Commenting on the publication of the Health Select Committee’s report, Urgent and emergency services, Dr Patrick Cadigan, registrar of the Royal College of Physicians said:
The RCP welcomes the conclusions and recommendations from the Health Committee regarding urgent and emergency care. RCP’s report Hospitalson the edge? showed that hospitals are experiencing increasing pressures on acute services and length of stay is beginning to raise.[1] This is threatening the quality of patient care. Our evidence to the Committee stated that this can be addressed by early senior review of cases and improved patient flow through the hospital system. We welcome this being reflected in the Committee’s recommendations.
The Health Committee is right to identify care of elderly patents as an area the NHS must prioritise improving. The recommendations regarding improved clinical responsibility for out of hours care, integration across primary, secondary and social care, and high-quality end of life care are also welcome. The RCP also wants to see quality improvement measures for care of the elderly in hospital developed, which will help prevent substandard care, as identified by Robert Francis at Mid Staffordshire NHS Foundation Trust, for example. We are addressing this by piloting a Quality Mark for Elderly Friendly Wards with the Royal College of Psychiatrists.
Finally, the Committee is right to highlight the problem in staffing emergency and acute departments and to conclude the solution is not solely remuneration. Over a quarter of medical registrars have reported an unmanageable workload [2] and the RCP wishes to work with Health Education England to address this.
Bodies who are tasked will resolving these issues must be adequately resourced. The RCP recommended to the Committee that trusts with a single commissioner helps to build a relationship where by new ways of working can be developed that can adequately compensate hospitals for the care they provide and facilitate integrated care.
Until the problems in acute care are addressed, patients will seek care where the lights are on, which are currently overstretched A&E and acute care departments. This threatens the quality of patient care and puts unmanageable pressures on both hospitals and doctors. The RCP is addressing this problem by convening the groundbreaking Future Hospital Commission, which will report on 12 September.
Last week the RCP, in partnership with the NHS Confederation, Society for Acute Medicine and College of Emergency Medicine, set out ten priorities for action to address the challenges faced by urgent and emergency care services.
Access Urgent and emergency care: a prescription for the future.
[1]RCP (2012) Hospitals on the edge? The time for action London www.rcplondon.ac.uk/projects/hospitals-edge-time-action
[2]RCP (2013) Medical registrars: Empowering the unsung heroes of patient care London www.rcplondon.ac.uk/projects/medical-registrar-empowering-unsung-heroes-patient-care
For more information please contact Lisa Cunningham on +44 (0)203 075 1468 / 0799 074 5610 or email lisa.cunnigham@rcplondon.ac.uk