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RCN backs creation of service ‘hubs’ to ease emergency crisis

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Accident and emergency departments should be transformed into “hubs” that include a range of services in order to deal with “crisis” levels of demand, according to a collaborative of clinicians.

A short report, written by representatives from both the nursing and medical professions, warned that A&E services were “facing their biggest challenge in well over a decade”.

“The pressures on emergency departments are no longer just a feature of the winter”

Janet Davies

Different approaches were needed to tackle A&E pressures, which were continuing “unabated”, said the Royal College of Nursing and the Royal College of Emergency Medicine.

Their joint report – The Medicine needed for the Emergency Care Service (see attached PDF below) – is based on the outcome of a recently-held “crisis summit” on the situation currently facing emergency care.

The event examined solutions to coping with booming A&E attendance rates that are outpacing the growth in the workforce and resulting in insufficient numbers of emergency doctors and nurses.

Crowded and chaotic departments were dangerous for patients and demoralising for staff, delegates at the summit agreed.

The idea of grouping primary care services together, though not new, was one of three recommendations put forward by the RCN and the RCEM.

They said A&E should become a “hub not a department”, of which the emergency department itself would be “just one, albeit key component”.

Patients should also have access to a range of staff including GPs, pharmacists, specially trained nurses and geriatricians, according to the report.

“The recommendations from the crisis summit are fundamental to providing effective patient care”

Clifford Mann

It highlighted that “the power of the A&E brand shows no sign of weakening”, despite many attempts to curb attendance. Instead, it would be more effective to plan services in a way that took into account the “reality of higher attendances and admissions”.

In partnership with Health Education England, the two organisations said they were conducting a census of A&E departments about the range of professionals currently providing emergency care and co-located care, which they would report on in future.

Meanwhile, the RCN and RCEM also cited the need for better staff education and training in emergency care, and more effective workforce planning.

There needed to be a commitment for both educational funding and provision of training time, and an effective and realistic workforce planning strategy, they said.

“Only by training, recruiting and retaining the right number of staff with the right range of skills can we meet the needs of an expanding and aging patient cohort,” they said in the report.

Both organisations noted “persistent and pervasive difficulties” in recruiting qualified permanent staff, and warned that burnout and high turnover were leading to “training deficiencies and an inexperienced workforce”.

They stated: “At present there is inadequate funding for education and insufficient resources to facilitate time away from the clinical environment to conduct training in the workplace.

CEM

Dr Clifford Mann

Clifford Mann

“As a minimum, local joint training sessions are vital to increase training time and foster teamwork,” they added.

In addition, the report recognised that A&E was only one part of an inter-connected hospital system, all of which could impact on each other.

It cited the need for a “new culture of collaboration”, where professionals within the wider hospital system worked more closely together to support patients.

“Whilst the spirit of the NHS is to work together, the pressures in the system push against this,” it warned.

It called for a new culture to accompany NHS England’s Five-Year Forward View strategy, so that healthcare professionals collaborated “more deeply to support their patients”.

RCEM president Dr Clifford Mann said: “The need for an effective strategy to increase the nursing and medical workforce to meet the demands on the emergency care service is now urgent.

Janet Davies

Janet Davies

Janet Davies

“Exhortations for hospitals simply to increase the number of emergency physicians and nurses working in A&E are doomed to fail when there simply aren’t enough doctors and emergency nurses to go round,” he said.

“The recommendations from the crisis summit are fundamental to providing effective patient care and must be implemented,” said Dr Mann.

RCN chief executive and general secretary Janet Davies added: “The pressures on emergency departments are no longer just a feature of the winter, they are present all year round.

“These problems cannot be solved overnight, and will require a system-wide approach to reduce the blockages which so often add to the pressures on A&E,” she said.

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