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Major German research funder launches audit of clinical trial portfolio

German public research funder Deutsche Forschungsgemeinschaft (DFG) is conducting an audit of the clinical trials it has supported in the past. The audit was announced in response to a request from TranspariMED asking DFG for a list of all its trials completed between 2009 and 2017, to which DFG replied that it currently has no such comprehensive dataset.

DFG stated that it is "currently preparing an evaluation of its clinical trials programme. In the framework of this evaluation the data you requested will be collected and analysed, as the outcomes of trials supported by DFG is of high interest including for DFG itself."

TranspariMED, an organisation which aims to end evidence distortion in medicine, sees this development as a good opportunity for DFG to check whether and when clinical trials were registered and their results made public.

Previous research has shown that nearly a third of German academic trials never make their results public.

This not only wastes public money, but also harms patients because it leaves gaps in the evidence base on the efficacy and safety of drugs, medical devices, and non-drug treatments.

Due to gaps in German law, there is still no legal obligation to make the results of many German clinical trials public.

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Source: TranspariMed, 20 December 2022

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Trust drops from ‘outstanding’ to ‘requires improvement’

A teaching hospital that was lauded for its culture and championed by ministers has been downgraded from ‘outstanding’ to ‘requires improvement’ by the Care Quality Commission.

CQC inspectors found multiple issues at Salford Royal Hospital during an inspection in August and September. These included nurse staffing, governance, and some cultural concerns. The trust’s urgent and emergency services were rated “inadequate” for safety.

The hospital in Greater Manchester had been rated “outstanding” since 2015, and was frequently hailed as a leader on the patient safety agenda, particularly by former health secretary Jeremy Hunt.

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Source: HSJ, 22 December 2022

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UK hospices warn of bed closures and staff cuts as energy bills soar

Hospice charities providing end-of-life services in partnership with the NHS have warned they will have to shut beds and sack staff because of the catastrophic impact of rising energy bills on their day-to-day running costs.

The UK’s network of independent, mainly voluntary-run palliative care providers said hospices were experiencing a perfect storm of soaring costs and rising demand just as revenues from traditional public fundraising methods are collapsing.

They have also warned that many patients who receive palliative care at home are struggling to maintain optimal care standards because they can’t afford to run central heating and the electrical medical equipment used in their everyday clinical care.

Hospices, which typically rely on charitable donations for 70%-80% of their running costs, and which are intensive users of gas and electricity, have reported facing energy bill rises of up to 350%.

Rachel McMillan, the chief executive of one of the UK’s biggest hospices, St Ann’s, in Greater Manchester, said: “We are at the point where we will have to take some very difficult decisions in terms of our business model and our service provision. Closing beds would be a last resort, but we are seriously going to have to think about this.

“The government needs to sit up and listen to hospices; we are an essential part of the care delivery system. We are not a luxury.”

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Source: 22 December 2022

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The real test is yet to come as ambulance strike causes little disruption

The NHS entered the last six hours of the ambulance strike with a sense that the real test will be seen in the coming days.

Call volumes were down and many A&Es quieter than in previous days. NHS111 was very busy.

Despite the fears expressed by leaders ahead of the strike not yet coming to fruition, the day ended with eight integrated care systems declaring critical incidents, along with all striking ambulance trusts and a number of hospital trusts.

Leaders across the country told HSJ they feared that those who stayed away today in response to pleas for “common sense” amid industrial action may come back tomorrow, seeing demand return strongly.

A senior London source said: “The ambulances will have stacked some calls and we may have a flood of movement tomorrow.”

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Source: HSJ, 21 December 2022

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How Covid has dealt the NHS a lasting blow

The NHS in England has more funding and staff than before the pandemic - but in many types of care, it is treating fewer patients. Why?

The Institute for Fiscal Studies (IFS) says this is a puzzle with no simple explanation - but the pandemic has dealt a lasting blow to the NHS and it could be costing more to treat patients, on average, than before.

Despite higher staff sickness rates, compared with pre-pandemic levels, the NHS has available to work:

  • 8% more nurses
  • 9% more consultants
  • 15% more junior doctors.

But - not counting those filled by patients who have tested positive for Covid, even though they may be there mainly for something else - there were 5% fewer beds available in the third quarter of this year than in 2019, the IFS says.

IFS research economist Max Warner says: "The NHS is showing clear signs of strain heading into the winter and is treating fewer patients than it was pre-pandemic, across many types of care.

"The real risk, almost three years on from the start of the pandemic, is that the Covid hit to NHS performance is not time-limited.

"Going forward, we need to grapple with the possibility that the health service is just able to treat fewer patients with the same level of resources."

A Department of Health spokesperson said: "As the IFS report acknowledges, Covid had a significant impact on the NHS, and we are focused on delivering the biggest catch-up programme in health history".

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Source: BBC News, 14 December 2022

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Fury as minister says strikers choosing to harm

Ambulance unions have reacted with anger after the health secretary said they had "taken a conscious choice to inflict harm on patients".

Steve Barclay said unions had refused to work with the government at a national level on how they would cover emergency calls during strike action.

Unison said it was "utterly shocked" by the comments, while the GMB union said they were "insulting".

Paramedics are among those striking in England and Wales on Wednesday.

Control room staff and support workers who are members of the Unison, GMB and Unite unions are also involved.

NHS bosses are warning patient safety cannot be guaranteed during the action, although unions say life-threatening callouts will still be responded to by an ambulance.

They also argue patients are already being put at risk due to waiting times and the pressure on the health service, made worse by staff shortages.

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Source: BBC News, 21 December 2022

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‘Significant rise’ in suspected UK scarlet fever cases brings total to nearly 30,000

The number of suspected scarlet fever cases since September has risen to nearly 30,000 after the UK Health Security Agency added almost 10,000 potential new infections in the last week.

More than 27,000 people could have had infections since 12 September, according to the UKHSA, who revealed on Tuesday that there were more cases than first thought because of the “significant rise” in infections.

The figures come from medical practitioners referring suspected cases to the local authority or health protection team.

A total of 16 children aged under 18 have died from invasive group A streptococcus (iGAS), otherwise known as strep A.

Parents are advised to contact 111 or a GP surgery if a child has symptoms. They can also include nausea and vomiting.

New serious shortage protocols were issued to pharmacists last week in an attempt to help those experiencing supply issues with penicillin.

Chemists had widely reported problems getting hold of liquid penicillin and amoxycillin due to the increase in demand. The antibiotics are often prescribed for children who have scarlet fever or strep A. People in the industry have also reported rising prices.

Pharmacists are now able to prescribe an alternative antibiotic or formulation of penicillin, such as tablets.

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Source: The Guardian, 20 December 2022

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Risk to patients getting worse, NHS leaders warn

The risk to patients will only get worse unless the government reaches an agreement to prevent further strikes, NHS leaders have warned.

In a letter to the prime minister and health secretary, they said there was "deep worry" about today's strike.

People are being asked to only call 999 in a life-threatening emergency, but NHS England says emergency care will continue to be provided.

Ambulance response times are already twice as long as two years ago.

The letter, signed by the leaders of NHS Confederation and NHS Providers, says the action being taken by ambulance workers "isn't just about pay but working conditions: many have said they are doing this because they no longer feel able to provide the level of care that their patients need and deserve."

They urged ministers to "do all you can to bring about an agreed solution".

Health Secretary Steve Barclay said the pay deal on offer to both ambulance staff and nurses had been agreed by an independent pay review body.

In England, eight out of the 10 major ambulance services have declared critical incidents - a sign of the intense pressure they are already under.

Ministers have urged the public to take extra care and suggested they avoid contact sports and unnecessary car journeys.

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Source: The Guardian, 21 December 2022

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93-year-old left ‘screaming in pain’ on floor during 25-hour ambulance wait

The Welsh ambulance service has apologised after a 93-year-old woman was left “screaming in pain” while lying on the floor with a broken hip during a 25-hour ambulance wait.

Elizabeth Davies fell at her care home on Saturday and was finally picked up at 1.15pm on Sunday and admitted to Ysbyty Gwynedd hospital in Bangor on Monday, where she endured another 12-hour wait before being admitted to a ward. A hip fracture was later confirmed in surgery.

Her family have said the incident, which occurred before a 24-hour strike on Wednesday by ambulance workers, was “unacceptable”. Her son, Ian Davies, from Pwllheli, said: “It was very upsetting to have to see her lying on the floor screaming in pain for over 24 hours.”

After her injury, staff at the care home, where Davies has lived for 17 years, are understood to have propped a pillow under her head and tried to make her comfortable on the wooden floor, using a small heater to keep her warm in case she went into shock, as well as providing an absorbent pad so she could urinate.

Her son, a community care worker, said: “They called for an ambulance but were advised an ambulance wouldn’t be available for six to eight hours as they were so busy.

“They said my mother would be a priority because of her age. The care home then called us and we came immediately.

“I don’t blame the ambulance staff because they are told what jobs to do and my mother wasn’t on the list.”

It is understood the care home made nine calls, with a 10th made by Ian Davies.

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Source: The Guardian, 20 December 2022

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Preet Gill calls for public inquiry into patient safety at University Hospitals Birmingham

The Birmingham MP Preet Gill has called on the UK health secretary to launch a major public inquiry into allegations that a bullying and a toxic culture is risking patient safety at University Hospitals Birmingham (UHB).

The MP for Edgbaston, where UHB is based, said she had received complaints from staff alleging elderly patients had been left on beds in corridors outside wards due to mismanagement, and medics were discouraged from speaking out about problems.

In a letter to Steve Barclay, seen by the Guardian, Gill said: “I have been inundated by messages from UHB staff, past and present, who have contacted me to share their experience of what has been repeatedly described as a toxic culture that has had an alarming impact on staff and patient care.”

After an investigation by BBC Newsnight earlier this month, which found that doctors at the trust were “punished” for raising safety concerns, the Birmingham and Solihull Integrated Care Board (ICB) announced a three-part review into the culture at UHB. The first report is expected at the end of January.

But Gill criticised the plans, saying she did not think it would “be sufficient to adequately investigate this scandal”, and instead called for a major independent public inquiry, similar to the 2013 Francis inquiry into the Stafford hospital scandal.

“We cannot rely on an ICB investigation to solve this issue. Many of those on the ICB are former members of the senior leadership team from UHB and would not offer the independence required to recommend the changes that are so needed or give confidence to whistleblowers,” she said.

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Source: The Guardian, 19 December 2022

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Avoid any ‘risky activities’ on ambulance strike day, says health minister

Health minister Will Quince has warned the public to avoid any “risky activities” on Wednesday as ambulance drivers stage strike action.

The NHS is set to be hit by major disruption as ambulance workers including paramedics, control room workers and technicians walk out in England and Wales.

During the strike, the military will not drive ambulances on blue lights for the most serious calls but are expected to provide support on other calls.

Mr Quince urged the public to avoid anything risky on Wednesday, telling BBC Breakfast: “Where people are planning any risky activity, I would strongly encourage them not to do so because there will be disruption on the day.”

The health minister did not offer examples of what might be defined as risky behaviour but told the public that in any emergency calling 999 should still be the first option.

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Source: The Independent, 20 December 2022

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Sick child’s mother rebukes Steve Barclay over NHS staff being ‘worked to the bone’

The mother of a sick girl has confronted the health secretary during a hospital visit in London, telling him that NHS staff are “worked to the bone” and the government is doing “terrible damage” to families on waiting lists.

Sarah Pinnington-Auld, whose three-year-old daughter, Lucy, has cystic fibrosis, rebuked Steve Barclay over NHS staff working conditions and long waits for treatment as he visited King’s College hospital.

She told the Conservative cabinet minister how her daughter was pushed off an “absolutely horrific” waiting list because of “the obscene number of people who came through and the lack of resources”.

“The damage that you’re doing to families like myself is terrible, because it was agony for us as a family waiting for that call,” she said. “Preparing our children, for their sister and her hospital visit, for then it to be cancelled. And I know you look and we’re all numbers, but actually they’re people waiting for care.”

“The doctors, the nurses, everyone on the ward is just brilliant, considering what they’re under, considering the shortage of staff, considering the lack of resources,” she said.

“That’s what’s really upsetting, actually, because we have a daughter with a life-limiting, life-shortening condition and we have some brilliant experts and they’re being worked to the bone, and actually the level of care they provide is amazing, but they are not being able to provide it in the way they want to provide it because the resourcing is not there.”

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Source: The Guardian, 19 December 2022

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Guernsey endoscopy waiting list patients 'at risk'

Some patients waiting for an endoscopy in Guernsey may be "at risk" because of a large backlog in procedures, the States medical director has warned.

The government has announced a tender process to bring in clinicians to help clear the list, which is three times longer than before the Covid pandemic.

More than 430 people were on the gastroenterology waiting list as of Tuesday, Dr Peter Rabey said.

"We're worried that there is risk to patients in waiting too long," he said.

"Although a lot of patients who get an endoscopy have completely normal results, and some have benign disease which can be treated with tablets and things, there will be some patients who might have cancer and we need to find out as best as possible".

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Source: BBC News, 20 December 2022

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Police investigating ‘rape of child’ at scandal-hit mental health hospital

Police are investigating allegations of rape of a child involving two staff members at a scandal-hit mental health hospital, The Independent can reveal.

Thames Valley Police confirmed it has launched an investigation after a report last month of rape made by a former patient of Taplow Manor, a private hospital in Maidenhead, Berkshire, run by The Huntercombe Group.

The incident was reported to have taken place in 2019. Mark McGhee, a solicitor for Hutcheon Law, who is representing the family of the patient in a clinical negligence claim, said the allegation had been raised to the police about the patient who was a child and that the allegation involves two staff members at the time.

In October, The Independent and Sky News revealed allegations of “systemic abuse” from 20 patients across The Huntercombe Group’s children’s mental health hospitals – Taplow Manor, Ivetsey Bank near Stafford, Watcombe Hall in Torquay, and The Huntercombe Hospital Norwich.

Since the report, 30 more patients have come forward with allegations of poor treatment and the provider now also faces nine legal claims from former patients.

Thames Valley Police are also investigating an incident involving the death of a child at the Maidenhead hospital in February. The CQC is conducting a separate criminal investigation into the serious incident which resulted in the death of the young person.

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Source: The Independent, 19 December 2022

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Nurse strike goes ahead in England, Wales and Northern Ireland

Nurses in England, Wales and Northern Ireland will strike today in an ongoing dispute with the government about pay and concerns about patient safety.

Up to 100,000 members of the Royal College of Nursing (RCN) will take part after it balloted its members in October. It has said that low pay is the cause of chronic understaffing that is putting patients at risk and leaves NHS staff overworked.

It will be the second day of strikes in December, after an initial day of industrial action on 15 December, the RCN’s biggest in its history. It meant the cancellation of thousands of outpatient appointments and non-urgent operations.

More strikes have been threatened for January unless talks between union negotiators and the government takes place before Thursday, 48 hours after the strike on Tuesday.

The RCN’s general secretary and chief executive, Pat Cullen, said: “For many of us, this is our first time striking and our emotions are really mixed. The NHS is in crisis, the nursing profession can’t take any more, our loved ones are already suffering.

“It is not unreasonable to demand better. This is not something that can wait. We are committed to our patients and always will be.”

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Source: The Guardian, 20 December 2022

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NHS ambulance strikes will put patients at risk – but delays already at record high

Nine ambulance trusts in England and Wales are expected to be affected by industrial action on Wednesday, coordinated by the GMB, Unison and Unite unions.

The ambulance strikes will involve paramedics as well as control-room staff and support workers. The threat to patient safety on Wednesday will be exceptional.

Under trade union laws, life-preserving care must be provided during the strikes. But there remains a lack of clarity about what will be offered. Even at this late stage, NHS leaders say negotiations are continuing between unions and ambulance services to agree which incidents will be exempt from strike action.

All category 1 calls – the most life-threatening cases – will be responded to, while some ambulance trusts have agreed exemptions with unions for specific incidents within category 2 calls.

However, in some cases, elderly people who fall during the strikes may not be sent help until they have spent several hours on the floor. Heart attack and stroke patients may get an ambulance only if treatment is deemed “time critical”.

There is no doubt that many of those patients making 999 calls on Wednesday will not get the care they need. Some will probably die as a result.

NHS leaders believe Wednesday’s strike will present a completely different magnitude of risk. Quite simply, patients not getting emergency treatment quickly enough can mean the difference between life and death.

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Source: The Guardian, 19 December 2022

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Private menopause clinics prescribing HRT at 'twice the recommended dose'

Private menopause clinics are prescribing HRT at "twice the recommended dose", an investigation has revealed.

The investigation by The Pharmaceutical Journal has revealed that patients attending private menopause clinics are subject to “unorthodox prescribing” by providers. Many are receiving oestrogen at up to double the recommended dose placing them at higher risk of cancer and vaginal bleeding.

Nuttan Tanna, a pharmacist consultant in women’s health at London North West University Healthcare NHS Trust, said she had seen referrals for “bleeding investigations” and then found the patient was on "very large doses [of oestrogen] prescribed previously by private providers”.

Brendon Jiang, a senior clinical pharmacist for North Oxfordshire Rural Alliance Primary Care Network, said that his team were increasingly getting letters from private clinics requesting for patients to be prescribed doses of oestrogen that are off-label or exceed licensed recommendations.

He also raised concerns that patients were not taking enough progesterone alongside increased doses of oestrogen. Taking increased doses of oestrogen alone can increase the risk of womb cancer but progesterone protects against that risk and therefore the two hormones should be taken together.

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Source: The Telegraph, 19 December 2022

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NHS lost a million working days to Long Covid last year

NHS trusts in England lost more than a million working days to long-Covid absences last year, analysis suggests.

Thousands of doctors, nurses and other health professionals have been forced to take long periods off work because of the lingering effects of coronavirus infection.

Data released to the all-party parliamentary group on coronavirus suggests that long-Covid absences are now higher than they were a year ago.

Layla Moran, who chairs the group, said: “Long Covid has upended the lives of millions and these figures suggest that the deeply damaging impact it is having on our economy and public services is only getting worse.”

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Source: The Times, 19 December 2022

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Take car in emergency during 999 strike, says cabinet minister

Patients should “make their own way to hospital” if they can do so during Wednesday’s strike by ambulance workers, a cabinet minister said yesterday, as the government warned that the industrial action would put lives at risk.

Senior government figures said that ambulance unions had still not agreed national criteria for what conditions would be considered life threatening and responded to during the strike.

Steve Barclay, the health secretary, is understood to be writing to all striking unions, including nurses, seeking discussions on patient safety.

Yesterday Oliver Dowden, the Cabinet Office minister, said people should still call 999 in an emergency but might in less serious cases have to make their own way to hospital. “We are working to ensure that if you have a serious injury, in particular a life-threatening injury, you can continue to rely on the ambulance service, and we would urge people in those circumstances to dial 999,” he told Sunday with Laura Kuenssberg on BBC1. “If it is the case that you have less serious injuries, you should be in touch with 111, and you should seek to make your way to hospital on your own if you are able to do so.”

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Source: The Times, 19 December 2022

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Nottingham hospital menopause scheme hailed by staff

Hospital staff in Nottingham have said they are keen to build on the success of its menopause support scheme.

Nottingham University Hospitals Trust (NUH) said 24% of its staff were aged 45-55, the most common age for the condition.

Staff can ask for lighter uniforms, shift changes, more time to complete tasks or access to fans in offices. Advice, awareness training and access to specialist staff are also part of the scheme.

The staff wellbeing team at NUH said they were "inundated" with messages from colleagues who were struggling.

Jenny Good, NUH Staff Wellbeing Lead, said: "We strongly believe that menopause is an issue for everybody. Everyone knows somebody who will go through it.

"We wanted to equip everyone who works at NUH with an awareness of what menopause is.

"We're really proud that we're the first NHS trust to get the accreditation.

"The conversation has opened up."

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Source: BBC News, 18 December 2022

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The mental health patients dying on NHS wards from starvation and neglect

Asystemic failure to provide basic physical care on NHS mental health wards is killing patients across the country, despite scores of warnings from coroners over the past decade, The Independent can reveal.

An investigation has uncovered at least 50 “prevention of future death” reports – used by coroners to warn health services of widespread failures – since 2012, involving 26 NHS trusts and private healthcare providers.

Cases include deaths caused by malnutrition, lack of exercise, and starvation in patients detained in mental health facilities. Experts warn that poor training and a lack of funding are factors in the neglect of vulnerable patients.

The Independent investigation uncovered:

  • Staff failing to carrying out basic health checks, such as assessment for risk of blood clots.
  • Cases of nurses and care assistants without adequate CPR training.
  • Doctors unable to carry out emergency response procedures.
  • Patients not treated for side effects of antipsychotic medication.
  • Rapidly deteriorating health going unnoticed and untreated.

Coroners have exposed multiple cases of mental health patients receiving inadequate treatment in general hospitals, with their illness being mistaken for a psychiatric problem.

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Source: The Independent, 18 December 2022

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Emergency patients staying an extra day in ‘congested’ hospitals

Patients are spending an extra day in hospital on average when admitted as an emergency compared to before covid, consuming millions of additional ‘bed days’, HSJ analysis has found.

The finding explains in part why fewer people are being treated in hospitals, but more resources are being consumed to do so. This has prompted concerns about an apparent big drop in productivity.

NHS England chief finance officer Julian Kelly told HSJ the marked increase in length of stay meant hospitals needed to focus on “discharge and decongest” of emergency care, to help recover activity rates and productivity in elective care. The NHS also needs to create more elective capacity insulated from emergency care, he said, and for “local leadership [to] keep people focused”.

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Source: HSJ, 19 December 2022

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US Joint Commission surveys to include safety briefings in 2023

The US Joint Commission will hold a safety briefing with healthcare organisations at the start of every accreditation survey starting in 2023, the organisation has said.

Site surveyors and staff members preselected by the healthcare organisation will conduct an informal, five-minute briefing to discuss any potential safety concerns — such as fires, an active shooter scenario or other emergencies — and how surveyors should react if safety plans are implemented while they are on site. 

 The change takes effect 1 January 2023 and applies to all accreditation surveys performed by the organisation. 

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Source: Becker's Hospital Review, 13 December 2022

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Tories ‘failing women’ as gynaecology waiting times treble in a decade

The Conservatives have been accused of “failing women” as analysis reveals gynaecology waiting times have trebled in the past decade, with more than 540,000 waiting for NHS care.

NHS England data shows that in October 2012, the average waiting time to see a gynaecologist was 4.8 weeks. By October 2022, the most recent month for which figures are available, that figure had increased by 225% to 15.6 weeks.

Many of the conditions experienced by women waiting to see a gynaecologist are progressive. Left untreated, they can need more complex or invasive surgery. Thousands are living in extreme pain as a result of the long waits, doctors, health experts and charities told the Guardian.

The figures reveal that 38,231 women have been waiting more than a year. Ten years ago there were 15 women in England waiting longer than 12 months – and no one waiting two years. Today, 69 women have been waiting more than 24 months.

Dr Ranee Thakar, the president of the Royal College of Obstetricians and Gynaecologists, said: “This new analysis adds to our own research that gynaecology waiting lists were outstripping other specialities long before the pandemic, and they continue to grow rapidly.

“Shockingly, the fact we can now track this pattern back 10 years, shows how long overdue action is to address the unequal growth in waiting lists.”

Thakar added: “Women’s health has been consistently deprioritised. Gynaecology waiting times are currently the longest we’ve seen since waiting list targets were introduced, leaving thousands of women with symptoms including extreme pain, heavy menstrual bleeding and incontinence.”

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Source: The Guardian, 19 December 2022

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Ambulance strike cover must be sufficient, says health secretary

Unions must ensure there will be "sufficient" staffing during this week's ambulance strike to protect patients, the health secretary says.

Workers in England and Wales will walk out on Wednesday in a dispute over pay, but life-threatening emergencies will be responded to.

Unions say discussions were still taking place with ambulance trusts to draw up detailed plans for cover.

Steve Barclay said there is a lack of clarity about what is being offered.

He said it was for the unions to ensure they "meet their obligations" for emergency cover so that people in crisis get the care they need.

But Unite leader Sharon Graham, whose union is co-ordinating the ambulance strikes with Unison and GMB, said Mr Barclay will "have to carry the can if patients suffer".

The ambulance walkouts will involve paramedics as well as control room staff and support workers.

The action by the three main ambulance unions - Unison, GMB and Unite - will affect non-life threatening calls, meaning those who suffer trips, falls or other injuries may not receive treatment.

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Source: BBC News, 19 December 2022

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