19THE ROYAL COLLEGE OF EMERGENCY MEDICINE |
BEST PRACTICE REPRESENTATIVE 2019
is to stabilise patients quickly and
then transfer them into the hospital
wards. Due to the fact that hospitals
are operating at close to full capacity,
whereas guidance from the National
Audit Office states that 85 per cent
bed capacity is the maximum, queues
form and emergency departments
often have to hold patients on trolleys,
providing “corridor medicine”. This
is known as “exit block”, where the
exit from the emergency department
is blocked due to inadequate hospital
bed capacity. There is pressure across
the system, and insufficient social care
capacity slows down the release of
patients from hospital, which only adds
to this pressure.
To try to combat this, we are
working with the NHS to expand
the workforce. It takes time to train
emergency physicians and advanced
care practitioners, but that work is
underway. It will actually be paid for by
savings from the spending on locum
or temporary staffing. The pressure
will remain while that training takes
place, but the funding settlement on
the NHS will start to help in 2019.
To make further progress to improve
patient flow through the system, we
are calling for an increase in acute
beds by 5,000 and more resources for
social care.
Protecting the four-hour
standard
We are concerned that the relentless
pressure on the system might
cause some to question whether to
abandon the four-hour standard.
Our view is clear: patient care must
be maintained, and the system must
focus on the quality of that care.
Emergency physicians remember the
very difficult situation that preceded
the introduction of this standard, when
public opinion was of the view that
the queues of patients in emergency
departments were unacceptable. We
do not want to see a return to that.
There are opportunities to do more to
develop ambulatory care, create more
medical assessment units and help
patients to better understand where
best to attend. In recent years, the
development of major trauma centres
has had a beneficial effect.
My views chime with those set out in
our document
Making the Case for
the Four-Hour Standard
, which argues:
“The Royal College of Emergency
Medicine takes the view that it would
be a mistake to conclude that a high
degree of compliance with the four-
hour standard is not possible. On
the contrary, the available evidence
suggests that with the right level
of investment, these targets remain
valid practical objectives that improve
patient care”.
I trust that in the search to be let off
the hook, decision-makers at the top
of the NHS and government don’t give
up on a measure that studies have
shown reduces patient mortality.
Our view is
clear: patient
care must be
maintained, and
the system must
focus on the
quality of that
care
“
“
Those who are seriously
ill or injured and need
hospital beds are the
main concern
Rt Hon The Lord David Blunkett
Rt Hon The Lord Eric Pickles
