Emergency Medicine 10 priorities Dr Cliff Mann FRCP

Emergency Medicine – 10 priorities Dr Cliff Mann FRCP FRCEM President of the Royal College of Emergency Medicine

Reported numbers of A&E staff or facility per 100, 000 attendances per annum in 2014 Type of staff or facility Consultants Junior doctors Career grade Drs ENPs Total nursing staff Resus cubicles Patient trolleys Minimum Maximum Average 5. 5 2. 7 1. 0 5. 0 20. 8 14. 8 24. 5 69. 0 10. 1 7. 7 7. 0 13. 4 Maximum to minimum ratio 3. 8 5. 5 24. 5 13. 8 39. 0 2. 0 6. 0 165. 0 9. 0 50. 0 94. 0 4. 8 29. 0 4. 2 4. 5 8. 3 (from the NHS Benchmarking Network’s data)

Irrevocable loss of capacity 2000 patients each 368 registrars Working life of 35 years 736000 patients 12 DGH EDs 25 million patients There is one EM Consultant for every 11, 500 attendances. Productivity increase of 7%

Sustainable Staffing EM doctors EM practitioners ACCS posts Increase from 225 to 325 Physicians Associates Faculty @ RCP Attrition From 50% to 25% DREEM ANPs Credentialing using RCEM curriculum from May 2016 Over 100 in 2 years Current fill rate for HST 79% Real interest in GPs credentialing in EM

Whilst it is essential to manage demand on EDs, this should not detract from building capacity to deal with the demand faced, rather than the demand that is hoped-for.

Comparative national public spending:

£ 1. 6 billion £ 8. 5 million Budget for 186 A&E departments Average annual budget per department

£ 8, 500, 000 £ 7, 000 £ 6, 000 £ 5, 000 £ 4, 000 £ 3, 000 £ 2, 000 £ 1, 000 £ 0 £ 3, 000 National Weekly ED locum spend Total Annual budget for average sized A&E

14 20 /1 4 /1 5 13 20 /1 4 /1 3 /1 2 /1 1 /1 4 13 20 12 20 11 20 10 20 Overnight Bed Availability 146, 000 144, 000 142, 000 140, 000 138, 000 136, 000 134, 000 132, 000 130, 000 128, 000

August October December February April June August October December February April Numbers of Patients and Acute Days Lost 120, 000 100, 000 80, 000 60, 000 Total Number of Patients Acute Days Lost 40, 000 Linear(Acute Days Lost) 20, 000 0 2010 -11 2011 -12 2012 -13 2013 -14 2014 -15 2015 -16

4 hr standard

Performance against the 4 hour standard is a useful proxy measure of crowding. ‘Performance against the four-hour standard shows how this standard is actually a quite sophisticated measure of complex interactions within the whole of a local health and care system’

The main causes of ED crowding include surges in demand lack of access to beds in the hospital system due to poor patient flow and high hospital occupancy rates ED crowding adversely affects every measure of quality and safety for patients & staff.

Emergency departments (EDs) should be fully resourced to practice an advanced model of care where the focus is on safe & effective assessment, treatment and onward care.