12:35 GMT27 January 2020
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    A&E nurses are warning that pressures impacting on the NHS in winter are compromising patient’s safety. For the first time in a decade, A&E departments missed the four-hour waiting target for almost all of their patients.

    95% of hospital admissions had to wait for more than four hours from the time they arrived to when they were transferred or discharged.

    The National Institute for Health and Care Excellence, NICE has issued guidelines for A&E departments to make sure there are enough nurses on the ward. It says the guidance will help hospitals to plan for safe staffing levels, so that they can meet the demands for their emergency services.

    Over 14 million people attended A&E departments in England last year.

    NICE suggests that there should be two nurses per patient in major trauma or cardiac arrest incidents. And there should be one nurse for every four cubicles in major and minor cases.

    “From being involved in a major trauma such as a car accident to the sudden worsening of a chronic condition like heart failure, medical emergencies can affect anyone at any time,” says Professor Mark Baker, director of clinical practice at NICE.

    Thousands of people come to major A&E departments every week, says Miles Scott, chief executive of St George’s Healthcare NHS Trust. “They range from serious injuries and illnesses to blood loss after an accident, to severe chest pain, to loss of consciousness.”

    Scott says organisations also need to be prepared for unpredictable peaks in patient numbers.

    Picking up the Pieces

    It’s not just doctors and nurses across the NHS and in A&E departments feeling the strain. The charity sector is being stretched beyond breaking point.

    Asheem Singh, Director of public policy at the Association of Chief Executives of Voluntary Organisations, (ACEVO), says due to cuts made by successive governments, an ageing population and crisis levels at some A&E departments, charities are being called upon more and more – but with less support to relieve pressure on NHS staff.

     “The government really need to wake up and realise this,” says Singh.

    The third sector has been relieving pressure for years, working with patients and vulnerable people. Charities are always the first service on the scene to pick up the pieces.

    “The government need to recognise the extent that charities are being called upon and put in place a clear plan to make sure the right charities in the right areas of the country are being properly used. Charities, like the British Red Cross are really feeling the strain.”

    Asheem Singh says the services charities already provide — and can provide, need to be accurately scaled up across the country, so that the most at risk areas are targeted efficiently.

    “British Red Cross home-helpers keep patients at home and prevent them from having a problem in the first place. If a patient has a relationship with a charity they won’t call the doctor or admit themselves to hospital.”

    “There’s a sense amongst our members that charities have to deliver more and more, and with less – and that is a problem,” says Singh.

    ACEVO has produced a plan for the government and charities to use help when the country is under pressure. “Charities are really making a difference but they need joined up proper agreements to make a real difference. Not just during the winter – but also to make sure the NHS is properly equipped in the future to deal with problems,” says Singh.

    Responding to the Reality

    Responding to the guidelines, Dr Peter Carter, chief executive and general secretary of the Royal College of Nursing says A&E departments are at breaking point.

    “They are facing huge demand for their services with patients having to wait for very long periods or being treated in corridors. For many years A&E departments have been understaffed or staffed with temporary and less experienced nursing staff.”

    Safe care cannot be delivered without safe nurse staffing levels, says Dr. Carter:

    “Staff to patient ratios are important but we may be years away from having a permanent solution to this problem, even if the level of demand stays the same – if it rises further, this will be even more difficult.”

    Dr Carter from the Royal College of Nursing says demand for A&E services can’t simply be solved within A&E:

    “Across the board, investment in nursing is needed now.

    Many A&E departments have been understaffed, or staffed with temporary or less experienced nursing staff for years,” says Carter.

    Professor Baker, director of clinical practice at NICE says: “As demand on A&E services continues to increase, we want to ensure that each and every A&E department across the country is clear on how to get nurse staffing right and is able to provide safe care to the millions of patients who walk through the door”.

    NICE is calling for feedback from nurses, emergency care professionals, the public and hospital trusts ahead of the final guidelines for the health service.

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