Keogh, Francis and Berwick reports and its impact on the future of urgent and emergency care

We are almost coming to the end of 2013. It has been an eventful year for NHS and in some ways for me too. After 8 years of working in a single emergency department, through certain unexpected circumstances I had a chance to work in a variety of emergency departments in the Greater Manchester area. Soon I shall be starting a new job in a different emergency department down south.

In the preparation for the new job I had another closer look at what these three gentlemen have been saying. I can clearly see that these three landmark reports are going to change the future of emergency medicine, acute care and the whole NHS over the next 10 years. This is irrespective of whether the NHS survives in its current form, which I very much doubt.

For those who have not yet looked into what these three reports are all about and just want an idiot's guide- Bruce Keogh's report is all about 14 individual hospital trusts and their unusually high mortality rates. Francis report is all about the mid Staffordshire debacle. Berwick is all about improving patient safety. The core message is the same in all three reports and most health care professionals with a few years experience and some common sense would have been able to give these answers even without a detailed investigation/review.

So what exactly is the core message

1-Put the patient first.
2-Do not get blinded by targets
3-Look after the health care professionals
4-Robust clinical governance and commitment to training and education
5-Have the right type of Leadership

There are going to direct and indirect implications for emergency departments in UK as a result of these reports and the current push for changes in the way urgent care is delivered and managed. There is an urgent need for emergency physicians to change the way they work currently. I can clearly see that the departments where senior emergency physicians(consultants and SAS doctors) work more flexibly and deliver actual clinical care will survive as emergency departments and the ones which are stuck in the old ways of crowding during office hours(mostly inside offices!) and disappearing afterwards will just slowly degenerate into glorified walk in centres.

There is also a need to work closely with our acute medicine colleagues to ensure that our patients get the highest quality treatment they deserve. The future hospital commission has tried to address the complex issue of delivery of acute care and has projected the need for clinicians who are trained to deliver acute care in a variety of settings. Any budding emergency physician( and current ones with more than a decade of working life left) will do well to read this report as well.

Further reading

http://www.nhs.uk/NHSEngland/bruce-keogh-review/Pages/published-reports.aspx

http://www.kingsfund.org.uk/projects/anticipating-francis-inquiry-report

http://www.kingsfund.org.uk/audio-video/don-berwick-improving-safety-patients-england-full-presentation

http://www.rcplondon.ac.uk/sites/default/files/future-hospital-commission-report.pdf

   

Crisis in Emergency Medicine

You have to be blind, deaf and from a different planet if you have not come across this statement from a variety of individuals and organisations in UK.

                       ' EMERGENCY MEDICINE IS IN CRISIS IN UK'

I thought I will reflect on this based on my own experience and exposure to emergency medicine in UK over the last 12 years. I did my medical education and surgical training in India. I came to work in NHS in 2000 to pursue further training in surgery. In about 2 years I realized that pursuing a surgical career in UK with a young family would be rather difficult. I choose to train and work in emergency medicine.

I come from a country where emergency medicine is in its infancy. I have seen the terrible loss of life and limb because of lack of basic emergency services. I understand the value of high quality emergency services.

Now let us look at why emergency medicine is in crisis is in UK. I will try  to steer clear of rhetoric and try and stick to objective facts as I see them. I apologize in advance for a certain degree of bias based on my experience.

There are many factors which have lead to the crisis in emergency medicine. Some of these factors are common to other acute care specialities.

1-Most doctors want to work 9-5 and want to do as little out of hours work as possible. This culture among the vast majority of doctors particularly the younger generation has lead to a staffing crisis in emergency medicine.

2-Governmental decision to abolish permit free training in 2006 because of short term target of ensuring the success of MTAS.

3-Inadequate remuneration for out of hours work which is forced upon non-consultant career doctors(SAS doctors and Clinical Fellows) and trainees.

4-Work intensity which is unsustainable for prolonged periods of time.

5-Emergency department overcrowding leading to a unhealthy work atmosphere.

Each of the above factors have multiple contributing factors. Until all stakeholders are willing to sit down and have a transparent constructive discussions this crisis will not be resolved. At the moment that is not happening and yet another short term fix is being planned by the people in charge of making these decisions. This is an ineffective way of dealing with the issues facing emergency medicine.