Shortage of emergency department doctors needs urgent action, says watchdog.

England’s spending watchdog has urged health bosses to deal with staffing shortages in NHS emergency departments as part of a package of measures to tackle rising numbers of admissions. The National Audit Office also said that the Department of Health had to encourage more doctors to work in accident and emergency, remove barriers to seven day working in hospitals, and ensure greater use of geriatricians. The recommendations were in a report, published on 31October, which also said that too many unnecessary emergency admissions were disrupting services to patients. In 2012-13 England had 5.3 million emergency admissions in England, up from 3.6 million in 1997-98, a 47% rise. In 2012-13 emergency admissions cost around £12.5bn (€14.7bn; $20bn), said the report, and hospitals with high numbers of emergency cases were more likely to struggle financially. The National Audit Office said that many factors were behind the rise, including “systemic” and policy issues, changing medical practice, demographic trends, and pressures facing emergency departments. Significantly, the proportion of patients attending emergency departments who were admitted for short stays was rising, it said. In 2012-13 over a quarter (26%) of all patients who attended a major emergency department were admitted, up from 19% in 2003-04. Emergency admissions within 30 days of a previous hospital admission have also been rising. At the same time, increased bed occupancy had limited the capacity of some hospitals to cope in winter, and delayed discharges had put further pressure on bed availability. Amyas Morse, head of the watchdog, said, “Many emergency admissions to hospital are avoidable, and many patients stay in hospital longer than is necessary. This places additional financial pressure on the NHS, as the costs of hospitalisation are high.” The report said that emergency departments and admission to hospital had come to be seen as the “default route” for urgent and emergency care and that the NHS had been “slow to develop comprehensive effective alternatives.” Many people, including frail elderly people with chronic conditions, could be treated more effectively in primary, community, and social care, and services should be better integrated, it said. The National Audit Office said that the Department of Health, NHSEngland, Health Education England, andNHS trusts should develop strategies to tackle staffing shortages in emergency departments. A shortage of senior (middle grade and consultant) doctors trained in emergency medicine was a problem in nearly all emergency departments, and a 50% vacancy rate in trainee posts would lead to a shortfall of senior trainees and future consultants, it said. Short term measures may need to include changing the mix of staff in emergency departments, such as making greater use of geriatricians. The report said that early senior clinical input into diagnosis and treatment could prevent admissions. The report concluded, “Improving the flow of patients will be critical to the NHS’s ability to cope with future winter pressures on urgent and emergency care services.” Until such systemic issues were dealt with, value for money in managing emergency admissions would not be achieved, it said. Richard Thompson, president of the Royal College of Physicians, welcomed the report, saying that the college had reached similar conclusions on restructuring acute care. He said that the college agreed that more doctors from other medical specialties should be available to manage patients on acute medical wards and to have a wider responsibility for identifying andmanaging patients with acute medical problems in the community. CliffordMann, president of the College of EmergencyMedicine, said that the college would be responding in detail to the report’s “authoritative” recommendations.