Acute care in the NHS: adapt or bust

Abstract

Acute care in the UK's National Health Service (NHS) hospitals is on the verge of collapse, according to a damning report released by the Royal College of Physicians (RCP). The report focuses on five major challenges. A third fewer general and acute beds are available now than 25 years ago, but emergency admissions have increased by 37% in the past decade. 65% of people admitted to hospital are older than 65 years and 25% have dementia, yet hospitals are not designed to cope with the complex needs of this population. Continuity of care is poor, with many patients not having one consultant with overall responsibility for their care. On nights and weekends, when mortality is 10% higher than on weekdays, care is often supervised entirely by junior doctors, who do not have the experience to manage complex cases. Finally, acute-care registrars and consultants believe that their workload is unmanageable, leaving them without enough time to teach junior staff.As a result of these challenges, acute-care jobs are unattractive, and training spaces for emergency and general medicine are not being filled, which could lead to a staffing crisis at a time when these workers are needed most.The report calls for a complete restructuring of hospital services to ensure that consultant care is available 24 h a day, 7 days a week. Too many patients, especially those who are elderly, are currently denied dignified, safe, coherent care, which should surely be the minimum expectation of a functioning health-care system. New Health Secretary, Jeremy Hunt, must listen to individuals on the front line of acute care to ensure that reforms are centred on the interests of the patient, and that acute-care workers are provided with the support and training that they need to do their jobs well.The RCP has launched a Future Hospital Commission to review the organisation of hospital services, which will make its recommendations in early 2013. Acute-care workers owe it to themselves and their patients to participate in this review to provide an accurate picture of present care, with all its challenges, failures, and successes, and to campaign for essential, positive change. Acute care in the UK's National Health Service (NHS) hospitals is on the verge of collapse, according to a damning report released by the Royal College of Physicians (RCP). The report focuses on five major challenges. A third fewer general and acute beds are available now than 25 years ago, but emergency admissions have increased by 37% in the past decade. 65% of people admitted to hospital are older than 65 years and 25% have dementia, yet hospitals are not designed to cope with the complex needs of this population. Continuity of care is poor, with many patients not having one consultant with overall responsibility for their care. On nights and weekends, when mortality is 10% higher than on weekdays, care is often supervised entirely by junior doctors, who do not have the experience to manage complex cases. Finally, acute-care registrars and consultants believe that their workload is unmanageable, leaving them without enough time to teach junior staff. As a result of these challenges, acute-care jobs are unattractive, and training spaces for emergency and general medicine are not being filled, which could lead to a staffing crisis at a time when these workers are needed most. The report calls for a complete restructuring of hospital services to ensure that consultant care is available 24 h a day, 7 days a week. Too many patients, especially those who are elderly, are currently denied dignified, safe, coherent care, which should surely be the minimum expectation of a functioning health-care system. New Health Secretary, Jeremy Hunt, must listen to individuals on the front line of acute care to ensure that reforms are centred on the interests of the patient, and that acute-care workers are provided with the support and training that they need to do their jobs well. The RCP has launched a Future Hospital Commission to review the organisation of hospital services, which will make its recommendations in early 2013. Acute-care workers owe it to themselves and their patients to participate in this review to provide an accurate picture of present care, with all its challenges, failures, and successes, and to campaign for essential, positive change.