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Staffing shortages force NHSE to abandon safety target

NHS England has this week told trusts it is abandoning a patient safety target ‘until maternity services in England can demonstrate sufficient staffing levels’ to meet it.

The Midwifery Continuity of Care model was designed to ensure expectant mothers would be cared for by the same small team of midwives throughout their pregnancy, labour and postnatal care. It was a key recommendation of 2016’s Better Births review of English midwifery services.

NHSE’s chief midwifery officer for England Jacqueline Dunkley-Bent championed the policy and guidance on its implementation was issued in October.

However, in her report on the care failures at Shrewsbury and Telford Hospital Trust’s maternity department, Donna Ockenden said the Midwifery Continuity of Care model should be suspended until more evidence was gathered about its effectiveness and there were enough midwives to meet minimum staffing requirements.

Ms Ockenden said patient safety had been “compromised by the unprecedented pressures that Continuity of Care models of care place on maternity services already under significant strain”.

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Source: HSJ, 23 September 2022

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Why Coffey's NHS plan has left many unimpressed

Tinkering around the edges, the King's Fund said. A few short-term fixes, according to the Health Foundation. And a plan that will have minimal impact, the Royal College of GPs added.

These were just a handful of the reactions from those involved with the NHS. And they were not even from organisations usually at the front of the queue when it comes to criticising government policies.

So why has Therese Coffey's first announcement as Health Secretary for England received such a negative response?

The fact is the problems the health and care system are facing are deep-rooted. Much is made of the impact of the pandemic but the health service was already struggling before Covid hit. The pandemic has simply exacerbated the situation.

At the heart of it all is a lack of staff.

Addressing this is not easy and cannot be done overnight. It takes five years to train a doctor, three a nurse, which is why there is a big push on international recruitment at the moment.

To free up GP appointments, pharmacists are being asked to take on some of their workload, while funding rules are being relaxed to allow GPs to use more of their money to recruit senior nurses.

But there is nothing in the plan about where these new senior nurses are going to come from, which is why the Royal College of GPs has been so dismissive.

It is a similar story for hospitals services, where accident-and-emergency waits, ambulance response times and the backlog in routine treatments such as knee and hip replacements have all worsened in recent years.

Coffey is also introducing a £500m fund to get thousands of medically fit patients out of hospital as soon as possible. Local areas will decide how to spend the money and it could allow hospitals to pay for extra help at home for patients who need it.

But it amounts to little more than a sticking plaster and is an approach already used to relieve the pressure during the pandemic. The real issue is the care sector is short of staff, with even more vacancies than in the NHS.

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Source: BBC News, 22 September 2022

 
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Patients choose surgery abroad as wait lists grow

Several patients awaiting treatment on the Welsh NHS have turned to surgery abroad as waiting lists hit record levels again.

Waiting lists hit a record of almost 750,000 in July prompting surgeons to demand "urgent action".

The Welsh government said waits of more than two years were improving.

Health Minister Eluned Morgan said there were "signs of hope" that a target for no-one to wait more than a year for their first outpatient appointment could be hit by the end of 2022.

But the Conservatives accused Labour ministers of having "little strategy" to tackle "extraordinary waits", while Plaid Cymru called for action "to increase capacity and improve patient flow".

Sharon Seymour, 62, from Monmouthshire, went to Lithuania after being told she faced a "two years plus" wait for a hip replacement.

The council worker said she also found out about Lithuania from other patients in Wales and had her surgery in July. She said the fact that people were taking matters into their own hands suggested the health system in Wales was not working.

"[The NHS] does need a huge cash injection... a rethink completely now," she said. "The sadder point is the people who have the ability to pay will get it.

"The inequality between those who can't and that [can is] a sad state of affairs," she added. "It's only through luck that we've managed to find the funds to go to Lithuania.

"For most people, it isn't an option and that's horrible."

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Source: BBC News, 22 September 2022

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Sickle cell: NHS to investigate racial inequalities for first time

Sickle cell patients’ experiences of barriers to treatment and racial inequalities will be investigated by an NHS body next month, The Independent has learned.

The NHS Race and Health Observatory has collaborated with Public Digital, a consultancy group, to lead original research into the experiences of people with sickle cell, including listening to NHS patients’ and carers’ first-hand accounts of acute emergency hospital admissions and managing the condition at home.

Research will focus on a series of interviews and ‘experience mapping’ workshops, the findings of which are anticipated to inform recommendations that will help improve emergency care and treatment pathways.

“As a priority, we need to discover new measures and treatment plans that can help eradicate the often unacceptable, substandard care people with sickle cell have historically received whilst being unwell and in acute pain,” Dr Habib Naqvi, Director of the NHS Race and Health Observatory, said.

This move comes after a parliamentary inquiry into avoidable sickle cell deaths called upon the Observatory to undertake work into sickle cell care in relation to race and ethnicity.

The inquiry published a report, ‘No one’s listening’, in November 2021, which uncovered the bleak reality of patients grappling with racism in the NHS while attempting to access healthcare.

Only half of healthcare professionals feel they have sufficient tools to manage the long-term damage that sickle cell disease brings, new research from Global Blood Therapeutics found, following extensive studies carried out across 10 countries including the UK, US and Canada.

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Source: The Independent, 22 September 2022

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‘Broken’ health system failing to tackle ‘unsustainable’ emergency care pressures

An integrated care system which has some of England’s worst waiting times for emergency care lacks “delivery structure and processes” to make desperately needed improvements, according to an external report.

Research by consultancy Prism into the Cornwall and Isles of Scilly integrated care system (ICS) concluded it had “unclear governance” for management and recovery of urgent and emergency care, with “multiple disconnected structures in place to manage tactical and strategic recovery of performance”.

The report comes as the ICS grapples with record waits for emergency care, with stroke and heart attack victims waiting three hours for an ambulance  and patients stuck for two days in Royal Cornwall Hospital’s emergency department.

The review was commissioned by the Cornwall Integrated Care Board to look at patient flow across the system and make recommendations about how this can be improved. 

Prism interviewed leaders from the organisations within the Cornish ICS. One leader described the system as “so broken”, while another commented that the role of the ICB in supporting and delivering urgent and emergency care “is not clear”.

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Coffey promises ‘absolutely no changes to four-hour A&E target’

Therese Coffey has pledged there will be no changes to the four-hour target for A&E waiting times – despite NHS England’s prolonged bid to axe the controversial measure.

The new health and social care secretary told the House of Commons Thursday: “I can absolutely say there will be no changes to the target for four-hour waits in A&E.”

Ms Coffey’s comments appear to represent a major blow to NHS England, which has since 2019 been pushing for a new bundle of metrics to replace the target.

Fourteen trusts have been trialling these, which include measures such as average time spent in an emergency department and 12-hour waits from time of arrival, as part of the Clinical Review of Standards.

NHSE had also, after a protracted battle, secured the support of key stakeholders, including the Royal College of Emergency Medicine, NHS Providers and Heathwatch England, to back its plans to ditch the target, for so long the NHS’s most significant performance metric.

The bold position – with Ms Coffey just weeks into the role – also contradicts the stance taken by both recent predecessors Sajid Javid and Matt Hancock, who both signalled they were supportive of scrapping the target. 

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Source: HSJ, 22 September 2022

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Health secretary sets up £500m fund to discharge medically fit NHS patients

Ministers are setting up a £500m emergency fund to get thousands of medically fit patients out of hospital as soon as possible in an attempt to prevent the NHS becoming overwhelmed this winter.

Thérèse Coffey, the new health secretary, unveiled the move in the Commons on Thursday as part of her plans to tackle the growing crisis in the health service, especially patients’ long delays for care.

The newly created adult social care discharge fund is intended to relieve the pressure on overstretched hospitals in England by ensuring that patients whom doctors have judged well enough to leave can be safely discharged either to their home or into a care home.

In her first speech since becoming the health secretary 16 days ago, Coffey told MPs: “I can announce today that we are launching a £500m adult social care discharge fund for this winter.

“The local NHS will be working with councils with targeted plans on specific care packages to support people being either in their own home or in the wider community. This £500m acts as the downpayment in the rebalancing of funding across health and social care as we develop our longer-term plan.”

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Source: The Guardian, 22 September 2022

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Low staffing during pandemic harmed US nursing home residents, House panel says

A special House panel investigating America's response to the coronavirus pandemic said it has found anecdotal evidence of understaffing at nursing homes that led to patient neglect and harm.

At a hearing Wednesday, the select subcommittee on the coronavirus crisis plans to discuss some of its findings, including how large nursing home chains reacted to complaints from staff and families.

“Many nursing home facilities were severely understaffed during the early months of the pandemic, leading to deficient care, neglect, and negative health outcomes for residents,” the committee reported Wednesday in a news release in advance of the hearing.

President Biden earlier this year instructed the Centers for Medicare and Medicaid Services [CMS] to develop minimum staffing standards for nursing homes. By highlighting problems during the pandemic, the House hearing on Wednesday increases pressure on nursing homes and the Biden administration as that work by CMS continues. The agency said recently it plans to study staffing levels through the winter.

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Source: The Washington Post, 21 September 2022

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Long Covid: protesters outside the White House demand better care

Protesters took to the pavement outside the White House on 19 September to demand a better deal for people affected by Long Covid, complaining that the Biden administration’s plans fell short on action and funding.

“The pandemic is over,” President Joe Biden declared the night before in a pre-recorded interview which aired on the news magazine 60 Minutes. “We still have a problem with covid,” he said. “We’re still doing a lot of work on it but the pandemic is over. If you notice, no one’s wearing masks. Everybody seems to be in pretty good shape. And, so, I think it’s changing.”

But the scene outside the presidential mansion the next day belied that message. Wearing black masks and red shirts, protesters called for research, medical treatment, and social services for those with Long Covid. Around half would qualify for a diagnosis of myalgic encephalomyelitis/chronic fatigue syndrome. The protest was organised by #MEAction, an international network of patient advocates.

“I went undiagnosed for 15 years, because doctors are not educated about the condition,” Jennifer Nish told The BMJ. Nish, from Lubbock, Texas, said that she was inspired to help organise the protest to raise awareness. “I don’t want anyone to go through what I had to go through,” she said and called on “the White House to treat this like the emergency that it is.”

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Source: BMJ, 20 September 2022

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Mental health patients face 'unacceptable' waits for emergency care

Patients seeking treatment for mental health problems at hospital emergency departments in England were twice as likely to experience "unacceptable" waiting times of 12 hours or more than other patients, according to a service review.

The Royal College of Emergency Medicine (RCEM) described its findings as "unacceptable" and said the system frequently failed who were most unwell and vulnerable, particularly children and young people.

The report, Mental Health and Emergency Care, is the latest in the RCEM's acute insight series summarising important issues in emergency care and making recommendations for policymakers, NHS England, integrated care systems, and trusts.

The analysis noted that recorded prevalence of patients experiencing mental health needs had "dramatically increased" over the last 5 years. Despite accounting for a small proportion of attendances to emergency departments (EDs), a "mismatch" between capacity and demand, cuts to dedicated mental health hospital beds, and poor patient flow through the hospital system had led to long waits in recent months.

The greatest concern was for patients waiting for a mental health bed, those waiting for assessment under the Mental Health Act, and children and young people presenting in crisis, the RCEM said. 

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Source: Medscape, 22 September 2022

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One in four people could be left without a GP within a decade, doctors claim

One in four people could be left without a GP within a decade, medics say.

The forecasts from Doctors’ Association UK suggest 16 million people in England could be left without access to a family doctor, amid growing staffing shortages.

Today the new Health Secretary is expected to set out plans to boost access to GPs, following warnings that public satisfaction is the lowest on record.

Research by the Health Foundation suggests that the NHS will lose up to 8,800 full-time equivalent GPs by 2030 if current trends continue. On Wednesday, Doctors’ Association UK said this could leave one in four people without access to a GP.

Dr Lizzie Toberty, GP lead for the Doctors’ Association UK, said the workload of a family doctor now placed “unrealistic demands” on them.

She said: “GPs will cut their hours, quit the NHS, or quit the country. We fear patients will suffer the same ‘postcode lottery’ for seeing their GP as many do now with getting an NHS dentist.”

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Source: The Telegraph, 21 September 2022

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‘Gross’ care delays could become ‘new normal’, says CQC report

The Care Quality Commission (CQC) has urged system leaders to move away from “quick fixes” to the “enormous gap in resources and capacity” in urgent and emergency care.

A report by the CQC and a large group of emergency clinicians and other health and care leaders calls for a ”move away from reactive ‘quick fixes’ such as tents in the car park or corridor care to proactive long-term solutions and to address the enormous gap in resources and capacity”.

The use of tents and treating more patients in corridors have been increasingly adopted by hospitals in recent months, sometimes encouraged by NHS England, particularly when they are under pressure to reduce handover delays from ambulances.

The report, 'People First: a response from health and care leaders to the urgent and emergency care system crisis', suggests:

  • expanding use of urgent community response teams to attend minor injuries 999/111 calls,
  • giving acute and social care providers direct access to GP and community service booking systems, and
  • providing “rapid access” to support packages to help people avoid hospital admission.

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Source: HSJ, 22 September 2022

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Hospital rated ‘inadequate’ after death prompts inspection

A private hospital has been rated ‘inadequate’ by a health watchdog following an inspection prompted by a young patient’s preventable death.

Woodbourne Priory Hospital, in Edgbaston, has had its overall Care Quality Commission rating downgraded from “good” to “inadequate” after inspectors visited in May.

The regulator’s visit was sparked by a prevention of future deaths report into the death of Birmingham University graduate Matthew Caseby, 23, who was placed at the hospital as an NHS-funded patient in September 2020.

Mr Caseby had been detained under the Mental Health Act but managed to escape Woodbourne and died after being struck by a train.

Earlier this year, an inquest concluded his death was contributed to by neglect on behalf of the hospital. 

In April, Birmingham and Solihull coroner Louise Hunt flagged urgent concerns about record keeping, risk assessments and security of courtyard fences with Priory Group and the Department of Health and Social Care.

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Source: HSJ, 22 September 2022

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Same-day pledge for GP appointments in England

The government is promising to improve access to GPs, including same-day appointments for those that need them, as part of a new plan in England.

Health Secretary Thérèse Coffey will make the pledge as she unveils her NHS plan for this winter and next.

GPs will be able to take on extra staff, including senior nurses, while pharmacists will be asked to take on more work to free up appointments.

Ms Coffey is due to announce the plan, which will also cover hospital services, in the House of Commons today.

She is expected to say: "I will put a laser-like focus on the needs of patients, making their priorities my priorities and being a champion for them on issues that affect them most."

Alongside same-day appointments when needed, Ms Coffey will promise no-one will have to wait more than two weeks for a routine appointment - currently one in five appointments take longer.

The promises on waiting times are not official targets, but Ms Coffey said they should be seen as clear expectations of what patients should be entitled to.

But GP leaders said the announcement would have a "minimal impact".

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Source: BBC News, 22 September 2022

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No mental health data taken in cyber attack, NHSE confirms

No patient data held by mental health trusts was taken following a cyber attack this summer, NHS England has confirmed.

The regulator told HSJ it had received confirmation from tech firm Advanced, which was the subject of a cyber attack in July, that no data had been breached on its Carenotes electronic patient record. The EPR is used by around a dozen mental health trusts.

The process of reconnecting trusts fully back to Carenotes also started this week, after providers spent two months with limited or no access to their EPR.

HSJ previously revealed that senior NHS chiefs feared patient data may have been taken or accessed by those responsible for the cyber attack, who issued ransom demands to Advanced.

Since then, experts have been brought in to investigate any potential data impact following the attack.

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Source: HSJ, 21 September 2022

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Women with type 2 diabetes have 60% increased chance of early death

Women in the UK with type 2 diabetes have a 60% increased risk of an early death and will live five years less than the average woman in the general population, early research suggests.

Scientists have also found that men with the disease have a 44% increased risk of dying prematurely and live 4.5 years less.

Results also suggest that smoking shortens the life expectancy of people with type 2 diabetes by 10 years, while diagnosis at a younger age cuts life expectancy by over eight years.

The findings, presented at the European Association for the Study of Diabetes in Stockholm, Sweden, are based on a cohort of nearly 12,000 patients at the Salford Royal Hospital in Salford.

“A woman with type 2 diabetes, for example, might live five years less than the average woman in the general population, while someone diagnosed at a younger age might lose eight years of life expectancy.

“It is vital that the groups at the highest risk are made aware of not just the increased risk that they face but also the size of the risk."

“Doing so may make the health advice they are given seem more relevant and so help them make changes that can improve their quality – and length – of life.”

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Source: The Independent, 21 September 2022

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Panel says US adults should get routine screening for anxiety

For the first time, a US government-backed expert panel has recommended that adults under 65 should be screened for anxiety disorders.

The influential US Preventive Services Task force also said that all adults should be checked for depression, consistent with past guidance.

The change follows widespread warnings from experts on the mental health toll of the Covid-19 pandemic.

The task force stopped short of a screening recommendation for suicide.

The panel acknowledged that suicide is a leading cause of death among American adults but said there was "not enough evidence on whether screening people without signs or symptoms will ultimately help prevent suicide".

The draft guidance is aimed at young and middle-aged adults, including those who are pregnant and post-partum. It envisions the mental health screening as part of routine visits with primary care physicians, said Dr Lori Pbert, a task-force member and professor in the Department of Population and Quantitative Health Sciences at UMass Chan Medical School.

"When you go to your primary care provider, you get screened for many, many preventive conditions - blood pressure, heart rate, all kinds of things," she said. "Mental health conditions are just important as other physical conditions, and we really need to be treating mental health conditions with the same urgency that we do other conditions."

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Source: BBC News, 20 September 2022

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Adult social care in England is in crisis, say Tory council leaders

Adult social care in England is in serious crisis, Tory council leaders have warned the government, as it faces a £3.7bn funding gap and a growing staffing shortage that has brought many local care providers to the brink of collapse.

The intervention by the County Councils Network, which represents 36 mainly Tory-run authorities, comes amid widespread local government concern over the increasing fragile state of social care. Care costs have accelerated recently, fuelled by unexpected wage and energy inflation.

“We face the perfect storm of staffing shortages, fewer care beds, and higher costs – all of which will impact on individuals waiting for care and discharges from hospital,” said Martin Tett, the Tory leader of Buckinghamshire county council.

Cathie Williams, the chief executive of the Association of Directors of Adult Social Services, said: “Too many people are missing out on vital care and support – we estimate that over half a million people are waiting for assessments, care, or reviews. With over 165,000 staff vacancies, this is only set to get worse. ”

A government spokesperson said: “The health and social care secretary is focused on delivering for patients and has set out her four priorities of A, B, C, D – reducing ambulance delays, busting the Covid backlogs, improving care, and increasing the number of doctors and dentists.

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Source: The Guardian, 21 September 2022

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Doctor appeals to government to rethink Covid drug

A leading academic is calling on new Health Secretary Therese Coffey to reconsider rolling out a Covid drug for people with weakened immune systems.

Last month the government decided it would not supply Evusheld in the UK.

But Dr Lennard Lee, an academic medical oncologist from Oxford University who is backed by more than 120 leading scientists and clinicians, said a rethink was needed.

The government said more data was required on the treatment.

Evusheld was approved for use in March, but was reviewed after the Omicron variant emerged. The drug's manufacturer AstraZeneca said there was "ample real-world data" that it worked. It is currently available in 32 countries.

Dr Lee told the BBC: "It's time for a re-review of the data, and to think about transparency in terms of why they decided not to do this, and also the pros and cons of doing this.

"We do know that coronavirus cases are likely to go up in winter, and we do know there are people who face increased risks...

"Therefore if there is anything we can do to protect... anyone immunosuppressed I think this is something that does need to be reconsidered."

Research from the US and Israel suggests Evusheld reduces the risk of infection by about 50%, and cuts the risk of serious illness by 90%.

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Source: BBC News, 21 September 2022

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Reasons for hospital admissions in people with type 2 diabetes are changing

The most common reasons why people with type 2 diabetes (T2DM) are admitted to hospital with greater frequency than the general population are changing, with hospitalisation for traditional diabetes complications now being accompanied by admissions for a diverse range of lesser-known complications including infections (i.e., pneumonia, sepsis), mental health disorders, and gastrointestinal conditions, according to an analysis of national data from Australia spanning seven years.

The findings, being presented at this year's European Association for the Study of Diabetes (EASD) Annual Meeting in Stockholm, Sweden (19-23 Sept), reveal that just four traditional diabetes complications (cellulitis, heart failure, urinary tract infections, and skin abscesses) were ranked in the top ten leading causes of hospitalisation in men and women with T2DM.

"Although traditional complications such as heart failure and cellulitis remain a substantial burden for people with T2DM, infections less commonly linked with diabetes and mental health disorders are emerging as leading causes of hospital admissions, and have substantial burdens that sometimes exceed the top-ranked well-known complications," says lead author Dr. Dee Tomic from the Baker Heart and Diabetes Institute, Melbourne, Australia.

She adds, "The emergence of non-traditional diabetes complications reflects improvements in diabetes management and people with diabetes living longer, making them susceptible to a broader range of complications. Increasing hospitalizations for mental health disorders as well as infections like sepsis and pneumonia will place extra burden on healthcare systems and may need to be reflected in changes to diabetes management to better prevent and treat these conditions."

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Source: MedicalXpress, 1 September 2022

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Scotland's A&E waiting times worst on record

Performance on waiting times targets at Scotland's hospital A&E units has hit a new low.

Figures for the week ending 11 September showed just 63.5% of patients were dealt with within four hours.

Health Secretary Humza Yousaf said the figures were "not acceptable" and he was determined to improve performance.

Scottish Tory health spokesman Dr Sandesh Gulhane said the figures showed the "crisis in A&E is not merely continuing, but deepening".

The Scottish government target is that 95% of patients attending A&E are seen and subsequently admitted or discharged within four hours.

Doctors working in emergency medicine have issued stark warnings recently about the impact of long waits in A&E. It is simply not safe, and patients are dying as a result, they say.

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Source: BBC News, 20 September 2022

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Millions in poor health due to lack of rehab after illness, warns UK report

Millions of people in the UK are suffering poor health because they miss out on vital rehabilitation after strokes, heart attacks and cancer, which in turn is also heaping further pressure on the NHS, a damning report warns.

Physiotherapists say some groups of patients are particularly badly affected. Without access to these services, many patients desperately trying to recover from illness became “stuck in a downward spiral”, they said, with some developing other health conditions as a result.

The new report by the Chartered Society of Physiotherapy (CSP) says millions of people in marginalised communities, including those from ethnic minorities, are not only more likely to live shorter lives, but also spend a greater proportion of their lives struggling with health difficulties.

Vital services that could tackle those inequities are either unavailable or poorly equipped to meet their needs, the report warns, adding that “some communities face particular barriers”.

Prof Karen Middleton, the chief executive of the CSP, said: “Rehabilitation services have been under-resourced for decades and were not designed coherently in the first place. This has exacerbated poor health outcomes, particularly for people from marginalised groups.

“It’s not only the individual who suffers. Without adequate access to rehabilitation, health conditions worsen to the point where more and more pressure is eventually piled on struggling local health systems and other public services.

“We desperately need a modernised recovery and rehabilitation service that adequately supports patients following a health crisis and prevents other conditions developing.”

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Source: The Guardian, 21 September 2022

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Many English maternity units not meeting safety standards

More than half of maternity units in England fail consistently to meet safety standards, BBC analysis of official statistics shows.

Health regulator the Care Quality Commission (CQC) rates 7% of units as posing a high risk of avoidable harm. A further 48% require improvement.

The figures are slightly worse than a few years ago, despite several attempts to transform maternity care.

The regulator says the pace of improvement has been disappointing.

In most cases, pregnancy and birth are a positive and safe experience for women and their families, says the CQC. But when things do go wrong, it is important to understand what happened and whether the outcome could have been different.

Laura Ellis lost her newborn son when he was unexpectedly breech during advanced labour. She checked out the CQC rating of her local hospital, Frimley Park, when she was pregnant. Maternity services were good.

But Laura didn't realise the unit had been told that it required improvement on safety.

Laura said: "It was just so hard. So hard to deal with. So hard to leave as well. How would you leave your baby in hospital when you should be taking them home?"

Frimley Park NHS Foundation Trust says it has made a number of changes since Theo died, including an emergency response if a baby is unexpectedly breech during advanced labour.

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Source: BBC News, 21 September 2022

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New national deadline to eliminate two-year waiters

NHS England has issued a new deadline to treat patients who have been waiting more than two years for treatment, a month after saying it had ‘virtually eliminated’ the longest waits, it has emerged.

The goal of no-one waiting more than 104 weeks for treatment by July this year was one of the first milestones in the elective recovery plan hammered out between NHSE and ministers.

They were not eliminated by the end of July, but the number was reduced to 3,000, having stood at 22,000 in January.

The remaining group consisted of nearly 1,600 patients who had been offered faster treatment elsewhere but did not want to travel, 1,000 who required complex treatment and could not be transferred to another provider and 168 who were not treated by the deadline, according to information issued in the summer by NHSE.

Now integrated care systems have been told there is a new “national expectation” to treat the remaining, final two-year waiters by the end of September. HSJ was told the goal has been framed as an ambition rather than a target because it includes patients who have chosen to wait longer.

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Source: HSJ, 21 September 2022

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US abortion bans leave grey areas in complicated pregnancies

Moments after unveiling a bill that would ban all abortions in the United States at 15 weeks, US Senator Lindsey Graham was interrupted by a mother with a devastating story.

"I did everything right and at 16 weeks we found out that our son would likely not live," Ashbey Beasley told a crowded room. "When he was born, for eight days he bled from every orifice of his body," she said.

But, she said, at least she got to choose how to handle her difficult pregnancy, while Mr Graham's law would take away that choice.

"What do you say to someone like me?"

Since the Supreme Court struck down Roe v Wade this summer, states across the US have pushed through abortion bans or severely restricted the procedure. But as such laws have gone into effect, unintended consequences have followed.

Doctors and patients say that confusing standards and the vague language of these laws have had a chilling effect on the medical field in anti-abortion states, leaving tragedies in their wake - and more in the making.

For the last year, Amanda Horton, a Texas doctor who specialises in high-risk pregnancies, has struggled to care for patients with pregnancy complications.

At times, Dr Horton must inform families that their babies have been diagnosed with a fatal foetal anomaly. These conditions are rare and likely to lead to the death of a foetus in utero, or shortly after birth.

But under a strict abortion ban in Texas, her hands are tied.

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Source: BBC News, 17 September 2022

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