A new year and an opportunity to reinvigorate our work at the College.
\nAs I write this, in mid November, it is a challenge to put oneself in mind of 2015 albeit only 8 weeks\u00a0hence. On this day that I put pen to paper I have met with the Secretary of State who has informed\u00a0me of further money to be released to ease the winter pressures; indeed a considerable sum –\u00a0\u00a3300 million on top of earlier monies totalling \u00a3400 million.
\nOf course I welcomed this news (noting that this applies to England only) but emphasised the\u00a0need to ensure that such ‘rescue packages’ should become unnecessary. The press release we\u00a0issued reads as follows.<\/p>\n
The College of Emergency Medicine welcomes the announcement today of further funding for\u00a0urgent and emergency care. This represents the largest annual additional funding yet seen. The\u00a0College and the public will expect this money to ‘follow the patient’ and as such we will hold budget\u00a0holders accountable for the necessary investment in A&E staffing levels to ensure our patients\u00a0receive high quality care in a timely fashion.<\/p>\n
The College has campaigned for equitable funding of emergency care to enable hospitals to\u00a0provide adequate services, plan with confidence and avoid the need for an annual winter funding\u00a0announcement and the associated short term spending associated with it.
\nThe College President, Dr Cliff Mann, said: \u2018The greatest challenge facing A&E departments in the\u00a0UK is the chronic under-staffing of these units brought about by tariffs that are unfit for purpose and\u00a0contracts that discourage employment in emergency medicine.\u00a0Last year over \u00a3150 million was spent on A&E locums and in the last few years we have further\u00a0squandered \u00a3130 million training doctors who have emigrated to work in emergency medicine in\u00a0Australia.
\nThe government\u2019s investment of \u00a3700 million this year sends a powerful message to Monitor, NHS\u00a0England and NHS employers to address these issues that blight every A&E department in the\u00a0country.\u2019<\/p>\n
The College will indeed hold others to account. The sums involved equate to over \u00a33 million\u00a0pounds per department, although how much of this funding each of us sees will depend upon\u00a0commissioners, boards and many others. In consequence we will be writing to each Clinical\u00a0Service Lead or equivalent to determine whether or not this investment in our EDs has occurred.<\/p>\n
I have attended a number of great events recently, including the Military Tri-Service conference\u00a0and the Scottish EM forum. I was struck by two people in particular. The first is a lady who is a\u00a0serving member of the armed forces who has undertaken several tours in Afghanistan. In the UK\u00a0she is an EM consultant in a major city department. She recounted the pressures placed upon her
\nin both these locations summing her reflections with the phrase ‘it is far more stressful working the\u00a0late shift in my ED than any shift in Camp Bastion’.<\/p>\n
The second is the Chief Executive of Scotland’s largest Health Board. He described how staffing\u00a0problems at middle and senior level in one of his emergency departments had almost led to its\u00a0closure. Through ingenuity and a targeted recruitment campaign they managed to secure five new\u00a0middle grade doctors. However the week before they were due to start he was informed one had\u00a0withdrawn as they had been unable to rent their apartment and couldn’t therefore afford the rent on\u00a0a second property in Scotland. The CEO intervened as a months rent in Edinburgh was less than\u00a0the cost of a weekend locum.<\/p>\n
So we find ourselves in the second decade of the 21st century with military personnel more\u00a0stressed by their own UK department than life in a war zone and CEOs reduced to arranging rental\u00a0agreements for accommodation for ED middle grades. Nothing could more eloquently encapsulate\u00a0the need for proper funding of our departments and equitable contracts for our workforce.<\/p>\n
A recurrent theme of my epistles has been the persistent misrepresentation of the real ED world.<\/p>\n
We were told there is no crisis in EM staffing – why then did HEE invest \u00a350 million in new posts?<\/p>\n
There was no problem with the activity data – why then did the DH and Treasury agree to let the\u00a0College lead the work to create a proper system and allocate \u00a31 million to enable it. We were told\u00a0that terms and conditions were not a barrier to recruitment – why then did the Secretary of State\u00a0agree they were when speaking at the dispatch box in parliament. We were told that many\u00a0organisations would not recognise the terms ‘exit block’ and ‘overcrowding’ – but we succeeded in\u00a0ensuring they formed part of the DH Winter Planning Guidance. We were told that the issues we\u00a0were exercised by were ‘niche’, ‘complex’ and ‘esoteric’ – why then did the BJHM commission us to \u00a0write a series of articles on these very topics and devote their entire November edition to them. I\u00a0could go on. Suffice it to say that it is for this reason our March policy conference will take the form\u00a0of a ‘myth busting’ exercise aimed at Trust executives, commissioners, managers as well as\u00a0clinicians. We have made great strides in publicising our message but much remains to be done. I\u00a0can assure you that wherever you work, in the UK or Ireland, the College will strive even harder in\u00a02015 to correct these myths, inform the debate with reliable data and argue a cogent case to\u00a0ensure the CEM10<\/a> are delivered. I wish you all a very happy 2015.<\/p>\n