Dr Thomas Shanahan MRCEM

Column | Surprisingly tough Tennessee election reveals House GOP has base problem A hard-fought victory in once-safe Republican territory came as polls show conservative support on the wane for GOP congressional majorities.

Column: Tuesday’s surprisingly competitive special election in Tennessee, after President Trump won the district by 22 percentage points last year, shows that Republicans may be in trouble with their base for midterm elections.

The Grauniad headline vastly exacerbated the slightly confused report by claiming "soaring demand" as the cause. This, as you say, distracts from the key actions that would fix the problem.

Media reporting (and parts of the RCN report) seem to conflate "increased demand for urgent care" with "increased pressures on hospitals".

In doing so - they're obscuring the drivers of the problem and leading readers towards ineffective solutions (i.e. more staff, more funding).

But it draws the wrong conclusions on workforce: worsening A&E performance has happened despite 30%+ increases in the number of nurses working in hospitals since 2019.

RCN implies these increases are insufficient due to "increased demand".

But, as we've seen, this is just incorrect!

The full RCN report is mixed. It's reasonable to highlight high bed occupancy rates as a driver of A&E problems.

If there's nowhere to admit patients to, they're either stuck waiting for hours, receive (unsafe) corridor care, or are forced to leave before receiving treatment.

The data *in the report cited* is enough to disprove the hypothesis that poor performance is driven by increased demand. (See +3% attendances vs +8,033% in 12 hr waits)

The real cause of long waits in A&E is poor patient flow, driven by operational dysfunction in other parts of hospitals.

The poor outcomes in A&E are obvious to anyone who looks at the numbers or has simply been to an ED in the last few years.

But as @policyskeptic.bsky.social has repeatedly argued, incorrect diagnoses of the *drivers* of poor outcomes are obstacles to solutions which will improve performance.

Numbers leaving A&E without treatment triples in six years Soaring demand has led to ‘shocking’ rise in untreated patients leaving NHS emergency departments in England, data shows

Misleading write-up - it's true that there is a crisis in A&E, but this is not because of "soaring demand".

The RCN report itself shows that A&E attendances are only 3% higher than in 2019, while 12+ hour waits are 8,033% higher.

www.theguardian.com/society/2025...

Listening to the Aussie former players / commentators absolutely hammering England after the 1st innings. They sd know better - you cant judge until both teams have batted. Eng excellent bowling attack. Batting was at least at a clip.

Overseas-trained doctors leaving the UK in record numbers Medical bodies warn that hostility towards migrants is behind a 26% rise in departures last year that imperils NHS

"Record numbers of overseas-trained doctors are quitting the UK, leaving the NHS at risk of huge gaps in its workforce, with hostility towards migrants blamed for the exodus"

Slow clap to the anti-immigrant rhetoric

External validation of the Dutch prediction model for prehospital triage of trauma patients in South West region of England, United Kingdom This paper investigates the use of a major trauma prediction model in the UK setting. We demonstrate that application of this model could reduce the n…

Really happy to find out today the below paper got accepted as meeting the FACEM research requirement!!! Another requirement ticked off before starting in February

www.sciencedirect.com/science/arti...

The Reality Trap Reform's struggles in local government

New post just out:

"The Reality Trap"

On Reform's struggles running councils.

What it tells us about how they'd fare if they won a general elections. And about how broken our system of local government is.

(£/free trial)

open.substack.com/pub/samf/p/t...

The first report of the All-Party Parliamentary Group on Emergency Care has revealed the scale of corridor care in England, and the harrowing impact it has on patients.

The report, built on research compiled by RCEM through data, surveys and patient testimony, is here: rcem.ac.uk/press-rel...

November's EMJ podcast has dropped, featuring...

🐱Garfield the cat (guest appearance) & @drsarahedwards.bsky.social

🫀 Resuscitation manikins & diversity
🧠 Functional neurology
👶 Serious bacterial infection in infants
🚁 Sedation in HEMS

🍎 lnkd.in/ebTjEkSw
🎧 lnkd.in/ekZij7MD
🛜 lnkd.in/esHRsMBz

Emergency Medicine Special Skills Registrar Positions - ACEM Training Year 2026 (Flinders Medical Centre Emergency Department, Flinders Drive, Bedford Park SA, Australia) Southern Adelaide Local Health Network – Flinders Medical Centre – Emergency Medicine Total Indicative Remuneration Package: $106,225 - $172,348 MDP2 (pro rata) | Full Time, Contract in-line with SMOE...

Great opportunity for a research special skills #ED registrar job at Southern Adelaide Local Health Network - Flinders.

There is a great research team in SA and lots of efforts to develop research opportunities for #ACEM trainees.

jobs.acem.org.au/job/3106/eme...

RCEM responds to NHSE’s Medical Training Review   - RCEM Tuesday, 28 October 2025 - Dean of the Royal College of Emergency Medicine Professor Simon Carley responds to the first phase of the Medical Training Review (MTR) into postgraduate training of newly q...

Dean of the Royal College of Emergency Medicine Professor Simon Carley responds to the first phase of the Medical Training Review into postgraduate training of newly qualified medics, published by NHS England last week: rcem.ac.uk/press-releas...

NHSE’s three-year healthcare plan ‘offers no meaningful roadmap’ to tackle long waits in EDs  - RCEM Tuesday, 28 October 2025 - A plan which outlines NHS England’s priorities for the next three years 'offers no meaningful roadmap’ to reduce dangerous long waits in Emergency Departments.

A plan which outlines NHS England’s priorities for the next 3 years ‘offers no meaningful roadmap’ to reduce dangerous long waits in Emergency Departments.

Our response to NHS England’s Medium Term Planning Framework 2026/27-2028/29: rcem.ac.uk/press-releas...

My poster at the ANZ Trauma Society Trauma Conference in Wellington. Great few days learning about cutting edge trauma research and practice. Enjoyed catching up with colleagues, meeting up with the trauma in older people community of practice and thinking about future collaborations.

#ANZTS25

"We have a debt crisis so I've joined the party that was in power for 14 years and under whom debt massively grew."

"Commentator of the Year"

I do think this has been a week in which new levels of 'why don't senior Labour politicians understand we can ALL hear them' have been reached. Why would Andy Burnham do a 'I'm gonna hike taxes on London and the south, you're all rich!' Why would Steve Reed use 'regional politician' as a putdown?

Maintaining independence at home after a fall: a process evaluation of the MAINTAIN multicomponent intervention for people living with dementia AbstractBackground. People with dementia who have a fall can experience both physical and psychological effects, often leading to diminished independence.

New paper out in @age-and-ageing.bsky.social: Maintaining independence at home after a fall: a process evaluation of the MAINTAIN multicomponent intervention for people living with dementia. Read it here: academic.oup.com/ageing/artic...

Happy to have my TS2 rotations confirmed for next year - 9 months MMC Clayton ED and 3 months Casey anaesthetics. Now need to just find a place to live.

Work that leads to residence If you’re 55 or younger and want to live in New Zealand (NZ) permanently, you can apply for a resident visa, or a work visa that leads to residence after working here for 2 years.

Nau mai, haere mai.

www.govt.nz/browse/immig...

<em>Emergency Medicine Australasia</em> | ACEM Journal | Wiley Online Library Ambulance ramping is the situation where patients who arrive by ambulance are forced to queue for access to an emergency department (ED) cubicle. Despite efforts to address the problem of ambulance r...

What Factors Could Create a More Comfortable Waiting Experience for Patients on Emergency Department Ramps? A Scoping Review - Binnie - 2025 - Emergency Medicine Australasia - Wiley Online Library onlinelibrary.wiley.com/doi/abs/10.1...

An interim care plan model of care for direct inpatient admissions

doi.org/10.1111/1742...

@wiley.com
#MedSky #EMSky #EMedSky #emimcc #ACEM

Empiric antibiotics for acute pyelonephritis

doi.org/10.1111/1742...

#OpenAccess

@wiley.com
#MedSky #EMSky #EMedSky #emimcc #ACEM

The relationship between the duration of transfer and the risk of in-flight deterioration in aeromedical trauma patients

#OpenAccess

doi.org/10.1111/1742...

@wiley.com @emfoundation.bsky.social
#MedSky #EMSky #EMedSky #emimcc #ACEM

ED headache patients without neurological features who are diagnosed with a serious secondary headache cause

#OpenAccess

doi.org/10.1111/1742...

@wiley.com @gkeijzers.bsky.social
#MedSky #EMSky #EMedSky #emimcc #ACEM

The Gendered Double Burden in Emergency Medicine

doi.org/10.1111/1742...

@wiley.com
#MedSky #EMSky #EMedSky #emimcc #ACEM

Labour must champion inclusivity to tackle advance of far right, says deputy leadership hopeful Exclusive: Alison McGovern says party needs emotive storyteller to fight against division promoted by Reform

A debate Labour badly needs to have: