Saturday, 19 March 2016
Exclusive: Britain's most senior A&E doctor says a crisis in casualty departments is escalating rapidly, with risks to safety amid desperate shortages of medics.
Casualty departments are on the brink of collapse and hundreds of doctors should be drafted from other duties to avert an immediate crisis, Britain’s most senior Accident & Emergency doctor has said.
Dr Cliff Mann said hospitals across the country were being overwhelmed by "unprecedented" levels of pressure and overcrowding amid desperate shortages of medics.
At several NHS trusts, more than half of A&E shifts for doctors have gone unfilled since a cap on spending on locum medics was introduced, the President of the College of Emergency Medicine said.
In an extraordinary intervention, he urged health officials to now divert hundreds of doctors from other hospital duties to get “all hands on deck” and ensure casualty departments could operate safely.
In a letter to The Telegraph, Dr Mann said overcrowding in A&Es had reached “unacceptable” levels as he called for urgent “exceptional measures” in order to protect the public.
Dr Mann said hospitals been under extreme strain despite a mild winter, but that the situation was rapidly escalating.
He told this newspaper: “The pressures have become unrelenting. In recent days I’ve been contacted by a number of senior doctors, medical directors, high-level people, who are saying the situation now is like nothing they’ve seen before.
“One medical director was describing scenes at 4am, endlessly firefighting, trying to keep people alive in corridors.”
“My own hospital had the busiest day I had ever experienced two weeks ago – these are situations where every time you turn round, there are another four ambulances queueing.”
He said A&E doctors were doing their best, but could not guarantee safety in such circumstances.
“We are not delivering best care and on some occasions we are not delivering safe care,” he warned.
The senior doctor, who works as a consultant in Taunton, said medics should now be drafted from every department which could spare them, to prop up A&Es.
“At the moment we just have to deal with this sheer volume of patients, the pressures are overwhelming,” he said. “We just need more hands on deck to cope.”
Rising demand from a growing and ageing population amid shortages of A&E doctors meant hospitals had been under severe pressure for some time.
But new rules limiting pay for agency workers meant many hospitals were now unable to find locums, pushing units closer to the edge, he said.
Limits were first set in November, dropping again in February.
Dr Mann said the latest restrictions have left NHS trusts struggling to find temporary doctors who will accept the rates, leaving vacancies or forcing trusts to breach the rules.
They will drop again in a fortnight.
Dr Mann said: “Since locum caps came in we are seeing data from a number of trusts – in Barnsley, Leeds, Bolton, Plymouth and London which shows 50 and 60 per cent of shifts going unfilled.”
Just one quarter of new A&E consultants posts were filled this year, he said, and there is a shortage of 450 trainee doctors.
“People aren’t choosing it and those who did are increasingly walking away,” he said. “They can’t sustain 30 year careers with this level of intensity.”
NHS England has refused to publish weekly data on casualty waiting times this winter – in a move which was heavily criticised.
However, the College’s own audit of 40 casualty departments suggests performance against an NHS target to treat 95 per cent of patients in four hours has reached a record low.
Just 82 per cent of A&E patients were treated in four hours in the first week of March, the new figures show, a fall from 89 per cent in December.
“We have been stretching an elastic band – it has now snapped,” the college warned in a briefing paper today.
A Department of Health spokesman said: "The NHS is coping well in the face of exceptional demand and compared to January last year saw 111,000 more people in A&E within four hours. We are committed to delivering a safer seven day NHS which is why we have invested £10bn to fund the NHS's own plan to transform services in the future.”
A spokesperson for NHS England said: “A&E visits are up sharply since Christmas but fortunately the number of A&E trolley waits is down compared with last winter.
"In fact fewer hospitals have reported serious operational issues, but winter has bitten later this year and following renewed pressures in January and February, detailed plans are being put in place for Easter to ensure good service availability over the four day bank holiday. In the face of these challenges it is a credit to all those working in emergency care that we are still admitting, treating and discharging almost nine out of ten patients within four hours”.
By Laura Donnelly, Health Editor
10:00PM GMT 18 Mar 2016
The NHS Bill has too much support from patients and doctors to be defeated by a few Tory filibusters. It will be back.
Image: NHS Bill supporters outside parliament. Image: NHS Bill Now.
Last Friday saw a fantastic day of action in support of the NHS Bill. Campaigners should be proud. Tens of thousands of people contacted their MPs to make sure the NHS Bill was across their desks. We saw demonstrations up and down the country in support. At a rally outside the Commons, speaker after speaker got up to say what a public NHS means to them. Toots of support from taxis, lorries, cyclists and cars didn’t stop.
I only wish the activities inside Parliament could have matched that spirit. A tiny group of clown-like backbench Tory MPs deliberately prevented the NHS Bill from being debated. For four and a half hours, they bored on about a crass two clause Bill (brilliantly criticised here), that they’d picked off a shelf to stop any real debates going forward.
As a result, the NHS Bill received only 17 minutes of debate.
There was good support in the Chamber from both the SNP and some individual Labour backbenchers, including Rachael Maskell, Valerie Vaz, Liz McInnes, Andrew Smith, Jim Cunningham and others who made their support clear. However, we needed far more Labour backbenchers to join them if were we to have any chance of putting a ‘closure motion’ to stop the filibustering jokers on the opposite benches.
Getting 100 MPs to cancel long-standing constituency engagements on a Friday in the face of Tory fools isn’t easy, and whilst it was very frustrating that we didn’t get the numbers on Friday, I believe we can mobilise that support in the future. There is huge and growing support for the Bill to keep our NHS public. The Bill’s backers include the BMA, Unite, (with 100,000 members in the NHS), the President of the Royal College of Paediatrics and Child Health, as well as great activists like Harry Leslie Smith, a raft of famous faces and many, many local NHS campaigners. The response on social media on Friday was enormous.
And we have made some progress with the Shadow Health team. As a result of Friday’s day of action in support of the Bill, the Official Opposition has now said, they are “supportive of the overall objectives of the Bill” but have concerns about reorganisation and would amend the Bill. This represents progress, albeit with a worryingly vague caveat.
It is absolutely right to ask whether the Bill would represent yet another top down reorganisation that NHS staff simply cannot take. The answer is that this is an essential ‘bottom-up’ simplification exercise to restore the NHS as a publicly provided, funded and managed service. Health Boards would be designed by and made up of the very people working in the NHS bodies they would replace. In answering the reorganisation question, it cannot be overstated that the National Health Service in England is being broken up and disorganised on a daily basis. It is being tendered into a mess and the Bill brings back coherence in order to preserve the NHS for the future.
Secondly, Scotland has undergone a similar process with minimal disruption, so we can do the same.
The heart of the NHS Bill is to stop the competition and bring back collaboration; to move on from the internal market, to learn from it and treat it as a failed experiment, and bring back coherence to our NHS. What we can usefully ask now, is whether or not the amendments that the Shadow Health Team have in mind would remove the guts of the Bill. I’m hoping they will meet with me to discuss this.
As for what next, technically the Bill is still live and is scheduled to be debated again on 22 April. As it has 25 bills ahead of it, there is no chance of it being debated on that date, but I have no doubt the Bill will be back after the Queen’s Speech. In the meantime, I will be meeting cross party supporters to discuss next steps, which makes it more vital than ever for campaigners to keep talking to their MPs.
As for the Government, no doubt they were perfectly happy for a handful of their ranks to steal the debate from the public. One way we can prove that this is an issue that the public cares about is to sign this petition against the dullard filibusterers– it has taken off with tens of thousands signing after Friday’s Tory antics. Parliament should be a place for proper debate, not time-wasting tactics. This Bill isn't going away. We will not sit back and let the Tory privateers get away with this vandalism of our Health Service.
CAROLINE LUCAS 16 March 2016
Last December every NHS Trust in London bar one missed their A&E waiting time targets. Our hospitals, run by Imperial College Healthcare Trust, had their worst performance for six months only seeing 88% of patients within four hours.
Still, that’s better than North Middlesex Hospital where an announcement was made over the tannoy telling people to go home unless they were in dire straits, as the A&E department could not cope with the numbers arriving for treatment.
At Charing Cross, there has been a 13% increase in the most serious cases attending A&E.
GPs are being asked to take the pressure off A&E, but are themselves under pressure from cuts in pharmacy budgets. Jeremy Hunt has announced plans to cut funding to community pharmacists by £170 million. I spoke on this issue during a Commons debate..
I also kept up to speed on the junior doctors’ dispute, meeting Johann Malawana, who chairs the BMA committee. Hunt is refusing to negotiate and intending to impose the new contract in August against the wishes of almost the whole medical profession. But public support for the doctors remain strong.
Dr Onkar Sahota AM says west London is suffering some of the worst A&E waiting times due to “under-resourcing, understaffing, and increased workloads”
'Recent and dramatic decline'
NHS Trust 'exceptionally challenged'
New procedures introduced
A source said paramedics had to stand in the corridor with patients for nearly three hours. Handovers are meant to take 15 minutes.
Royal Liverpool Hospital's A&E department showing large queues
Demonstration in response to growing concerns health bosses will shut down paediatrics under a smokescreen of making cuts to improve services.
Check the photos gallery here:
'The delay could be serious or fatal'
GET WEST LONDON
Shadow Chancellor John McDonnell declared his 100% support for the strike as he joined doctors outside Hillingdon Hospital.
Stephen Cowan joins the picket line outside Charing Cross Hospital, in Hammersmith
Two further walkouts planned for April
BMA plans to apply for judicial review over unfaircontract
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