Huge Strains on Staff in Hospital Emergency Departments is Putting Patient Safety at Risk.

Our fear is that we are on the brink of a crisis in urgent and emergency care, and fewer staff will be inclined to work in Emergency Medicine and a depleted workforce will be facing higher demand.”

Dr Katherine Henderson, President of the Royal College of Emergency Medicine

The Royal College of Emergency Medicine is calling for all the Governments in the UK to act now to achieve safe staffing levels in Emergency Departments after a workforce survey found that three in five Emergency Medicine staff say they have experienced high levels of burnout, stress, and exhaustion.

Amongst the recommendations that the report makes is that:

A new, actionable, long term health and social care strategy is now required in all four nations to enable the delivery of high quality Urgent and Emergency Care.

Before the Pandemic took hold in the UK in March 2020 our NHS Emergency Staff were already facing worsening conditions ‘in understaffed and under-resourced departments.’

The report says that the NHS should aim for a ratio of 1 Whole Time Equivalent (WTE) consultant per 4,000 annual attendances. This table shows we are nowhere near to achieving that in England, Scotland, or Wales.

Despite the increasing pressures on the workforce the response from all those working in the NHS to adapt the way they could deliver a safe service at the start of the Covid pandemic was incredible.

Emergency Departments “expanded into new areas of the hospital, changing the way that staff worked. There was a transformation in cross-specialty working, with an “all hands-on deck” approach, and what had previously seemed like an impossibility was achieved overnight.” We should never forget how all these workers, often with insufficient PPE, rose to the challenge of a pandemic.

As each wave of the pandemic hit all parts of the UK with increased opening up and transmission of new strains of the virus through travel, this same workforce was finding it more and more difficult due to burnout.

  • 59% of respondents experienced burnout during the second wave of the pandemic.
  • 82% of respondents indicated that their workload affected their ability to function at work.
  • 44% of respondents experienced moral injury during the second wave of the pandemic

In the second wave which hit the same time as winter pressures “in England, this resulted in record high numbers of patients waiting 12-hours or more from ‘decision to admit’, as crowding not only returned to pre-pandemic levels but surpassed them.”

This is important because on 19th of July Prime Minister Boris Johnson intends to drop all restrictions ushering in a new and more drastic rise in Covid cases. Johnson’s Freedom Day ‘a dangerous and unethical experiment’

Dr Katherine Henderson, President of the Royal College of Emergency Medicine, said:

“The fact that half of Emergency Medicine staff are considering reducing their hours in the near future and over one quarter are considering taking a career break, is deeply worrying.

“Emergency Medicine has always been an exciting yet challenging career, but the intensity of the pandemic and the current severity of the pressures has exacerbated these challenges vastly and increased burnout and exhaustion among staff, and ultimately discouraged existing staff from continuing their career in the specialty.

“Operational pressures are seen by staff as the most significant reason for considering reducing hours, changing careers, or retiring early. Therefore, we must make Emergency Medicine a sustainable career and improve staff retention.

“Demand for urgent and emergency care has increased significantly over the past few years, but the workforce has not grown adequately to keep up with this demand. The result has led to an increase in crowding and corridor care, with more delays and more long stays for patients in Emergency Departments, while staff have been spread more and more thinly trying to cope with intense pressures. These factors put huge strains on staff and put patient safety at risk.

“This is not sustainable for staff, and if Emergency Departments must be the safety-net of the system and the place where people go when they have nowhere else to seek treatment, we must be staffed appropriately to deal with that.

“Our fear is that we are on the brink of a crisis in urgent and emergency care, and fewer staff will be inclined to work in Emergency Medicine and a depleted workforce will be facing higher demand.”

Yesterday, 11th of July, the Scottish Government announced £12 million in additional funding to health boards across Scotland to support non-COVID emergency care. It is hoped this extra funding will be used to  reduce waiting times for urgent or emergency treatment, with a focus on boosting staffing levels and available beds.

Cabinet Secretary for Health and Social Care, Humza Yousaf

Health Secretary in the Scottish Government, Humza Yousaf said:

“We are acutely aware that hospitals are facing significant challenges due to a rise in non-Covid attendances and that some health boards are taking necessary measures to protect urgent and emergency care capacity. This £12 million will support them to do so. We are working closely with those Health Boards experiencing the greatest challenges to ensure the funding delivers the improvements required.

“Our NHS staff continue to work tirelessly to respond to the pandemic whilst providing vital non-Covid treatment and safe patient care. Any reductions to service will be short term to ensure those of most critical need have immediate medical attention. Urgent treatment, including vital cancer treatment will continue during this challenging period.”

The Royal College of Emergency Medicine is calling for a workforce plan that achieves safe-staffing levels in Emergency Departments; currently the College estimates there is a shortage of between 2000-2500 Emergency Medicine Whole Time Equivalent consultants across the UK. Their report states that there has been an overreliance on locums due to this understaffing.

Dr Katherine Henderson continued:

“We urgently need decisive action and leadership, we must achieve safe-staffing levels in Emergency Departments across the UK, and this workforce must be formed of staff trained and qualified in Emergency Medicine.

“We must see a long-term Health and Social Care strategy that recognises the value of urgent and emergency care and enables high-quality care and performance – this should be done by funding Same Day Emergency Care and Ambulatory Emergency Care, through expanding capacity, funding local health systems, and rigorously determining the effectiveness of NHS 111 and maximising its potential – all these steps must be taken to address the problems facing emergency care.”

The report is a call for action. It states:

We need a coherent, joined up and long term vision and strategy that places patients at the heart of the system and includes a clear plan to manage surges in emergency demand

Commenting on the additional funding from the Scottish Government Chief Executive of NHS Lothian Calum Campbell said:

“Hospitals across Scotland are dealing with the pandemic, while seeing an increase in non-covid patients arriving at their doors.

“We are grateful to the Scottish Government for working with us to ensure everyone who needs urgent or emergency care is prioritised – such as vital cancer treatment or accident and emergency care for life-threatening conditions.

“This funding will be vital in helping to provide extra staffing and bed capacity to further enhance improvements in unscheduled care and support delivery of the NHS Recovery Plan.”

You can read the report from the RCEM here:

Related article: Our NHS Heroes Are Suffering From Burn Out

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