NHS urgent and emergency care is under intolerable strain. This strain is increasingly causing harm to patients. Timely and high-quality patient care is often not being delivered due to overcrowding driven by workforce and capacity constraints. This drives low staff morale perpetuating burn out and high absence levels which currently dominate. Whilst COVID19 has accentuated and arguably expedited the crisis; the spiral of decline in urgent and emergency care has been decade long and unless urgent action is taken, we may not yet have reached its nadir.

In the short-term there must be honest discussions with staff and the public on what the NHS can deliver. There needs to political acceptance of the severity of the urgent and emergency care position. In the UK, there needs to be collaboration across all four nations and it would be pertinent to utilise some of the national incident actions enacted during COVID19. There is no doubting the gravity of the situation among frontline acute care workers; who desperately need to see light at the end of the tunnel. The haemorrhaging of skilled and experienced staff must be ceased. Long-term, we need bold and deliverable plans to increase workforce and capacity so we can deliver first class acute medical care that patients deserve, and we wish to deliver.

Acute medicine is at the heart of finding opportunities to mitigate the current crisis and future innovative, adaptive, quality and sustainable urgent and emergency care. The fundamentals of the specialty – well functioning Acute Medical Units and Same Day Emergency Care – alongside enhanced care areas and evolving Acute Medicine led hospital at home models^1,2 is essential for UEC and whole system recovery. They are increasingly core to the delivery of urgent care internationally.

Well resourced analysis and understanding of patient flow as well delivery of local services is key. In this edition, Wood et al. demonstrate the value of understanding local trends to match acute medical demand and improve service.³ On a national level, SAMBA benchmarks performance and can guide the development of future clinical quality measures but also needs to support local quality improvement.^4,5 Subbe et al. review the importance of co-design in acute care so that the experiences of patients and caregivers is utilised to improve service.⁶

Alongside its core work, acute medicine can promote and deliver important public health messages. Murphy et al illustrate this with their “teachable moment” for AMU patients and demonstrating an opportunity to improve physical activity post discharge.⁷ Delivering patient health education is often the aspect of care sacrificed in overburdened acute environments.

NHS pressures are at unsustainable levels and current results are scant justice for acute medical teams who continue to strive to deliver reasonable quality of care for their patients. This situation must not become an unacceptable new normal for our teams and patients; it is essential that it does not deteriorate further. The commitment of acute medicine teams remains a source of pride for anyone associated with our specialty and provides the greatest hope that this will not happen.

References

1. Rajaiah N, Kainth HK, Knight T, Clare S. EPICENTRE - Delivery of high quality acute medical care without transfer to hospital. Acute Med. 2021;20(3):235.
2. McGlen SE, Stoesser N, Woodrow C, Dudley J, Newton D, Lasserson D. Tocilizumab for treatment of SARS-CoV-2 infection at home: A case report. Acute Med. 2022;21(1):53-55
3. Wood C, Underwood J, Davies C, Taylor P. Patient Characteristics and Variables Influencing Acute Medical Flow. Acute Med 2022; 21(4): 168-175
4. Atkin C, Knight T, Cooksley T et al. Society for Acute Medicine Benchmarking Audit 2021 (SAMBA21): assessing national performance of acute medicine services. Acute Med. 2022;21(1):19-26.
5. Atkin C, Knight T, Cooksley T et al. Length of stay in Acute Medical Admissions: Analysis from the Society for Acute Medicine Benchmarking Audit. Acute Med. 2022;21(1):27-33.
6. Subbe C, Goodman A, Barach P. Co-design of interventions to improve acute care in hospital: a rapid review of the literature and application of the BASE methodology, a novel system for the rapid development of prototypes with patients based epistemology of stakeholders. Acute Med 2022; 21(4): 182-189
7. Murphy J, Le Jeune I. Can we improve patients’ physical activity levels after discharge by interventions on the Acute Medical Unit? The “teachable moment”. Acute Med 2022; 21(4): 196-202