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West Midlands

Safety not guaranteed at 18 understaffed A&E units in Midlands, warn clinicians in letter


Patient safety at 18 accident and emergency departments in the West Midlands cannot be guaranteed according to a joint letter signed by leading clinicians from across the region.

In the letter, sent to acute hospital chief executives and clinical commissioning groups in the West Midlands, the group of emergency department clinical leads say their departments are in a “state of crisis” which needs to be “urgently addressed.”

They state: “The position is such that we can no longer guarantee the provision of safe and high quality medical and nursing care in our emergency departments.

“It is not a case of standards slipping, but the inevitable consequence of being forced to work in sub-standard conditions. The aforementioned issues have led to us routinely substituting quality care with merely safe care; while this is not acceptable to us, what is entirely unacceptable is the delivery of unsafe care; but this is now the prospect we find ourselves facing on too frequent a basis.”

The letter claims the 18 A&E departments manage more than 1.5 million patient attendances each year, 8.5 per cent of all A&E attendances in England.

It claims all 18 departments have seen “inexorable rises” in year on year attendances, with increasing intensity and an older population with more complex needs.

This adds up to what the letter describes as “toxic overcrowding, the likes of which we have never seen before.”

Nurses and doctors are providing care in corridors with patient privacy and dignity being sacrificed, the letter says, adding staff are “frequently operating at the absolute margins of clinical safety.”

In a stark warning to NHS leaders the letter continues: “Our departments are simply not equipped to safely care for such numbers of patients. All of the available evidence demonstrates that in-hospital mortality is increased when the ED is overcrowded and patients have to wait excessively for beds. Such overcrowding is now the norm in our EDs.”

As a result of the pressure the doctors warn of an “inevitable” increase in serious clinical incidents and complaints, as well as delays and deficiencies in care.

“For every incident reported, we know there are multiple examples of substandard care that go under the radar. We and our staff are carrying a huge burden of clinical risk which no other agency seems willing or able to share.”

The letter also highlights the lack of emergency staff claiming junior doctors are unwilling to join the service due to the “Herculean burden of work, responsibility and clinical risk”.

It warns of “institutional exhaustion” among A&E staff at all levels adding: “recruitment is almost impossible, and retention is becoming hugely challenging.”

They warn that the introduction of the NHS 111 number and penalties for delaying ambulance crews will not be solutions but instead will add to the problems.

“The unilateral and dictatorial manner in which these and other policies have recently been introduced have only served to compound the problems in our departments,” it says.

The letter calls for clinical leads in A&E departments to be involved with changes to the system and A&E reconfigurations.

It concludes: “We call urgently on behalf of our patients and our staff for a radical health economy-wide response to the urgent care needs of the population of the Midlands. We furthermore call for our EDs to be suitably staffed and supported whilst under such pressure and while longer term solutions are put in place.”

The trusts and hospitals represented in the letter are:

  • Mid Staffordshire Foundation Trust;
  • Burton Hospitals Foundation Trust;
  • University Hospitals Coventry and Warwickshire Trust;
  • Solihull Hospital; Worcester Royal Hospital;
  • University Hospital of North Staffordshire;
  • Worcestershire Acute Hospitals Trust;
  • Alexandra Hospital, Redditch;
  • Walsall Healthcare Trust;
  • Heart of England Foundation Trust;
  • Shrewsbury and Telford Trust;
  • Dudley Group of Hospitals Foundation Trust;
  • Sandwell and West Birmingham Hospitals;
  • Good Hope Hospital, Sutton Coldfield;
  • South Warwickshire Foundation Trust;
  • Birmingham Children’s Hospital;
  • Wye Valley Trust, Hereford.

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Readers' comments (11)

  • This is the result of "managers" failing to listen
    to what clinicians have been warning of for a long time!

    The arrogance and incompetence of NHS "managers" is breath taking but as long as they are allowed to wheel away massive bonuses whilst not being held accountable for the mess they create nothing will change.

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  • and hunt will lay the blame with everyone else but the tories as usual

    its the tories that are destroying our nhs on a daily basis...they never listned to front line staff who said these health reforms will be a disaster...

    the new nhs direct what a joke, they are sending more and more people to A&E, what do you expect with minimum wage staff...who brought that in..tories

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  • This is a national issue. Hats off to the Trusts for admitting it. Very brave and absolutely honest as the NHS should be. We have a real problem in out Trust with A&E attendances as we are frequently in a bed crisis. We even had to open a 'ward' on our endoscopy unit for a while! That of course, meant that endoscopies were cancelled, another delay. I find it galling to hear all the political rhetoric about how this Government having reduced waiting lists, improved services when it certainly does not seem to be the case in our hospital.

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  • The aftermath of the earthquakes in A&E is felt through out the hospital.
    On the ward I work in, the pressure to get patients out is unbearable. These discharged patients soon go back to A&E to be admitted. We work like we are in a factory not a hospital.
    Still we have the senior sisters walking around putting pressure on us to get the beds empty without offering even a little bit of help.
    Perhaps we should get these walking around sisters to do some work at the start of the earthquakes(A&E) or at the end (admitting wards).

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  • Anonymous | 22-May-2013 2:07 pm

    sounds like 'revolving door' healthcare at its best.

    one would imagine senior sisters had been in the profession long enough and gained enough experience to be helpful and useful to these patients and staff.

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  • Anonymous | 22-May-2013 11:53 am

    I don't think that the 'Trusts' have admitted to anything. My understanding is that senior clinicians working within the listed Trusts have written this letter sent to their leaders and CEOs.

    It is now up to the Trusts to respond.

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  • tinkerbell

    so, so glad, that clinicians are SPEAKING UP, well done to all of you. Enough is enough.

    Something had to give and now we are taking matters into our own hands because everything is at breaking point if not already completely broken. Well done all politicians who have had a hand in destroying the jewel in the crown of our civilised society that once provided a SERVICE to its citizens.

    You will all no doubt make huge profits once it's privatised having sold all NHS principles down the swanee to make a fast buck. You F*****S!

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  • re tinkerbell above

    well said

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  • ED waits, bed pressures etc etc used to have winter to blame now t s all year round crisis. This article represents every trust with an ED up and down the uk, anyone who says it doesn't live in planet NHS.
    Our beds are at >97% of the time all the time, no decant ward to get ward cleans or if you are lucky enough to get a lick of paint. Everything is rammed to bursting. Managers obsessed by counting internal waits, LOS, get em out as quick as possible move he patients in the middle of the night, bring the up to the wards from ED even if there are no beds. It's heartbreaking, we have used the post op recovery time for patients, recovery what's that , it means go home.
    The pennies have to be saved ignore the big at salary of yet another ops manager, etc etc the NHS cannot continue like this.

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  • tinkerbell

    'Abandon hope all ye who enter here' should be the sign above most hospital wards it appears now. This is due to the contempt nurses and doctors have had to deal with due to these unrelenting cutbacks and unnecessary reforms that have wasted more money than could ever be saved trying to privatise a SERVICE but calling it a reform, but because it is tory ideology to try and privatise everything that can (move or has a pulse) to make 'them' even richer they don't give a toss about the effect it is having on the nations health and well being.

    I have never, ever been involved with anything political in the past, but we all need to wise up to what is going on here, no one wants to die from ignorance.

    We need a campaign to plaster it across the TV, billboards and radios of England that we are all being taken to the cleaners and local undertakers if we don't wake up to what is going on.

    We need to STOP this onslaught now and get involved in whatever way we can.

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