The NHS across the UK is currently under the most severe pressure it has ever faced. There are senior clinicians and managers who are profoundly concerned that services could collapse in some areas in the coming weeks.

The Omicron variant of COVID-19 is clearly a huge threat to the population. While we don’t yet know how harmful it can be, it appears to be highly transmissible so that many thousands of people are likely to catch the virus. At that scale, we must expect significant numbers of people will require either care from their GP or potentially life-saving treatment in hospital. Some modelling suggests NHS services could be overwhelmed within a few weeks.

This is, in part, because we simultaneously have our urgent and emergency care services in secondary care and our GP services under unprecedented strain. With the extraordinary pressures in general practice, the ambulance service, emergency departments, wards, and social care the whole system is in a precarious position.

The Academy of Medical Royal Colleges and all its members believe it is essential to recognise that the problems of COVID19 and the crisis with urgent and emergency care are inextricably linked.

 One of the key reasons that patients are not flowing through the system into A&E departments and then out again into hospital if required, is that there are insufficient beds available in hospitals.  We believe that the total bed numbers are in themselves insufficient, but the problem is compounded by the fact that many beds – 7672 at the start of this week –  are currently occupied by patients with COVID19. Infection, prevention and control measures also require greater spacing for beds and treatments which further reduces the capacity.

 In most places opening additional beds is not a viable option either because there is simply not the available space in hospitals or, most commonly, there is not the workforce available to staff the beds.

At the same time, social care is facing inordinate pressures which are making discharge from hospital into care more difficult.

This is why it is essential to ensure that we do all we can to ensure that hospitals do not face a flood of COVID admissions in the new year. Additional COVID patients would occupy bed spaces which will not then be available for other patients coming out of emergency departments. This then results in further delays in emergency departments and ambulances.

However, it is also important that urgent surgery and treatment continues to be provided by the NHS, and where possible, planned operations will continue too. Anyone waiting for planned surgery who finds their condition is deteriorating should come forward.

It is essential to break this vicious circle and to do it quickly. And the best way to do this is to ensure as everyone is not only vaccinated, but also gets their appropriate booster jabs along with strict and comprehensive adherence to personal prevention measures.  

Vaccination benefits everyone, including children and young people, those pregnant and seeking to become pregnant and particularly those who are immunocompromised or with underlying health conditions.

The Academy and Colleges believe there is a responsibility on the public to have their vaccinations and boosters and strongly support the government’s push for a mass booster programme.

However, the logistics of providing a booster jab for almost a million people a day until the end of the month are simply enormous. And it has to be recognised that seeking to deliver this – which is essential – will have knock-on consequences.

Doctors and other staff who are delivering booster vaccinations will not be delivering care to other patients. This inevitably means that there will be patients who are not going to be treated at the time they should be. That will have potentially serious implications for some patients.

Tackling this crisis requires:

  • An honest dialogue with the public about the scale of the challenges and their implications whilst not discouraging people from seeking urgent or emergency treatment
  • Full commitment to the vaccination booster programme
  • Clear consistent messaging to the public about the importance of continued diligent use of infection prevention and control measures and remote working – the current differences across the four UK nations are unhelpful and inevitably undermine public health messages
  • Political leadership which acknowledges the issues and seeks to harness the expertise of clinicians and managers and the experiences of patients in a collaborative fashion to address them
  • Recognition of the pressures staff are under and the impact of staff shortages which could potentially lead to issues of patient safety as the GMC has acknowledged.
  • Acceptance that too many staff are close to breaking point and require appropriate support to safely remain in their crucial roles
  • Renewed efforts to address the workforce pressures both in the long term, as set out in the proposed workforce planning amendment to the Health and Care Bill, and with short term measures as the Academy has set out in its publication “A dozen things the NHS could do tomorrow to help the medical workforce crisis

 

A version of this statement was set out in an opinion piece in the Guardian by Academy Chair, Professor Helen Stokes-Lampard, on 14 December.

15 December 2021