Written evidence submitted by the Royal College of Emergency Medicine (DEL0081)
The Royal College of Emergency Medicine (RCEM) is the single authoritative body for Emergency Medicine in the UK. Emergency Medicine is the medical specialty which provides doctors and consultants to A&E departments in the NHS in the UK and other healthcare systems across the world. The Royal College works to ensure high quality care by setting and monitoring standards of care and providing expert guidance and advice on policy to relevant bodies on matters relating to Emergency Medicine.
Emergency Departments before the pandemic
- In 2019, 18 million people attended Emergency Departments across the UK. Last winter, we showed that over 100,000 patients waited 12 hours or more from arrival to departure in our Emergency Departments.
- In many hospitals ‘corridor care’ had become commonplace as most Emergency Departments were stretched beyond the capacity they were designed and resourced to manage at any one time.
- Many of our existing Emergency Departments are too small, run down and in need of repair but most have coped with even the surge of patients attending with Covid-19 because of the unexpected drop off of A&E attendances which has been seen since the lock down.
- Emergency Departments had to rapidly reconfigure to create capacity and segregated areas designated as red and green zones.
- COVID19 patients have been managed by multi-specialty teams in an atmosphere of considerable cooperation and focus.
Attendances during the pandemic
- Emergency Departments have not been ‘overwhelmed’ during the pandemic.
- Attendances to Type 3 Departments in March decreased by 35% when compared to March 2019. Similarly, there has been a 26% decrease in attendances to Type 1 Departments.
- It is not clear how much of this, and in what proportion, is due to changes in disease patterns (e.g. trauma), behaviour (e.g. alcohol and social gatherings), patients being treated by alternative pathways, (e.g. improved access to specialist services), or by anxiety over presenting to hospitals.
- Most of the decline has certainly been in lower acuity groups, but worryingly, there is some evidence of seriously ill patients staying at home.
- It is vital that patients with serious illness contact health services and come to the ED if they need to. Emergency Medicine clinicians deliver time critical interventions and lifesaving medical care.
The positive changes we must ‘normalise’ moving forward
- The role of the Emergency Department is to deliver time critical care to the acutely ill and injured, including those with mental health problems. Emergency Departments are no longer picking up the pieces where community or specialist care has struggled to cope, particularly ‘out of hours’.
- There is a moral imperative to ensure that we never see a return to crowding or ‘corridor care’. We cannot protect patients and staff from each other in overcrowded conditions.
- We must recognise the huge change that has occurred in the way patients access Urgent & Emergency Care and make sure that we take this opportunity to reboot the services in a way that maximises the value of the clinical capabilities of EDs as well as maintaining patient safety and healthcare worker safety.
- Current Infection Control and Prevention measures will need continue and we should future proof our Emergency Care system and hope for a dividend of reduced nosocomial infections in the long term.
- Endemic COVID19 changes how undifferentiated patients should be managed within the health system.
- As NHS services restart, we must make sure that bed capacity can cope with the backlog of work as well as the requirement for patients to move out of the Emergency Department.
- Ensuring Emergency Department facilities are adequately configured to manage both COVID19 and non-COVID19 patients.
- Addressing ongoing PPE needs, staffing, and testing turnaround times.
- Moving forward we will need to address the challenge of asymptomatic healthcare workers working with vulnerable undifferentiated patients.
- Although we do not yet know the detail of the risk to BAME, EDs have high numbers of this demographic working as doctors.