“Unless working conditions improve for everyone across the NHS, it will collapse beyond repair”

 RCP Wales: "Unless working conditions improve for everyone working across the NHS, it will collapse beyond repair"

The Royal College of Physicians (RCP) has today published the results of a snapshot survey on the winter pressures faced by doctors in Wales 

As consultant physicians, trainees, nurses, GPs and pharmacists gather at the North Wales Future Hospital Joint Symposium today (Thursday 20 April) to discuss the future of hospital services, the RCP is calling for more specialty care to be delivered in the community. Among the results of its recent survey, the RCP found that:  

• Almost three quarters of respondents said that there had been a big rise in NHS demand in the past 12 months
• More than half of respondents thought patient safety in their hospital had deteriorated in the past 12 months
• Four out of five respondents told us that they had experienced staff shortages across the team in the past 12 months
• More than three quarters of respondents had experienced delays in discharge due to a lack of capacity in social care

In all our hospitals, we are now seeing the impact of a historically underfunded social care system. We must transform a fragmented NHS by improving joined-up planning across health and social care. Above all, we need to give front-line clinicians – and their partners in social care – the time and space to innovate, and the freedom and support to step beyond organisational walls. The NHS in Wales must step up to the challenge:

• We need more specialist care delivered in the community: Physicians and specialist medical teams should spend more time working in the community. The role of the community physician should be developed.
• We need new ways of communicating: More patients should be able to communicate with healthcare professionals using telemedicine to reduce pressure on hospital beds. Communication between primary, secondary, community and social care should be improved.
• We need to break down barriers: Wales should actively promote itself as a place to develop highly specialist skills in rural and community-based medicine, with doctors working in collaboration with their partners in social care and community teams.

Topics at the symposium today will include the role of the community specialist physician; telemedicine and the future of rural medicine; and delivering 24/7 care in smaller hospitals.

Dr Gareth Llewelyn, RCP vice president for Wales said:

“Across Wales, consultant and trainee physicians are working at the hospital front door and on the wards. These physicians are leading the multidisciplinary care of thousands of people every day, working with colleagues in primary and social care to put patients at the very centre of our NHS. But despite their hard work, these doctors are struggling to cope. The recruitment crisis is getting worse – last year, we were unable to fill 40% of consultant physician vacancies in Wales and there are major trainee rota gaps in every hospital in Wales. This simply cannot continue.

“As part of the solution, the RCP wants a fresh look at how specialist doctors will work with their primary care colleagues in the future. For example, hospital doctors should be able to hold more of their clinics in the community as part of the wider primary care team. This is important because we desperately need to break down the barriers between hospitals and the community.

“It’s really important that future investment into the health service does not go towards propping up the old, broken system. The recommendations we’ve published today, along with our recent report on the medical workforce, ‘Physicians on the front line’ show that we want to work with the NHS to develop a really ambitious long-term vision, improve patient care and solve the workforce crisis.”

Notes

The Royal College of Physicians (RCP) aims to improve patient care and reduce illness, in the UK and across the globe. We are patient centred and clinically led. Our 33,000 members worldwide, including 1,200 in Wales, work in hospitals and the community, diagnosing and treating millions of acutely sick patients across 30 medical specialties, including diabetes, stroke, cardiology and respiratory medicine.

All quotations in this publication are anonymous.

·         The snapshot survey report will be available to download from our website from 1pm today.

·         The RCP 2016 report on the medical workforce in Wales, Physicians on the front line, is available to download from our website.

·         The RCP Wales action plan for the Welsh Government 2016-2021, Focus on the future, is available to download from our website.

·         The 2014 RCP Wales policy report, Rising to the challenge, is available to download from our website.

‘It seems to get worse, year on year. This January has

certainly been worse than I’ve ever seen it and I worry

that we won’t be able to sustain things for much longer.’

Consultant physician in acute medicine, NHS Wales

The Royal College of Physicians (RCP) recently ran a snapshot survey in which
we asked our members to tell us about their experiences on the front line. Across Wales, consultant and trainee physicians are working at the hospital front door and on the wards, managing acutely sick patients across 30 medical specialties, including diabetes, stroke, cardiology and respiratory medicine. These physicians are leading the multidisciplinary care of thousands of people every day, working with colleagues in primary and social care to put patients at the very centre of our NHS. Despite their hard work, these doctors are struggling to cope.

In all our hospitals, we are now seeing the impact of a historically underfunded social care system. We must transform a fragmented NHS by improving joined- up planning across health and social care. Above all, we need to give front-line clinicians – and their partners in social care – the time and space to innovate, and the freedom and support to step beyond organisational walls.

Keeping patients safe

Patient safety. More than half of respondents told us that patient safety in their hospital has

deteriorated over the past 12 months.a

‘An increasing demand [alongside] an increasing lack of beds means that patients are often nursed on trolleys in the A&E corridors. It is also often very difficult to find a suitable space in which to see a patient, meaning that they wait longer to be seen. Two years ago, several community beds were closed

by the health board, which has also exacerbated the situation.’
Consultant physician in acute medicine, NHS Wales

Bed closures. More than one-third of respondents told us that they had experienced

bed closures in their hospital in the past 12 months, despite demand being high.b

‘Bed numbers have been reducing steadily, with the result that patients are often sent to unsuitable locations or inappropriate wards. Staff shortages (affecting not only numbers, but also the skill mix) and the pressure to discharge patients further contribute [to the challenge].’

Consultant physician in geriatric medicine, NHS Wales

a 49 of 94 respondents

b 34 of 94 respondents

Understaffing and workforce morale. Four out of five respondents told us that they

had experienced staff shortages across the team in the past 12 months,c and three-quarters told us that the NHS workforce is demoralised.d Three in ten respondents told us of their concerns that this had contributed to lower-quality patient care.e

‘We already have fewer than the recommended number of consultant oncologists. In 2016, we advertised posts and had no applicants. I am pessimistic regarding the ability of the health board to fill vacant consultant posts. With the increasing complexity of treatment for cancer, our services will be stretched to the limit.’

Consultant physician in medical oncology, NHS Wales

Demand for services.

Almost three-quarters of

respondents said that there had been a big rise in NHS demand in the past 12 months.f

‘Unprecedented demand means that some patients receive substandard care. Delays at the front door caused by lack of community beds mean that lives are put at risk, with sick people waiting in ambulances.’

Consultant physician in cardiology, NHS Wales

c 78 of 94 respondents, d 69 of 94 respondents e 29 of 94 respondents, f 68 of 94 respondents

Getting patients home

Delayed transfers of care.

Half of respondents said that

these had risen over the past
12 monthsg and more than three-quarters had experienced delays caused by a lack of capacity in social care services.h

‘We are currently running an emergency service from a waiting room or in trolleys in the corridor. This compromises the care we’re delivering and it demoralises the workforce. Despite recruitment drives, empty senior posts are unfilled and this is likely to get worse … Unless working conditions improve for everyone working across the NHS, it will collapse beyond repair.’

Consultant physician in acute medicine, NHS Wales Speaking up for patients

Whistleblowing. Worryingly, more than half of respondents told us that they did not feel

confident in raising concerns and issues in their organisation, including those around transparency and patient safety.i More than two-thirds told us that they were worried or very worried about the ability of their service to provide safe patient care.j

‘It’s very much a culture of blaming those who speak out, and inaction at best or hostility at worst from administrative and management staff.’

Junior doctor, NHS Wales

g 48 of 94 respondents, h 73 of 94 respondents i 50 of 94 respondents, j 65 of 94 respondents

Time for action

More specialist care delivered in the community. Physicians and specialist medical teams

should spend more time working in the community in order to deliver more specialist care in, or close to, the patient’s home. The role of the community physician should be developed.

New ways of communicating.

More patients should be able to

communicate with healthcare professionals from their homes using telemedicine, in order to reduce pressure on hospital beds. Communication links between primary, secondary, community and social care should be drastically improved, with electronic patient records introduced to save time and improve patient safety.

Breaking down barriers to deliver patient care. Wales should actively promote itself as

a place to develop specialist skills in rural and community-based medicine, with doctors working in collaboration with their partners in social care and community teams. A whole-system approach across health and social care is now required to deal with the impact of unscheduled care pressures.

Royal College of Physicians (Wales) Baltic House, Mount Stuart Square Cardiff CF10 5FH

Tel +44 (0)29 2049 8712 Email wales@rcplondon.ac.uk

www.rcplondon.ac.uk/wales

Get involved

On the RCP website, you can read about existing examples of innovative practice and listen to doctors talking about how they achieved change in their hospital. You can also inform the RCP’s work in Wales by sending us your comments, ideas and examples of good practice.

To help shape the future of medical care in Wales, visit www.rcplondon.ac.uk/wales

To tell us what you think – or to request more information – email wales@rcplondon.ac.uk

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