Emergency Medicine – 10 priorities Dr Cliff Mann FRCP FRCEM President of the Royal College of Emergency Medicine

Maximum to minimum ratio Reported numbers of A&E staff or facility per 100,000 attendances per annum in 2014 Type of staff or facility Minimum Maximum Average Maximum to minimum ratio   Consultants 5.5 20.8 10.1 3.8 Junior doctors 2.7 14.8 7.7 Career grade Drs 1.0 24.5 7.0 ENPs 5.0 69.0 13.4 13.8 Total nursing staff 39.0 165.0 94.0 4.2 Resus cubicles 2.0 9.0 4.8 4.5 Patient trolleys 6.0 50.0 29.0 8.3 (from the NHS Benchmarking Network’s data)

ED unlike in-hours care provided on an appointment system basis has huge hourly variations in consultation requirements

Irrevocable loss of capacity 368 registrars 2000 patients each 736000 patients 12 DGH EDs Working life of 35 years 25 million patients There is one EM Consultant for every 11,500 attendances. Productivity increase of 7%

Sustainable Staffing EM doctors EM practitioners ACCS posts Increase from 225 to 325 Attrition From 50% to 25% DREEM Over 100 in 2 years Current fill rate for HST 79% Physicians Associates Faculty @ RCP ANPs Credentialing using RCEM curriculum from May 2016 Real interest in GPs credentialing in EM

Whilst it is essential to manage demand on EDs, this should not detract from building capacity to deal with the demand faced, rather than the demand that is hoped-for.

Comparative national public spending:

£1.6 billion £8.5 million Budget for 186 A&E departments Average annual budget per department

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4 hr standard

Performance against the 4-hour standard is a useful proxy measure of crowding. ‘Performance against the four-hour standard shows how this standard is actually a quite sophisticated measure of complex interactions within the whole of a local health and care system’

The main causes of ED crowding include surges in demand and lack of access to beds in the hospital system due to poor patient flow and high hospital occupancy rates ED crowding adversely affects every measure of quality and safety for patients & staff.

Emergency departments (EDs) should be fully resourced to practice an advanced model of care where the focus is on safe & effective assessment, treatment and onward care.