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'It is impossible to deliver more with less funding year on year'

Dr Ian Crawford, Vice President (NI) of the Royal College of Emergency Medicine, says there is a deepening crisis” and this winter we must be prepared for “unprecedented risks” to quality of care and patient safety.

'It is impossible to deliver more with less funding year on year'

In a statement to the Derry News, Dr Ian Crawford, Vice President (Northern Ireland) of the Royal College of Emergency Medicine, paints a bleak picture of the pressures emergency departments are currently under. He says there is a “deepening crisis” and this winter we must be prepared for “unprecedented risks” to quality of care and patient safety. He has pointed to an ageing population, delayed transfer of care, inadequate nurse staffing levels and lack of funding as contributing factors.


“While often seen by many as an ED standard, waiting times such as the ‘4 hour standard’ and the number of patients spending > 12 hours in our EDs are better seen as barometers of the wider health and social care system pressures.
“Over a third of our patients currently spend > 4 hours in our EDs, with 18110 patients spending > 12 hours in our EDs in the 6 months from April - September 2019 - a year on year increase of 101%.
In the last 24 hours alone around 340 patients spent > 12 hours in our EDs.
“The waiting times in our EDs are virtually entirely attributable to factors out with the control of our ED teams.
“Increasing numbers of patients attending our EDs are as a result of our growing and ageing population compounded by failures in other parts of the health and social care system including access to primary care, elective care and palliative care.
“Increasing numbers of patients attending our EDs is accompanied by increasing numbers of patients requiring hospital admission and therefore beds on wards.
“There is a lack of functional capacity in our hospitals as a result of the reduction in the number of hospital beds by around 30% since 2005/06 compounded by the extraordinary number of bed days lost as a result of delayed transfers of care.
“A delayed transfer of care is where a patient is deemed to be medically fit to be discharged from hospital but where this cannot occur due to the lack of availability of social care, such as packages of care to support a patient in returning home, or residential or nursing home places.
“The outrun of this is that bed occupancy is running at (or operationally beyond) 100% across many of our hospital sites in core specialties such as general internal medicine and care of the elderly when the widely accepted standard is 85%.
“Consequently, there is a lack of patient flow through our hospitals and onwards into the community, with the majority of our patients referred for hospital admission spending long periods of time in our EDs awaiting beds onwards.
“When the majority, or all, of the rooms/cubicles in our EDs are occupied by patients awaiting beds on wards then there is physically no appropriate space to assess further patients.
“Furthermore, there are often inadequate nurse staffing levels to safely manage the clinical workload. The numbers/skill mix of nursing staff may be below that required to deliver safe, effective care in a timely manner to our ED patients, let alone to do so concurrently with those patients awaiting beds on wards.
“The lack of appropriate physical space and inadequate nurse staffing levels further impacts on the waiting times for those patients who are not referred for admission.
“As we approach the winter months from our lowest ever baseline we must expect waiting times and the unprecedented risks to quality of care and patient safety to increase further as even more of our patients spend even longer in our even more crowded EDs.
“In practical terms, it is simply impossible for our ED teams to be expected to deliver more with less year on year.
“The Royal College of Emergency Medicine has consistently highlighted the deepening crisis in our EDs over time.
“Seeking to do things differently or more efficiently will not offset the need for corrective investment to increase staffing, the number of acute hospital beds and the social care that are fundamentally required.”

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