THERE MUST BE ‘A FULL RECRUITMENT INTO EMERGENCY MEDICINE’ – essential for the safety of patients

Lobby of the High Court last Wednesday demanding a judicial review to stop the closure of Ealing Hospital
Lobby of the High Court last Wednesday demanding a judicial review to stop the closure of Ealing Hospital

THE College of Emergency Medicine on Monday announced guidelines titled Creating satisfaction and maintaining wellbeing in Emergency Medicine.

The College of Emergency Medicine said in s statement it ‘recognises the tremendous pressures being placed on senior staff in Emergency Departments.

‘The publication last week of Stretched to the limit – a survey of Consultants in Emergency Medicine in the UK has provided strong evidence to confirm this.

‘We are presently in discussions with government, healthcare regulators, commissioners, the BMA and NHS Employers on ways in which we can improve aspects of system design and working conditions to make care delivery consistently safe and effective in our emergency departments.

‘We also recognise that we need to provide guidance for employers and commissioners on ways in which to protect the senior medical workforce in Emergency Medicine in their present working practices.

‘This is vital not only to retain safe, sustainable working but also to create careers that are attractive to our future trainees and satisfying for our present colleagues.

‘We appreciate that in some parts of the UK and Ireland the situation is much worse than in others and that these “fragile” systems need extra support with a range of networked solutions.

‘To address these issues, the Professional Standards Committee of the College formed a working group in early 2013 that has now produced a set of resources, the first of their kind by the College, collectively called Creating satisfaction and maintaining wellbeing in EM.

‘This initial guidance is now available on the College website for consultation for two months.

‘Over the next year, we will continue to engage with colleagues around the UK and Ireland, as well as internationally, to gather the best available evidence-based strategies in this important area and to develop the guidance further.’

Dr Taj Hassan, Vice President of the College said: ‘We believe that these materials are an important contribution to the way in which clinicians and managers can work together to create sustainable and satisfying careers in Emergency Medicine.

‘We are seeking constructive feedback over the next 6 weeks to ensure that we can refine what we have produced and address the major areas of concern.’

Dr Clifford Mann, President of the College said: ‘This consultation report shows that the College is committed to playing its part in resolving the current crisis.

‘However, many of the necessary actions are the responsibility of others.

‘The College expects all stakeholders to take the necessary actions to ensure full recruitment into emergency medicine as a sustainable career.

‘This is essential to ensure the future safety of patients requiring emergency care.’

The College of Emergency Medicine is the single authoritative body for Emergency Medicine in the UK.

The College works to ensure high quality care by setting and monitoring standards of care, and providing expert guidance and advice on policy to relevant bodies on matters relating to Emergency Medicine.

The College has over 4,000 fellows and members, who are doctors and consultants in Emergency Departments working in the health services in England, Wales, Scotland and Northern Ireland, Eire and across the world.

l The first ever study to evaluate the economic cost of cancer across the 27 countries of the EU has found that the total cost of cancer in the EU in 2009 was 126bn euros, with cancer in Germany, France, Italy, and the UK together accounting for just over two-thirds of this cost (83bn euros).

The results, published in The Lancet Oncology, reveal substantial disparities between different countries in the EU in spending on health care and drugs for cancer, with Luxembourg and Germany spending the most on health care for cancer per person, and Bulgaria spending the least.

Overall, expenditure on drugs for cancer accounted for around a quarter of the total cost (14bn euros). Spending on cancer medications as a percentage of health care costs was lowest in Lithuania, and highest in Cyprus.

A team of researchers from the Health Economics Research Centre, at the Nuffield Department of Population Health, University of Oxford, UK, and from King’s College London, Institute of Cancer Policy and KHP Cancer Centre UK, collated data obtained from international health organisations (WHO and EUROSTAT), as well as national ministries of health and statistical institutes to estimate the total cost of cancer across the EU in 2009, the most recent year for which comprehensive data were available.

The overall calculation included the cost of health care for cancer (including the cost of drugs), the cost of productivity losses (due to premature death, and people being unable to work due to illness), and the cost of informal care from friends and relatives, estimating the overall cost in 2009 to be 126bn euros.

Around two fifths (51bn euros) of this cost was incurred by health care systems, with the rest incurred by patients’ families, friends, and society overall.

Friends and relatives of people with cancer were estimated to have provided three billion hours of unpaid care overall, valued at 23.2bn euros. Lost productivity – due to premature deaths and illness from cancer – was estimated to have cost 52bn euros.

The researchers also examined the different contribution of the four cancers which in the EU contribute to around half of all new cancer diagnoses and deaths – breast cancer, colorectal cancer, lung cancer, and prostate cancer.

They found that lung cancer had the highest overall cost, at 18·8bn euros (just over a tenth of the total), and was also responsible for the biggest loss of productivity.

Health care costs were highest for breast cancer (6·7bn euros, 13 per cent of total cancer-related health care costs), largely due to a high rates of spending on drugs for this illness.

What is more, the researchers point out that these estimates are conservative, as some categories of health care costs, such as screening programmes, were not included due to the inability to obtain these data for all countries under study.

Previously, the same researchers used the same methods to estimate the economic burden due to cardiovascular disease, allowing these estimates to be compared to the new figures for cancer.

While the overall economic burden due to cardiovascular disease in the EU is higher than that for cancer (195bn euros vs 126bn euros), the cost of productivity losses due to premature death was nearly twice as high for cancer as that for cardiovascular disease (43bn euros vs 27bn euros), reflecting the higher number of cancer-related deaths in people of working age.

Professor Richard Sullivan, King’s College London, said: ‘More effective targeting of investment may prevent health care systems from reaching breaking point – a real danger given the increasing burden of cancer – and in some countries better allocation of funding could even improve survival rates.’

Writing in a linked Comment, Professor Gary Lyman of Duke University School of Medicine, Durham, USA states that, ‘Implementation of high-quality cancer care is difficult without a thorough understanding of the total burden of disease and the resources needed to provide appropriate care. . . .

‘This is a comprehensive and detailed assessment of cancer costs in the EU from a societal perspective, modelled on similar previous work assessing the economic burden of cardiovascular disease and dementia in the EU.’