RCoA warns that one-third of anaesthetists are struggling to deliver effective patient care

New research released today by the Royal College of Anaesthetists (RCoA) shows that one-third of anaesthetists in UK hospitals find it hard to deliver safe and effective patient care due to wide-ranging lack of resources1. The RCoA is warning that a tipping point for patient care and clinicians will soon be reached unless these issues are addressed, threatening patient trust in NHS services.

Anaesthetists are the largest single specialty group of doctors in hospitals and play a critical role in the care of patients before, during and after surgery. Over two-thirds of hospital patients will come into contact with an anaesthetist.

Of the 5,196 UK anaesthetists who took part in the RCoA research, one-third indicated that a demoralised, fatigued workforce, inadequate facilities, disengagement and lack of co-operation by management, and the lack of qualified staff is restricting the delivery of safe and effective patient care.

However, this contrasts starkly with new research2 showing high levels of satisfaction among patients receiving anaesthesia.  A research study, led by The National Institute of Academic Anaesthesia’s Health Services Research Centre (HSRC), examined the quality of anaesthesia care of over 15,000 patients in 257 NHS hospitals. Over 85% of patients were very satisfied with their anaesthesia care, and 99% percent of the patients who responded to the NHS Friends and Family Test stated they would recommend the anaesthesia service3. Patients most commonly reported anxiety to be the worst aspect of their operation (33%), followed by pain (16%); thirst was also a commonly experienced symptom.

RCoA President Dr Liam Brennan said: “As highly skilled doctors who manage patients through their surgical journey, we treat patients when they are at their most vulnerable. We have worked as a specialty to build the trust and confidence of patients in anaesthesia, as the excellent results in our patient research show. Despite the difficulties that anaesthetists have told us they are facing, the findings that patient satisfaction with anaesthesia services are very high demonstrates what a professional job our members are doing.

However, it is unacceptable that one-third of anaesthetists in hospitals report patient care potentially being compromised. The results are a robust reflection of the issues that anaesthetists and the NHS face. For example, I have heard reports of anaesthetists being given no option but to have sensitive conversations with patients in corridors or on shared seating due to a lack of appropriately confidential facilities. While clinicians strive to provide the highest possible quality of care for all patients, those patients should have the utmost trust in the services their NHS provides.

“Along with workforce issues, demoralisation and spiralling service pressures, we are heading for a tipping point with implications for the welfare of both patients and clinicians. Our research results show that fatigue and morale is an issue across the whole anaesthetic workforce. We are working with our members and hospital leaders on practical solutions to help address these critical issues.

“The RCoA continues to press government for adequate funding for a sustainable NHS.  We are also working with Health Education England to address training and workforce issues. Although government has recently announced an additional 1,500 medical training places, those doctors that go on to specialise in anaesthesia will not complete their training until 2032 at the earliest. The increase in numbers, whilst welcome, will still not address the shortfall that was identified in the 2015 RCoA Medical Workforce Census4. The contribution of doctors from overseas, who make up 30% of the UK anaesthetic workforce, is invaluable and will remain invaluable for the future of the NHS.”


Notes to Editors

1. 17,844 RCoA members were emailed the 2016 RCoA membership survey. A total of 5,196 responded to the survey, and were representative of the wider membership.  Members were asked “Is there anything that makes it harder for you to deliver safe and effective patient care?” 1,914 (a third) responded and free text answers were assigned to four themes: lack of qualified staff; inadequate facilities; disengagement and lack of co-operation; demoralised and fatigued workforce. A total of 509 responses were categorised as “None” and were excluded from the final analysis.

The question’s full breakdown of 1,914 responses is as follows by numbers of members and quotes.  Responses are grouped into the four themes.

Lack of qualified staff
474  lack of medical staff (25%)
112  rota gaps (6%)
92  underqualified staff working at hospital (5%)

“…As a hospital, poor staffing levels do impact on the ability to deliver safe and effective care particularly in areas where there is a heavy reliance on the use of locums and agency staff.”

“Staffing levels are poor, often sickness or absence of one person can put the rota to unsafely low levels of staff with higher risks of mistakes.”

Inadequate facilities
324  shortage of beds, especially critical care beds (17%)
113  lack of access to quality medical equipment and drugs (6%)
79  poor or malfunctioning IT and communications infrastructure (5%)
32  condition, or lack, of medical facilities (2%)

“Not enough beds, therefore delayed admissions and longer days and corners being cut which potentially lead to unsafe practise..."

“…Inadequate or unavailability of accommodation often means little privacy, and may impact on consultation with and examination of the patients.”

“My theatres are falling apart, rebuild has been delayed again and again due to cost, tiny anaesthetic rooms, and tiny theatres with no prep rooms.”

“Equipment being changed to poorer quality cheaper alternatives without consulting anaesthetists.”

Disengagement and lack of co-operation
221  management makes it difficult (12%)
92  increase of (national) guidelines and targets (5%)
60  poor internal cooperation and communication (3%)

“Management too focussed on cost and short-term planning - failure to work across teams/departments. Failure to assist medical staff in improving patient and staff conditions. Top down driven management. Lengthy process to initiate change."

“Recognition of Management (NHS/Trust level) of the importance of anaesthetists in service delivery and the need to get them involved in decision making. Currently, no one understands what we do and how we do it.”

Demoralised, fatigued workforce
560 demoralised (23%).  Of demoralised anaesthetists, 57% are consultants, 34% are junior doctors, 4% are SAS doctors and 5% ‘other’ (on a career-break/working overseas/recently retired). Specifics include:
211  lack of funding (11%)
189  general “everything” (10%)
162  lack of time (9%)
131  lack of resources (7%)
121  overwork and exhaustion (6%)
106  bad morale amongst employees (6%)
53  lack of adequate staff facilities (3%)
47  lack of opportunities for training and professional development (2%)
13  atmosphere of bullying and intimidation (1%)

“Not enough time often to adequately pre-assess patients and spend as much time listening to and answering their concerns as I would like in the rush to get a list started in the mornings. I worry how it must appear to the patient when I am trying to see them in a few minutes and explain their anaesthetic before rushing off to see the next patient, then rush to the theatre to start the list.”

“Continuously being asked to work extra shifts due to rota gaps. Many trainees working well over 48hrs a week. Many trainees exhausted due to commute to work due to being rotated around hospitals that are many miles away.”

“Lack of adequate rest facilities on night shift. I strongly believe if work-load permits, an hour’s sleep in an `appropriate facility can protect against fatigue adversely impacting on subsequent clinical performance.”

2.  EMK Walker, M Bell, TM Cook, MPW Grocott, and SR Moonesinghe for the SNAP-1 investigators. Patient reported outcome of adult perioperative anaesthesia in the United Kingdom: a cross-sectional observational study. British Journal of Anaesthesia 2016. In press. A pre-publication version of this article (accepted for publication on British Journal of Anaesthesia http://bja.oxfordjournals.org) is posted on the RCoA website with permission of  the BJA and the authors. Upon formal publication later in 2016 the full article will be free to view.

3.  There are many positive anecdotal comments from patients responding to the Guardian blog on 21 July 2016 “The secret life of an anaesthetist: if surgeons are the blood, we are the brains.”

4.  Royal College of Anaesthetists 2015 Medical Workforce Census www.rcoa.ac.uk/census2015

27 October 2016