A&E Improvement Campaign Launched

The body which represents A&E doctors has launched a campaign aimed at improving the quality and safety of emergency care in Scotland's NHS. The Royal College of Emergency Medicine's (RCEM) Step campaign sets out a series of measures to address the problems facing A&E departments across the country. It comes as many NHS boards continue to struggle to meet national A&E waiting-time targets. The campaign calls for safe and sustainable'' staffing levels andfair and effective'' terms and conditions and funding. It also calls for exit blocking'' and overcrowding to be tackled by locating primary care NHS services alongside emergency departments. The RCEM said that while the number of A&E consultants in Scotland has increased, it is still short of the target of 230 whole-time equivalent agreed with the Scottish Government in 2012. It warned that trainee doctors are exiting the speciality insignificant numbers'' while more doctors and consultants are emigrating to work abroad. It has called for the life-career fit'' of emergency doctors to be addressed by reviewing terms and working conditions, and for more to be done to retain and value trainees. Over-reliance on more costly locum doctors is also inhibiting the development of a sustainable service and this money could be allocated to improve the working conditions of emergency doctors, the RCEM said. It has also urged the Government and health boards to undertake an evaluation of funding for A&E. Meanwhile, exit blocking - when patients cannot be transferred from emergency departments and admitted into a hospital bed - must also be addressed, the RCEM said. It believes the issue should be dealt with by co-locating primary care facilities with A&E units to make transfers faster and more safe. Dr Martin McKechnie, vice president (Scotland) of RCEM, said:This campaign is essential for providing immediate support to, as well as ensuring the future of, Scotland's emergency departments. The college welcomes the support the Scottish Government has given to increasing staffing and tackling crowding in our emergency departments.We now need real action to be taken to champion our talented emergency medicine workforce, otherwise we will continue to lose staff to emigration and to other specialities. We must recognise and value the importance of emergency medicine to NHS Scotland.'' The campaign has been welcomed by the Royal College of Physicians of Edinburgh (RCPE) but the Royal College of Nursing (RCN) Scotland warned against an isolated approach. RCPE president Professor Derek Bell said:The Step campaign highlights issues that are also being considered by the Scottish Government's unscheduled care review and it is important that both these initiatives are supported and driven by all professions associated with health and social care, and that a whole system approach is planned and adopted.'' RCN Scotland director Theresa Fyffe said: Focusing on A&Es in isolation is an oversimplification of the problem.So, instead of taking a piecemeal approach - via individual taskforces such as on delayed discharges, out-of-hours services, seven-day services and unscheduled care - we think the Scottish Government should put in place a sustainable approach to the whole health and social care system.''

Health Secretary Shona Robison said: The four points suggested by the college are relevant and in line with the work we are already doing to improve A&E performance as it faces challenges like increased demand and an ageing population.

For example, we have continued to drive increased recruitment.

Since September 2006 the number of emergency medicine consultants has risen from 75.8 whole time equivalent staff to 205 - an increase of 170.6% and we are committed to working with the RCEM on this issue.

The new emergency department workload tool, which will be rolled out later this year across Scotland, is being designed with doctors and nurses to help ensure that hospitals continue to have in place appropriate staffing to meet the variable workload demands.

Our new collaborative approach to unscheduled care across Scotland, developed in partnership with RCEM, aims to ensure the whole NHS system works together effectively. That includes working specifically with primary care and GP services to deliver solutions.

Fixing the exit block from the emergency department and how a patient moves back into the community is also a priority.

We have committed £100 million specifically to help tackle delayed discharged and are piloting innovative, world-leading ideas on patient flow.

Finally, our consistent commitment to funding the NHS and in particular our accident and emergency departments is clear.

The three-year, £50 million investment in an unscheduled care action plan demonstrates that, as does the increases in funding for all boards.''