John Houlihan


Call for action Kathy Moore explains why she presented a resolution on the crisis in emergency care at RCN congress last month AT RCN congress in Bournemouth last month, I presented a resolution calling on council to put pressure on the UK governments to address the crisis in the emergency care service. This was presented on behalf of the East Dorset branch. I do not work in an emergency department (ED), minor injury unit (MIU) or acute hospital, so you may wonder why I proposed this resolution. As a nurse, I cannot ignore what I hear from branch members, colleagues and the media. A colleague who has worked in an acute setting for 40 years told me recently she has never experienced such relentless pressure on her ED as she did last winter. We all know about the crisis in EDs and how the care of our patients is being compromised. In the first week of January this year, for example, 14 trusts in England declared major incidents as waiting times soared to the worst on record (Donnelly and Malnick 2015). Availability of acute beds has fallen, ED attendances have increased and as a result patients are receiving care on trolleys in corridors. Long waiting times in EDs mean poor patient experience, but they also compromise patient safety and reduce clinical effectiveness. EMERGENCY NURSE

Despite campaigns to educate the public about types of injuries and illness that require emergency treatment, people continue to use EDs inappropriately. They do so partly because the wider healthcare system is difficult to navigate and they are confused about how to use telephone advice lines, MIUs and walk-in centres. EDs are the easiest places to go for people who are worried, partly because the lights are always on, and asking them not to do so is counter intuitive. Blueprint We should not forget that, due to cuts in social care and community services, beds are not being freed up as quickly as they should be. Between 15% and 30% of people who visit EDs could be managed in primary care (Triggle 2013), but there is a problem with the system and, in the past decade, the number of district nurses has been cut. The old winter crisis has become ‘an all-year-round crisis’, pressure is relentless, hospitals are reaching tipping point and there is a major workforce-workload imbalance. To improve the situation, a blueprint for urgent and emergency care was unveiled in November (Moore 2014). This involves improving self-care, out-of-hospital and

the NHS 111 telephone advice service, as well as better signposting and networks across emergency care. However, these improvements are expected to take between three and five years. Individual EDs and hospitals are relieving pressures by boosting nurse staffing levels, improving skill mix and staff ratios, employing emergency nurse practitioners, introducing patient flow co-ordinators and developing specialist services to target frequent attenders. But all parts of the healthcare system need to work together to ensure patients receive the right care, in the right place at the right time. I hoped that the debate last month would give people the opportunity to share ideas and best practice, and to provide RCN council with the ideas, ammunition and evidence to continue the discussions with government. As nurses, we work across all sectors of patient care, so we are best able to identify what needs to be done to improve pathways for our patients. The resolution sparked great debate, so much so that individual debating time was limited to one minute so that as many people could speak at the mic as possible. Members commented, for example: ‘Patients who were not seriously ill were attending EDs due to problems with GP and 111 services’, ‘Episodic cash injections are merely a shot in the dark’ and ‘Patients are still queuing to be admitted and this is in the middle of summer’. The resolution was overwhelmingly passed and created national media interest. I hope the work taken forward by RCN council will ensure appropriate investment in community services to provide an alternative to emergency care, prevent inappropriate admission and encourage timely discharge from hospital. See also feature, pages 14-19 Kathy Moore is an interim operations manager for continuing health care at NHS Dorset Clinical Commissioning Group

References Donnelly L, Malnick E (2015) A&E crisis: soaring numbers of hospitals declare major incidents. The Telegraph. (Last accessed: June 29 2015.) Moore A (2014) Action stations to relieve A&E. Nursing Standard. 28, 27, 20-22. Triggle N (2013) Staff under ever more pressure as patient demands grow. Emergency Nurse. 21, 4, 6-7.

July 2015 | Volume 23 | Number 4 11

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Call for action.

AT RCN congress in Bournemouth last month, I presented a resolution calling on council to put pressure on the UK governments to address the crisis in ...
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