United Kingdom Field Report: 2015

Published on July 16, 2015
After relentless media coverage of the state of many EDs in England, Northern Ireland, Scotland, and Wales, the pressure is on to reform key A&E processes and funding mechanisms.

Emergency Medicine (EM) in the UK is in an unprecedented state of crisis, that much is undeniable. Within the speciality, of course, we have long realised that the situation of increasing demands and ever-dwindling resources was unsustainable. But the lone voice in the wilderness that was EM went unheard, year upon year, until the autumn of 2014. Relentless media coverage over the preceding months exposed the parlous state of the nation’s emergency departments (EDs) to the public. This finally provided a platform for senior emergency doctors to voice our concerns at a national level.

On 25th November 2014 the Royal College of Emergency Medicine launched the STEP campaign, urging government, politicians and National Health Service leaders to take action to address the issues facing EDs. The college holds that there are four key areas to be addressed in order to rebuild EM in the UK, namely staffing, tariffs, exit block and primary care.

1. Staffing – Increasing workload and poor work-life balance has driven many doctors out of the speciality, or deterred them from considering EM as a career option. Many more have left the UK to work overseas, particularly in Australia, at an estimated cost of £130m to the taxpayer. Unfilled training places has led to spiralling costs, estimated at a further £120m, due to reliance on locum doctors.

2. Tariffs –In England, EM is subject to a bizarre system of routine underfunding, whereby the hospital receives only a fraction of the cost of non-elective admissions to hospital. As the hospital can only recoup this loss by increasing the number of elective cases they admit, this increases pressure on acute beds, leading to exit block.

3. Exit Block – Exit block occurs where a patient in the ED requires an acute hospital bed, but none is available. This leads to ED overcrowding, and increased mortality. Exit block affects approximately 500,000 patients per year in the UK.

4. Primary Care – The ED workload is substantially increased by primary care patients attending, particularly outside of office hours. Innovations to remedy this situation have mostly proved ineffective, therefore a new approach of co-locating primary care facilities and sharing investigative resources, such as X-ray and laboratory testing, has been suggested. This is likely to be popular with patients, cost efficient and is endorsed by the Department of Health and several Royal Colleges, amongst others.

More recently, the College gave evidence to the House of Commons Health Select Committee about the crisis facing emergency departments in the UK. However, despite the high public profile of emergency care in the past year, it would appear most hospitals have not implemented the College’s recommendations, despite £700m emergency funding being made available. Following the general election in May 2015, which produced a non-coalition Conservative government, the future of emergency medicine in the UK remains uncertain.

Author Disclosure: Dr Clayton is currently avoiding the crisis in UK EM by working in Australia.

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