Many of you will have been looking forward to this holiday period as one in which things might be a little more ‘normal’ for the NHS, but instead it is shaping up to be more extraordinary than ever.While our third Christmas under the shadow of COVID-19 won’t see as many coronavirus cases as a year ago, it is still very much having an impact on hospitals – earlier this month there were 6,957 people with COVID-19 in hospital in the UK (6,720 of them in England).
This time, however, we must also deal with hospitalisations due to the much-predicted increase in flu, some of it very serious, and invasive group A streptococcal disease (iGAS). At the same time, hundreds of beds in our already diminishing bed base are closed due to norovirus, and hundreds more are occupied by patients who are medically fit for discharge, but unable to leave hospital because of a lack of social care provision.
And then, making everything even harder, there is the ongoing workforce crisis. As a mother memorably told the health secretary at her daughter’s hospital bedside this week, ‘we were short of doctors, we were short of beds going into the pandemic’ – but the shortage is now felt much more keenly. The workforce feels undervalued as well as overstretched, with many seeing little option but to resort to industrial action. I hope the government will urgently step up, listen to them and negotiate.
In the meantime, we have to consider and plan for the impact of winter viruses and reduced capacity. This week we are hearing that transfers of patients between hospitals by ambulance may become very limited, which could have an impact on clinical treatments and outcomes.
We have recently worked with partner organisations to produce a new statement laying out priorities for urgent and emergency care for patients with acute medical presentations. Focused on deliverable interventions and avoiding delays, the statement includes ten updated recommendations to hospitals and integrated care systems. At this time, we’d also like to remind you about our ethical guidance on conversations for ethically complex care, providing care in a system under pressure and endemic COVID-19.
Further to its recent joint letter with the four chief medical officers, mentioned in my last email, the GMC has announced that it will make initial contact with a doctor by phone if it needs to investigate a concern about a doctor’s practice, as part of a more compassionate approach and to reduce anxiety for doctors.
All of this said, I want to use this, my last bulletin of the year, to offer not just my thanks but also my promise that we will keep doing all we can on your behalf and for an NHS that feels more and more fragile.
The message about needing to increase the size of the workforce is hitting home and we will continue to use the RCP’s influence to shape solutions to the health service’s many issues. That will take time, I know, but we are also trying to improve the here and now, while signposting anything that will help you to deliver the care which I know you want to provide for your patients. We will continue to lobby for more doctors and for the other professionals who are part of our team, and we’ll continue to work with national improvement programmes to optimise patient pathways and improve the patient experience.
I don’t underestimate how difficult this winter is and will continue to be, at work and at home with the cost-of-living crisis, but I hope that you are all able to have some much-needed and well-deserved time off with family and friends. I wish you a happy festive season and look forward to working with you next year.
Dr Sarah Clarke
President
Royal College of Physicians