PERFORMANCE: Patient safety at 18 accident and emergency departments in the West Midlands cannot be guaranteed according to a joint letter signed by leading clinicians from across the region.

In the letter, sent to acute hospital chief executives and clinical commissioning groups in the West Midlands, the group of emergency department clinical leads say their departments are in a “state of crisis” which needs to be “urgently addressed.”

As data shows A&E departements across the country struggling to cope the clinicians warn: “The position is such that we can no longer guarantee the provision of safe and high quality medical and nursing care in our emergency departments.

“It is not a case of standards slipping, but the inevitable consequence of being forced to work in sub-standard conditions. The aforementioned issues have led to us routinely substituting quality care with merely safe care; while this is not acceptable to us, what is entirely unacceptable is the delivery of unsafe care; but this is now the prospect we find ourselves facing on too frequent a basis.”

The letter claims the 18 A&E departments manage more than 1.5 million patient attendances each year, 8.5 per cent of all A&E attendances in England.

It claims all 18 departments have seen “inexorable rises” in year on year attendances, with increasing intensity and an older population with more complex needs.

This adds up to what the letter describes as “toxic overcrowding, the likes of which we have never seen before.”

Nurses and doctors are providing care in corridors with patient privacy and dignity being sacrificed, the letter says, adding staff are “frequently operating at the absolute margins of clinical safety.”

In a stark warning to NHS leaders the letter continues: “Our departments are simply not equipped to safely care for such numbers of patients. All of the available evidence demonstrates that in-hospital mortality is increased when the ED is overcrowded and patients have to wait excessively for beds. Such overcrowding is now the norm in our EDs.”

As a result of the pressure the doctors warn of an “inevitable” increase in serious clinical incidents and complaints, as well as delays and deficiencies in care.

“For every incident reported, we know there are multiple examples of substandard care that go under the radar. We and our staff are carrying a huge burden of clinical risk which no other agency seems willing or able to share.”

The letter also highlights the lack of emergency staff claiming junior doctors are unwilling to join the service due to the “Herculean burden of work, responsibility and clinical risk”.

It warns of “institutional exhaustion” among A&E staff at all levels adding: “recruitment is almost impossible, and retention is becoming hugely challenging.”

They warn that the introduction of the NHS 111 number and penalties for delaying ambulance crews will not be solutions but instead will add to the problems.

“The unilateral and dictatorial manner in which these and other policies have recently been introduced have only served to compound the problems in our departments,” it says.

The letter calls for clinical leads in A&E departments to be involved with changes to the system and A&E reconfigurations.

It concludes: “We call urgently on behalf of our patients and our staff for a radical health economy-wide response to the urgent care needs of the population of the Midlands. We furthermore call for our EDs to be suitably staffed and supported whilst under such pressure and while longer term solutions are put in place.”

The trusts and hospitals represented in the letter are:

  • Mid-Staffordshire Foundation Trust;
  • Burton Hospitals Foundation Trust;
  • University Hospitals Coventry and Warwickshire Trust;
  • Solihull Hospital; Worcester Royal Hospital;
  • University Hospital of North Staffordshire;
  • Worcestershire Acute Hospitals Trust;
  • Alexandra Hospital, Redditch;
  • Walsall Healthcare Trust;
  • Heart of England Foundation Trust;
  • Shrewsbury and Telford Trust;
  • Dudley Group of Hospitals Foundation Trust;
  • Sandwell and West Birmingham Hospitals;
  • Good Hope Hospital, Sutton Coldfield;
  • South Warwickshire Foundation Trust;
  • Birmingham Children’s Hospital;
  • Wye Valley Trust, Hereford.