many. The significant deficit of hospital beds results in patients waiting for a place on a ward, blocking access to cubicles in overcrowded EDs.

In response, EDs overstretch their workforces and are forced to use hospital corridors to lodge patients in an attempt to offload ambulances and prevent delays in time-critical treatment.

Ambulances arriving with acutely unwell patients have to wait outside or activate the national ‘immediate handover’ policy, resulting in undiagnosed, frail and immobile patients experiencing the indignity of being left in a corridor.

The result is unprecedented pressure and stress on an overstretched emergency nursing workforce and harm to patients as treatment is delayed and incidents such as falls increase. These ‘winter pressures’ now continue all year round.

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Ambulances arriving with acutely unwell patients often have to wait outside

Picture credit: Alamy

Before COVID-19, patients were losing faith in the historic GP-led model of healthcare. The inaccessibility of GPs over the past two years has had a significant effect on public behaviour, with disillusioned patients choosing to access healthcare via their local EDs. This behaviour goes against government policy and reflects the failures in community healthcare.

Failure to address recruitment

Unfortunately, it is too late to open essential hospital beds in response to this national emergency. Efficiency savings have seen a failure to address the recruitment, training and retention of an effective healthcare workforce.

‘One solution would be to introduce a clinically led national task force to design and deliver a sustainable workforce model, ensuring nursing becomes an attractive option for people seeking a rewarding career’

If the current situation has not been developed deliberately then the alternative explanation is that utter incompetence has resulted in the national nursing crisis we now see.

One solution would be to introduce a clinically led national task force to design and deliver a sustainable workforce model, ensuring nursing becomes an attractive option for school-leavers and mature individuals seeking a rewarding career.

Maintain patient dignity

Pay and working conditions must reflect respect for the work nurses undertake and maintain the dignity of patients. Last winter my organisation’s senior team endorsed a clinically led plan to improve patient safety. This included opening a unit where patients could await ward transfer to free space in the ED and an escalation process to ensure that if corridors were ever to be used, this would never include undiagnosed patients. This resulted in a 50% reduction in ambulance waits.

Residential care bed capacity must increase, with campaigns to encourage local people to engage their ageing communities.

It is time to take action, not for pay, but in the name of patient safety and protecting our NHS, which remains the envy of many and could, with visionary leadership, grow to be the envy of all.

This is an abridged version of an article at rcni.com/emergency-care-crisis

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