What’s happening in A&E?
24 Sep 2021 | Anne Marie Fogarty
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Accident and Emergency (A&E) medicine is a challenging, fast-paced and rewarding specialty for any doctor considering this path in medicine.
You’ll manage the full and varied spectrum of emergencies at any hour of the day or night. A&E is the hub of any NHS acute hospital. Open 24/7, 365 days a year, yes, it is demanding, but it is the place for a doctor who thrives on helping people at their most vulnerable, working on the frontline and craves the fast pace of the rapid response of emergency medicine. Often referred to as the ‘adrenaline rush’, there’s one thing for sure, you’ll never feel bored!
In this piece, we take a deep dive into A&E departments and the challenges across the UK. Did you know that there are different types of A&E departments in the UK?
What type of A&E departments are in England?
The three main types of A&E departments in England:
- Major emergency departments with consultancy-led round the clock care. These types of A&E have a fully fitted out department, including resuscitation units. They account for the majority of attendances (63 per cent in 2018/19)
- The second type are consultant-led facilities but for single specialties, for example, dedicated to treating only eye conditions or only dental problems.
- The third and final type treats minor injuries and illnesses, including stomach aches, cuts and bruises, minor lacerations, and rashes.1
Data from the Royal College of Emergency Medicine; suggest there are approximately 180 individual emergency type departments in England.1 That’s a large number of staff required to treat patients safely. Lack of staff and resources can lead to problems such as longer waiting times. So, what are waiting times like now in the A&E?
What are A&E waiting times like?
A&E waiting times are often used to measure the overall performance of the NHS and social care system. This is usually because A&E waiting times may be affected by what’s happening and pressures in other departments. For example, when A&E decide to admit a patient, there needs to be enough bed capacity in the hospital for that patient, if there is no free bed, then the patient must wait in A&E; therefore, the delay is not really in A&E, but until other services open up the patient must wait there.
A&E waiting times have got worse over the past decade, as the NHS has experienced a sustained period of staffing pressures. Here, the flexible workforce has supported our NHS through this challenge. Working in collaboration to solve the staffing crisis, the flexible workforce supports the NHS with quality healthcare workers with vast experience and varied skillsets. Hiring flexible workforce solutions helps decrease waiting lists and helps to clear NHS backlogs much quicker.
How we continue to support the NHS can be further looked at here.
A&E departments face longstanding challenges in recruiting and retaining sufficient staff to cope with rising demand. The Royal College of Emergency Medicine notes that emergency medicine has a high attrition rate from doctors in training, high early retirement rates for experienced clinicians, and significant reliance on temporary workforce clinical staff. In the most recent General Medical Council survey, nearly three-quarters of emergency medicine trainees rated the intensity of their workload as heavy or very heavy, substantially more than any other specialty. This can lead to losing good doctors. We should analyse the root cause of the staffing issues and provide solutions to retain our great A&E staff.
As winter approaches, A&E departments are concerned about the effects of the pandemic and backlog of services that looms.
We need a solution that works, sustains staff, and makes A&Es function better, safer and more effective. In a solution-focus approach, key points to note include:
- An effective and efficient solution-focused approach is required.
- The NHS is vastly understaffed, that was the case pre-COVID, and it is now more apparent than ever before post-COVID.
- A lack of staff severely impacts patient care delivery, so ensuring staffing levels and skill mix remain within safe levels is critical.
- The flexible workforce can hire quickly and efficiently, will help, healthcare organisations thrive and could potentially save lives in the process, therefore always putting people first.
Working together-the NHS and the flexible workforce can support a better A&E going forward. Issues around staffing such as training more recruits, making the working environment more palatable to graduates, better working conditions and resolving pay issues are all core items that require assessment and solutions if A&E departments are to solve staffing problems and attract new graduates.
Winter is a challenging time for health and care services; A&E departments in particular struggle to meet demand.
- It’s not that significantly more patients go to A&E in winter, but more people require admission to acute services due to more respiratory illnesses, flu coughs, colds etc. Often these minor illnesses can progress to more serious ones like pneumonia, so people require hospital admission.
- Of course, staff in A&E departments being human too, suffer from winter illnesses. When the sick rate increases in A&E, staffing pressures come to play, and there is a lack of sufficient staff to patient ratio.
- Lack of hospital beds can lead to severe pressure on services. This can be due to increased admission or delays in discharging healthy patients.
- The volume of hospital beds can also be heavily affected by norovirus outbreaks, leading to whole wards being shut down for deep cleaning. The increase in service demands and the reduction in bed capacity leads to long waiting times in A&E, especially during winter.
- In recent years, staffing pressures and lack of hospital beds have become a crisis for the NHS, resulting in longer waiting times in A&E departments as a widespread reality.
Lack of staff and resources has become the reason an A&E crisis exists for decades. But now, the situation has become even worse due to the COVID-19 pandemic. More than ever before your NHS needs you – the A&E specialists to come forward and join your comrades at the frontline of our national health service. We understand as a people-first flexible workforce solution, that your working conditions are paramount to providing safe quality care to patients. And, we understand the real staffing issues on the ground, that’s why we are talking about all these pressures you face, the conditions that need improvement and the staffing levels that need urgent action.
A&E – Making a real difference
A&E is, without doubt, a high-pressure department but can be alive with activity, a real opportunity to treat emergencies on the frontline, and no day is ever the same. As a healthcare worker in A&E, you’ll never be bored, lack a challenge or feel you don’t make a difference- a career in A&E is a rewarding career like no other. With the proper staffing and processes in place, you can make a real difference to people and save lives as an A&E healthcare professional.
If you are interested in a position in A&E, we have a vast array of opportunities, contact us today and let’s talk through your needs and put you in control of your work-life balance.
- What’s going on with A&E waiting times? | The King’s Fund. https://www.kingsfund.org.uk/projects/urgent-emergency-care/urgent-and-emergency-care-mythbusters