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Leaks reveal record waits for emergency care due to covid pressures

Very long waits for emergency hospital care have surged in London since mid December, due to a rapid rise in COVID-19 admissions combined with limited capacity, according to figures leaked to HSJ.

Data sent to HSJ indicates that December will set a new record high nationally for the number of 12-hour “trolley waits”. This is when there are 12 hours or longer from the decision is made to admit a patient from the emergency department to hospital, to when they are actually admitted to a bed.

It adds to fears about what will happen if rising covid occupancy — which has left some hospitals running out of staff and acute beds, and intensive care well over normal capacity —  combines with potential additional winter demand in coming weeks.

Several senior hospital managers in areas heavily affected by covid said there were two main factors. One is shortage of beds and operational issues: there are about 6,300 fewer general and acute beds open nationally this winter, due to infection prevention measures. The beds that remain have to be split between covid positive and negative, often taking time to convert more.

Two sources said bed shortages were exacerbated by problems with discharge, particularly of covid patients who no longer need acute care, including “local authorities taking their eye off the ball on designated settings and covid-positive pathways”, according to one.

And another reason behind delays is waiting for covid test results before admitting patients.

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Source: HSJ, 4 January 2021

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Coronavirus: No increase in severe child cases, paediatricians say

Doctors have sought to reassure parents that there has been no increase in the severity of COVID-19 cases among children because of the new variant.

The Royal College of Paediatrics and Child Health (RCPCH) said children's wards are not seeing any "significant pressure" from COVID-19.

It comes after a London hospital matron told BBC Radio 5 Live of having a ward full of children with coronavirus. 

Laura Duffel said the surge in cases was "much scarier" than the first wave. Ms Duffel, who has been working on Covid wards since the beginning of the UK's epidemic and specialises in children's intensive care, told 5 Live's Chiles on Friday show that people were "wrong" to say busy hospitals were merely a reflection of normal winter pressures on the NHS.

"This wave has just hit us so fast. It's literally in the space of a week that this has gotten so bad," she said.

However, doctors denied that the virus is putting significant additional pressure on children's wards across the country. 

Prof Russell Viner, president of the RCPCH, said: "Children's wards are usually busy in winter. As of now we are not seeing significant pressure from COVID-19 in paediatrics across the UK.

"As cases in the community rise there will be a small increase in the number of children we see with Covid-19, but the overwhelming majority of children and young people have no symptoms or very mild illness only.

"The new variant appears to affect all ages and, as yet, we are not seeing any greater severity amongst children and young people."

Dr Ronny Cheung, a consultant paediatrician at Evelina Children's Hospital, in London, added: "I've been the on-call consultant in a London children's hospital this week. Covid is rife in hospitals, but not among children - and that is corroborated by my colleagues across London."

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Source: BBC News, 3 January 2021

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Medics complain of 'bureaucracy' in bid to join Covid vaccine effort

When dentist Andy Bates offered to help administer the coronavirus vaccine, he hadn't bargained for the "overload of bureaucracy" he says came his way.

Dr Bates, from North Yorkshire, is one of a number of health staff to criticise the paperwork needed to gain NHS approval to give the jabs.

Some medics have been asked for proof they are trained in areas such as preventing radicalisation.

The PM said the health secretary would be "taking steps" to address the issue.

Asked about reports potential volunteers were being deterred by the additional training and forms about "de-radicalisation measures" and "fire drills", Mr Johnson told the BBC's Andrew Marr on Sunday: "I think it's absurd and I know that the health secretary is taking steps to get rid of that pointless bureaucracy."

The NHS has previously said training and checks were needed for vaccinators.

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Source: BBC News, 3 January 2021

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New data reveals the 23 trusts with over a third of beds occupied by covid patients

Twenty-three hospital trusts had more than a third of their core bedbase occupied by COVID-19 patients on Tuesday, and occupancy is still rising at all but one.

Three trusts (North Middlesex in north London, as well as Medway and Dartford and Gravesham in Kent) had more than half of general and acute beds occupied by patients who had the virus, and others were not far behind.

Several trusts saw their covid occupancy share up by more than 10 percentage points in a week — a rate of growth which would soon see them entirely filled by covid patients, a situation with radical consequences for emergency hospital care in those areas.

London as a whole had a third of these beds occupied by patients with COVID-19.

HSJ has analysed data published for the first time by NHS England last night. The data concerns the status of adult general and acute beds, which make up the large majority of the acute bedbase. They do not include intensive care, which is also now under huge pressure in London, the south east and the east of England. Most hospitals in these areas are stretching IC capacity above normal levels.

Such high covid occupancy in both intensive care and the core bedbase is putting severe strain on hospitals’ ability to treat other patients. Most or all of the trusts under the greatest pressure have now cancelled routine planned surgery, and many are struggling with crowding, delays getting patients into and out of emergency departments due to the space available, and a lack of staff.

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Source: HSJ, 1 January 2021

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Elderly fall victims having to wait six hours for ambulances dealing with Covid patients

Elderly people who suffer falls are having to wait up to six hours for an ambulance because of rising Covid pressures, a medical body has warned. 

The delays are due to paramedics having to prioritise 999 calls from people suffering from coronavirus related breathing difficulties.

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Source: The Telegraph, 1 January 2021

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Covid: 12-week vaccine gap defended by UK medical chiefs

The UK's chief medical officers have defended the Covid vaccination plan, after criticism from a doctors' union.

The UK will give both parts of the Oxford and Pfizer vaccines 12 weeks apart, having initially planned to leave 21 days between the Pfizer jabs.

The British Medical Association said cancelling patients booked in for their second doses was "grossly unfair".

But the chief medical officers said getting more people vaccinated with the first jab "is much more preferable".

Pfizer has said it has tested the vaccine's efficacy only when the two vaccines were given up to 21 days apart.

But the chief medical officers said the "great majority" of initial protection came from the first jab.

"The second vaccine dose is likely to be very important for duration of protection, and at an appropriate dose interval may further increase vaccine efficacy," they said.

"In the short term, the additional increase of vaccine efficacy from the second dose is likely to be modest; the great majority of the initial protection from clinical disease is after the first dose of vaccine."

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Source: BBC News, 1 January 2021

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NHS staff face burnout as Covid hospital admissions continue to rise

England’s chief nurse has said that NHS and care staff are working incredibly hard to cope with record numbers of COVID-19 patients, amid concern that frontline staff are close to burnout.

Ruth May pleaded with the public to follow the coronavirus advice to help relieve the pressure on hospital staff, after two days of record hospital admissions.

Adrian Boyle, the vice-president of the Royal College of Emergency Medicine, told BBC Breakfast that health employees were “tired, frustrated and fed up”.

He said: “What is it going to be like over the next couple of months? I don’t know, I am worried. We are very much at battle stations.

“There will be short-term surges of morale but people are tired, frustrated and fed up, as everybody is, whether they work in hospital or not. The people who go into emergency medicine expect it to be tough from time to time.

“There is a real worry about burnout.”

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Source: BBC News, 1 January 2021

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Roll out covid vaccinations to frontline staff ‘immediately’, says NHS England

COVID-19 vaccinations should now be “immediately” rolled out to frontline staff, NHS England has told trust leaders.

New instructions from the national body follow the approval today of the Oxford/AstraZeneca coronavirus vaccine, which NHS England said will “substantially to accelerate vaccine delivery”. Until now, only limited quantities of the Pfizer/BioNTech vaccine have been available.

NHS staff are in the second priority category for covid vaccines, behind care home residents and alongside over 80s. But there have been complaints from clinicians around the country that they have been unable to get the jab, as well as uncertainty about how the vaccine deliveries should be divided between the priority groups.

A letter to local leaders from NHS England says that until now, healthcare workers who have been identified at highest risk of serious illness from covid-19 have been given the vaccine in unfilled appointment slots.

The letter, from chief executive Sir Simon Stevens and senior officials, now states: “Increased supply means that vaccination can also now immediately be expanded to frontline health and social care workers.”

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Source: HSJ, 31 December 2020

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Covid vaccine: UK doctors criticise rescheduling of second doses

Plans to delay giving the second dose of a Covid vaccine to more than 500,000 people who have received the first jab have caused outcry among doctors who say cancelling appointments wastes time, causes confusion among patients and is potentially unethical.

On Wednesday the government announced a change to its Covid vaccination strategy, saying second doses of the newly approved Oxford/AstraZeneca vaccine and the previously approved Pfizer/BioNTech jab would now be given up to 12 weeks after the first dose.

The move applies to people scheduled to have their second dose of the Pfizer jab after 4 January, as well as those yet to receive either jab. The government said it hoped the approach would mean as many people as possible soon have some protection against the disease.

However, the announcement caused controversy, with Pfizer and BioNTech warning that two doses of their vaccine were required for maximum protection against Covid and that they did not have evidence that the first dose alone offered protection after three weeks.

Now doctors have said cancelling appointments for the second dose will take huge amounts of time and could lead to confusion.

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Source: The Guardian, 31 December 2020

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COVID-19: Frontline doctors speak out about struggle to maintain care standards

Frontline doctors have testified to deteriorating conditions in hospitals in London and the south east as the NHS deals with a surge in COVID-19 cases.

Speaking to the Independent SAGE group of experts on 30 December, Jess Potter, a respiratory doctor in east London, told how she and colleagues were afraid of resources running out.

“My greatest fear is having a patient that I cannot provide lifesaving treatment to,” she said. “We had one of our largest medical intakes yesterday, the vast majority with coronavirus. What do we do when we run out of resources, and who is going to provide that guidance? It will harm our patients and our staff, because we have a set of values by which we practise, and we will have to reduce the level of care we deliver.”

She added, “Back in April I never saw a case where we didn’t provide a bed to a patient who needed it in intensive care, and decisions were taken as if in normal times. Now I hear from medics across the country that things are very bad, and the situation is the same as in April, if not worse. We are afraid of what will happen if we don’t act now.”

Sonia Adesara, a doctor in London, spoke to Independent SAGE after a set of night shifts at her trust and told of a chronic shortage of continuous positive airway pressure (CPAP) capacity.

“In the past few days, despite my hospital significantly increasing intensive and critical care capacity, our intensive care unit has been full, and there is no spare CPAP capacity. Medics are spending shifts trying to closely monitor all of our patients who are on the highest level of oxygen that we can give with a normal mask, assessing who is most unwell and unstable—and then frequently checking on patients who are on CPAP and then swapping people [around]."

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Source: BMJ, 31 December 2020

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Oxford vaccine: People with allergies and pregnant women can now get inoculation, updated guidance says

People with allergies and pregnant women can now be given the country’s two approved COVID-19 vaccines, the medical regulator said on Wednesday.

Previous advice from the Medicines and Healthcare products Regulatory Agency (MHRA) said people with a range of allergies to food and medicines should not be given the Pfizer vaccine.

Dr June Raine, the MHRA’s chief executive, said growing evidence from a pool of at least 800,000 people in the UK and around 1.5 million people in the US who have had the vaccine has "raised no additional concerns".

This, she continued, "gives us further assurance that the risk of anaphylaxis can be managed through standard clinical guidance and an observation period following vaccination of at least 15 minutes.

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Source: The Independent, 30 December 2020

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COVID-19: Expedite vaccination or deaths will surge, researchers warn

Deaths from COVID-19 in England in the first half of 2021 could exceed those seen in the whole of 2020 unless the vaccination programme is vastly increased and a national lockdown implemented—with educational settings closed for at least a month—researchers have warned.

In a preprint released on 24 December, researchers from the London School of Hygiene and Tropical Medicine used modelling to compare the effects of varying COVID-19 restrictions on the virus spread, hospital and intensive care admissions, and deaths from 15 December 2020 to 30 June 2021. The model took account of the new variant spreading rapidly in southern England, which it estimated to be 56% more transmissible than non-variant COVID-19.

The study, which has yet to be peer reviewed, said that control measures similar to the November national lockdown would be “unlikely to reduce the effective reproduction number to less than 1, unless primary schools, secondary schools, and universities are also closed.” It added that it would be necessary to “greatly accelerate vaccine rollout to have an appreciable impact in suppressing the resulting disease burden.”

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Source: BMJ, 29 December 2020

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London faces ‘ticking time bomb’ over oxygen supplies as another hospital issues warning to staff

Concerns are mounting over the number of coronavirus patients being admitted to hospitals in London as another NHS trust in the capital issued an urgent warning over its oxygen supplies.

On Tuesday afternoon, the North Middlesex University Hospital Trust warned clinicians the numbers of coronavirus patients it was treating “was putting a strain” on the oxygen system, sparking several alarms.

The trust currently has around 200 patients using oxygen with the trust consuming 2,400 litres of oxygen a minute. It normally uses around 1000 litres a minute and has a limit of 3,000 above which the system could cut out.

It is only the latest hospital to face the problem – which is caused by the sheer demand for oxygen by sick Covid patients, which is more than the hospital piping can physically deliver.

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Source: The Independent, 30 December 2020

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COVID-19: Oxford-AstraZeneca coronavirus vaccine approved for use in UK

The Oxford-AstraZeneca vaccine has been approved for use in the UK, with the first doses due to be given on Monday amid rising coronavirus cases.

The UK has ordered 100 million doses - enough to vaccinate 50 million people.

This will cover the entire population, when combined with the full order of the Pfizer-BioNTech jab, Health Secretary Matt Hancock said.

It comes as millions more people in England are expected to be placed under the toughest tier four restrictions.

On Tuesday, 53,135 new Covid cases were recorded in the UK - the highest single day rise since mass testing began - as well as 414 more deaths within 28 days of a positive test.

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Source: BBC News, 30 December 2020

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Covid: Essex declares major incident over virus cases

A major incident has been declared in Essex amid fears the number of COVID-19 cases could overwhelm the county's health services.

The Essex Resilience Forum (ERF) said "growing demand" was putting stress on hospitals and social care settings.

On Tuesday Mid and South Essex NHS Trust placed all three of its hospitals on critical alert.

All of Essex is in tier four and the south of the county has some of the worst-affected districts in England.

Essex Police Chief Constable BJ Harrington, who is co-chairman of the ERF, said declaring a major incident allowed it "to seek further support from the government to address the severe pressures which the health system is under".

The forum said the number of patients being treated for Covid in the county had exceeded the levels seen at the peak of the first wave and "these levels are likely to increase further in the coming days".

The ERF - comprised of health services, blue light responders and councils - said issues included "critical care and bed capacity, staff sickness/self-isolation levels and the system's ability to discharge patients quickly into safe environments".

Mr Harrington urged the public to continue only dialling 999 or attending A&E in an emergency.

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Source: BBC News, 30 December 2020

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Nightingale hospitals stand empty despite surging Covid cases as medics warn of staff shortages

The flagship Nightingale hospital is being dismantled as medics warn that there are not enough staff to run the facilities despite the NHS being at risk of being overwhelmed by coronavirus.

Amid surging virus case numbers, elective surgery is being cancelled as the number of patients in hospitals in England passes the peak of the first wave in April. 

Although the NHS is "struggling" to cope, the majority of the seven Nightingale hospitals, created at a cost of £220 million, have yet to start treating COVID-19 patients during the second wave. The Exeter Nightingale has been treating Covid patients since mid-November. 

The facility at London's Excel centre has been stripped of its beds and ventilators.

The NHS has told trusts to start preparing to use the overflow facilities in the coming weeks, but bosses have failed to explain how they will be staffed.

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Source: The Telegraph, 28 December 2020

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All vulnerable people to be vaccinated by ‘late spring’ says head of NHS

All vulnerable people will have been offered a coronavirus vaccination by “late spring” the head of NHS England has said as he warned the health service was “back in the eye of the storm.”  

In a New Year message, Sir Simon Stevens described 2020 as the “toughest year” and he paid tribute to nurses, doctors, therapists and other NHS staff including hospital cleaners, carers and volunteers as well as care home staff.

Sir Simon visited a new vaccination centre on Monday saying: “We think that by late spring with vaccine supplies continuing to come on stream we will have been able to offer all vulnerable people across this country Covid vaccination. That perhaps provides the biggest chink of hope for the year ahead.”

His comments came as the NHS in London was said to be “teetering on the edge” as latest data showed the numbers of hospital admissions in the capital jumped more than 200 per cent since the end of lockdown on 2 December.

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Source: The Independent, 29 December 2020

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Paediatricians sound alarm at huge surge in child eating disorders

Cases of anorexia and other eating disorders have quadrupled in some areas during the coronavirus pandemic, doctors say.

The Royal College of Paediatrics and Child Health (RCPCH) issued an alert to parents, saying the Christmas and new year period can be stressful for young people who struggle with disordered eating.

That comes on top of massive disruption to schooling and other areas of life due to Covid-19 which has led to a loss of physical and social activity, plus money worries and bereavement for some.

“In our tier 4 under 13s mental health inpatient unit we have seen a three- to fourfold increase in children referred to our service with eating disorders, and they are just the tip of the iceberg.” Dr Nancy Bostock, a consultant in Cambridge, said in a statement provided by the college.

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Source: The Independent, 29 December 2020

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COVID-19: Health workers 'back in eye of storm', says NHS chief

Health workers are "back in the eye of the storm" as coronavirus cases continue to rise, NHS England's chief executive Simon Stevens has said.

It has been the "toughest year" for the NHS, which has treated 200,000 severely ill Covid-19 patients, he added.

Hospitals in England are currently treating more Covid patients than at the peak of the first wave in April.

A government scientific adviser has warned national restrictions are needed to prevent a "catastrophe".

On Monday, a record 41,385 new Covid cases were reported in the UK, though it is thought the infection rate was higher during spring when testing was much more limited.

NHS England said 20,426 people were being treated for the virus in hospitals in England on Monday, which is higher than the previous peak of about 19,000 in April.

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Source: BBC News, 29 December 2020

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I'm a consultant in infectious diseases. 'Long Covid' is anything but a mild illness

With the excitement of the Covid vaccine’s arrival, it may be easy to forget and ignore those of us with “long Covid”, who are struggling to reclaim our previous, pre-viral lives and continue to live with debilitating symptoms. Even when the NHS has managed the herculean task of vaccinating the nation, COVID-19 and the new mutant variants of the virus will continue to circulate, leaving more people at risk of Long Covid. Data from a King’s College London study in September suggested as many as 60,000 people in the UK could be affected, but the latest statistics from the Office for National Statistics suggest it could be much higher.

Joanna Herman is a consultant in infectious diseases. "Long Covid' is anything but a mild illness". Nine months on from having the virus, she is seriously debilitated. She explains how the new NHS clinics need to help the thousands of people with Long Covid.

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Source: The Guardian, 27 December 2020

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Trusts told: prepare for ‘top quartile productivity’ as covid inpatients rise ‘almost everywhere’

New planning guidance asks local NHS organisations to prepare for a major waiting-list catch-up by seeking “top quartile performance in productivity”, but also to “safely mobilise all… available surge capacity over the coming weeks” as the service battles rising covid levels “in almost all parts of the country”. 

An end-of-year planning letter was issued by NHS England to local NHS chief executives last night.

It warns: “With covid-19 inpatient numbers rising in almost all parts of the country, and the new risk presented by the variant strain of the virus, you should continue to plan on the basis that we will remain in a level 4 incident for at least the rest of this financial year and NHS trusts should continue to safely mobilise all of their available surge capacity over the coming weeks.

“This should include maximising use of the independent sector, providing mutual aid, making use of specialist hospitals and hubs to protect urgent cancer and elective activity and planning for use of funded additional facilities such as the Nightingale hospitals, Seacole services and other community capacity.”

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Source: HSJ, 24 December 2020

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Clinicians warn of ‘serious’ safety risk at crowded teaching hospital

Staff at a teaching hospital which has struggled with emergency care pressure this winter have warned that patient safety is being compromised as crowding is becoming “normalised”.

A letter sent by a group of clinical staff at Cambridge University Hospitals Foundation Trust to the trust board calls for immediate action to tackle concerns.

It says: “The normalisation of crowding, the lack of effective flow management and the lack of effective escalation policies and procedures are resulting in patient safety, dignity and comfort being repeatedly and seriously compromised.”

Details of the letter were shared with HSJ but it is unclear how many and which staff it is signed by.

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Source: HSJ, 23 December 2020

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NHS told to prepare for use of Nightingale hospitals in coming weeks

NHS England has told hospitals to begin planning for the use of Nightingale Hospitals as the numbers of coronavirus patients in hospitals is expected to surge in coming weeks.

In a letter sent on Wednesday night hospitals were told to activate all of their emergency capacity to cope with the expected pressures over the coming weeks.

This is likely to mean the mass redeployment of staff and designating wards, surgical theatres and recovery areas as makeshift intensive care units for patients.

NHS England did not explain how the Nightingale Hospitals would be staffed if the decision was made to activate them.

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Source: The Independent, 24 December 2020

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New heart failure drug for thousands of UK patients given go ahead

More than a quarter of a million patients living with heart failure could be eligible for a new drug that reduces deaths and hospitalisation after medical regulators gave it the greenlight.

The National Institute for Health and Care Excellence (Nice) has approved dapagliflozin, made by AstraZeneca, for use on the NHS.

It can help treat patients with a form of chronic heart failure that means their blood does not pump blood out to the body as well as it should.

It is estimated almost one million people are living with heart failure in the UK which causes an estimated 65,000 unplanned hospital admissions a year. Around half of patients will die within five years of being diagnosed.

Evidence from a clinical trial shows that adding dapagliflozin to standard care lowers the risk of dying from heart disease and decreases hospitalisation or an urgent outpatient visit because of heart failure by 26% compared with standard care alone.

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Source: The Independent, 24 December 2020

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'Horrendous' ambulance delays at West Midlands hospitals

An ambulance crew had to wait seven hours to hand over a patient in the West Midlands, it has been revealed.

The case on 11 December was highlighted in the West Midlands Ambulance Service's in-house magazine, which said average waits had "ballooned".

It said average waits at one hospital were running at nearly three hours in early December.

The ambulance service said it hoped to put another 40 crews on the road by January.

Delays in hospitals taking over care of patients is considered "risky", NHS England said, because it not only delayed patients receiving specialist assessment and treatment, but also reduced the number of ambulances available to respond to emergencies.

The West Midlands trust's weekly briefing magazine, published on 17 December, said only the East of England trust had experienced a similar level of "horrendous" delays. It added that another four hospitals in the West Midlands had average delays of about two hours.

The "knock-on" effect it said was some high-risk patients were waiting longer for an ambulance than they should.

Meanwhile, some staff had to work late beyond their shifts and missed meal breaks.

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Source: BBC News, 23 December 2020

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