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Lack of ‘psychological safety’ at trust with ‘acceptance of poor behaviours’

An acute trust has “palpable” cultural problems and staff “at all levels” have described an acceptance of “poor behaviours”, according to the Care Quality Commission.

Some staff at Gloucestershire Hospitals Foundation Trust also reported a lack of trust in their senior managers and a “fear of speaking up”.

The Care Quality Commission feedback was set out in a post-inspection letter to the trust’s acting chief executive Mark Pietroni last month following an inspection in June. The trust’s CEO Deborah Lee is currently off work as she recovers from a stroke.

According to the CQC letter, published in the trust’s board papers ahead of a full inspection report which is due in the autumn, staff “articulated [to inspectors and said they] had observed rudeness and incivility throughout the organisation”.

In a written statement, Professor Pietroni told HSJ he “fully recognised” the CQC’s feedback.

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Source: HSJ (24 August 2022)

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Former King's Lynn journalist Kath Sansom's Sling the Mesh campaign raises awareness of mesh implant surgery

Kath Sansom, a former journalist from Lynn is raising awareness about the potential risks associated with vaginal and rectal mesh surgery.

Mesh implant surgery is used to treat prolapse and incontinence in women usually following childbirth, and some men have also had the procedure. But pain and complications after the implants have left hundreds of people in the UK in pain and so a campaign in 2015 was launched which has led to the Government announcing a suspension in the use of vaginal mesh.

Kath initiated the Sling The Mesh campaign in 2015 following her own experience of mesh surgery. She said: "What is most important to women is financial redress. We are all innocent and have had our health and lives compromised. We shouldn't have to wait 40 years, as the victims of contaminated blood have. Some women are in wheelchairs and have lost pensions. I am not the woman that I was. It has taken a financial, physical and emotional toll."

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Source: Lynn News (24 August 2022)

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UK to recruit nurses from Nepal under new government deal

Up to 100 nurses are to be recruited from Nepal to work in the NHS, despite global restrictions on employing health workers because of staff shortages in the country.

The Department of Health and Social Care (DHSC) and the Government of Nepal have signed a new government-to-government agreement regarding the recruitment of Nepali health professionals to the UK.

The move comes after the new health and social care secretary Steve Barclay announced plans to “significantly increase” overseas recruitment of health workers to help mitigate staff shortages in the UK. A 15-month pilot phase will initially see up to 100 nurses recruited from Nepal to work at Hampshire Hospitals NHS Foundation Trust.

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Source: Nursing Times (23 August 2022)

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NHS 111 chaos may harm patients, experts claim

Patients may come to harm as a result of NHS 111 chaos, experts claimed on Tuesday as patients were advised to avoid the service this weekend. The helpline for urgent medical advice was targeted by cyberhackers earlier this month, leaving staff working on pen and paper.

The Adastra computer software, used by 85 per cent of 111 services, was taken offline after the attack leaving call handlers unable to book out-of-hours urgent appointments and fulfil emergency prescriptions. But almost three weeks on, most staff are still operating without the system, leaving GPs unable to see patients’ medical records during urgent consultations or automatically forward prescriptions to pharmacies.

The NHS has told hospitals to prepare public awareness campaigns to “minimise” pressures on urgent and emergency care services this winter. Some hospitals have already issued messaging urging patients not to turn up at accident and emergency (A&E), unless they are facing a “serious emergency.”

Helen Hughes, chief executive of the charity Patient Safety Learning, said the continuing chaos raises “serious patient safety concerns” and will “inevitably result in avoidable harm”. 

Telling patients not to go to A&E “unless it is absolutely necessary” is only possible if GPs and NHS 111 “have the capacity and the resources to meet the demands that this places on them”, Ms Hughes said.

“Significant delays in receiving a response are potentially missed opportunities for patients to receive timely medical advice and treatment that may prevent future harm,” she added. “Delays in receiving timely care and treatment will inevitably result in avoidable harm to patients.”

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Source: The Telegraph (23 August 2022)

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Liz Truss: I’ll halt NHS doctor exodus

Liz Truss has pledged to halt the exodus of doctors from the NHS to tackle the Covid backlog and surging waiting lists.

The frontrunner in the Conservative leadership race is planning to unveil a series of radical reforms that will stop doctors from retiring early and entice retirees to return.

One in 10 consultants and GPs is expected to retire in the next 18 months because of pension rules that mean they are "paying to work". A source close to her said she would deal with it by “cutting red tape and dealing with issues in the pension and tax system that currently act as barriers for people wanting to return”.

It comes amid concerns that the NHS backlog after lockdown is causing more than 1,000 excess deaths per week - more than the figure now killed each week by coronavirus.

A source close to Liz Truss also said: “The Covid pandemic put unprecedented strain on our NHS, and the resulting backlog is seeing people struggling to get appointments and treatments. We must act to tackle it, and we will. We will make it easier for doctors and nurses who have recently left or are planning to leave the NHS but want to return or stay to do so.” 

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Source: The Telegraph (20 August 2022)

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LMC creates letter for GPs to reject hospital workload dumping ‘tsunami’

An LMC has created template letters to help practices reject secondary care workload dumping, including rejected referrals and requests to complete work on behalf of hospital trusts.

Cambridge LMC said it developed the tools amid a growing ‘tsunami’ of secondary care workload transfer into general practices.

One template letter tackles the rejection of a referral ‘on the basis that a proforma was not enclosed or completed in full’. It points out that the GMC requires GPs to refer when they ‘believe it is necessary to do so’ and that their ‘contractual obligations make no mention of a requirement to complete a proforma’.

Cambridgeshire LMC chief executive Dr Katie Bramall-Stainer told Pulse that ‘we need the temperature to rise on the understanding around pressures across general practice’.

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For more information on the issues raised, read a blog by Patient Safety Learning about the patient safety risks of rejected outpatient referrals.

Source: Pulse (19 August 2022)

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New Covid warning over symptom that affects sleep

An immunologist has warned the new strain of Covid-19 could be causing different symptoms – including one that emerges during the night.

Omicron BA.5 is a highly-contagious subvariant prompting concern as it contributes to a fresh wave of infections across the globe, including the UK. Scientists have been finding differences with previous strains, including the ability to reinfect people within weeks of having Covid.

“One extra symptom from BA.5 I saw this morning is night sweats,” Professor Luke O’Neill from Trinity College Dublin told an Irish radio station in mid-July.

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Source: The Independent (24 August 2022)

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Cost of living: 700 doctors could leave Welsh NHS over pay - union

Nearly 700 doctors are likely to leave the Welsh NHS as a result of a recent 4.5% pay rise, the British Medical Association has warned.

The warning follows a survey by BMA Cymru, in which more than half of the 1,397 respondents said they could leave and most felt morale had dropped.

The below-inflation pay rise will apply to consultants, junior doctors and GPs. The Welsh government said it accepted the NHS pay review body's advice and was limited on how far it could go.

Dr Iona Collins, chairwoman of the BMA's Welsh Council, said the findings resonated with what she was hearing from colleagues across Wales. "Doctors' take-home pay has reduced over several years, making the NHS an increasingly unattractive employer," said Dr Collins.

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Source: BBC News (23 August 2022)

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NHS whistleblower recorded her bosses’ ‘racist’ chat

A black NHS worker has launched legal action against the health service’s blood and transplant authority after witnessing years of alleged racism within the service.

Melissa Thermidor, 40, from Bushey, Hertfordshire, has lodged an employment tribunal claim against NHS Blood and Transplant (NHSBT) and two executives who have since left the authority. Betsy Bassis and Millie Banerjee, who were the chief executive and chairwoman, have denied the allegations and intend to fight the tribunal claims.

One colleague allegedly said: “White donors are more likely to shop at Waitrose and black donors at Tesco.” At subsequent meetings, the phrase “Tesco donors” was used. Staff also allegedly referred to “you people” when speaking to black members of the team.

Thermidor claims she was constructively dismissed after whistleblowing about racism within NHSBT. The health authority, which supported 3,386 organ donations in the year to March last year as well as collecting blood from 761,000 donors, has been embroiled in allegations of bullying, racism and poor culture under Bassis and Banerjee’s leadership.

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Source: The Times, 21 August 2022

Read NHS Blood and Transplant's response to the article.

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25 million children missed out on lifesaving vaccines in 2021, WHO and UNICEF data shows

Vaccine coverage continued to decline worldwide in 2021, with 25 million children missing out on lifesaving vaccines, according to data published by the World Health Organization and UNICEF.

"The largest sustained decline in childhood vaccinations in approximately 30 years has been recorded," the organisations have said.

Between 2019 and 2021, there was a 5-point drop in the percentage of children who got three doses of DTP3, the vaccine against diphtheria, tetanus and pertussis. This took the coverage down to 81%.

DTP3 coverage is used as a marker for broader immunization coverage, WHO and UNICEF said.

"As a result, 25 million children missed out on one or more doses of DTP through routine immunization services in 2021 alone. This is 2 million more than those who missed out in 2020 and 6 million more than in 2019, highlighting the growing number of children at risk from devastating but preventable diseases," they said. Eighteen million of these children didn't get a single dose of the vaccine, the majority of whom lived in low- and middle-income countries.

Other decreases were seen in HPV, with which over a quarter of the coverage achieved in 2019 was lost, and measles, with which first-dose coverage dropped to 81% in 2021. WHO notes that this is the lowest level since 2008 and means 24.7 million children missed their first dose in 2021.

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Source: CNN, 14 July 2022

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Large hospital trusts still missing key crisis support in A&E

Some of the country’s leading acute hospitals are not meeting a key NHS standard for mental health support in emergency departments, HSJ research suggests, with some regions faring better than others.

Latest official estimates indicate that more than a third of EDs (36 per cent) are not yet meeting ‘core 24’ standards for psychiatric liaison – which requires a minimum of 1.5 full-time equivalent consultants and 11 mental health practitioners.

The long-term plan target is for 70 per cent of acute trust emergency departments to have the optimum ‘core 24’ standard service by 2023-24. The NHS appears to be on track to hit this, with significant progress made, despite the pandemic.

Annabel Price, chair of the Royal College of Psychiatrists’ liaison faculty, said tackling the workforce crisis with a fully funded plan would “prove instrumental in boosting recruitment across all acute trusts”.

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Source: HSJ, 23 August 2022

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NHS trialling 'smart goggles' so nurses can see more patients

NHS nurses will wear “smart goggles" as part of efforts to see more patients under a £400,000 pilot scheme.

Health chiefs said the virtual reality headsets would mean details of a consultation could be directly transcribed, reducing the amount of time spent filling in patients’ notes.

The technology will also allow live footage to be streamed to hospital specialists for second opinions, so patients do not have to have extra appointments in hospitals.

The intention is to give nurses more time for clinical duties such as checking blood pressure, dressing wounds and assessing a patient’s health needs.

Dr Tim Ferris, NHS director for transformation, said: “These new smart glasses are the latest pioneering tech and really show us what the future of the NHS could look like.

“They are a win-win for staff and patients alike, freeing up time-consuming admin for nurses, meaning more time for patient care.”

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Source: The Telegraph, 20 August 2022

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Staffing crisis leaves many English care home residents’ basic needs unmet

Thousands of vulnerable people are suffering inadequate care as severe staffing shortages in previously good care homes push operators to break rules and put residents at risk.

A wave of inspections has revealed the human impact of a worsening nationwide staffing crisis, with people being left in their rooms 24 hours a day, denied showers for over a week, enduring assaults from fellow residents, and left soaking in their own urine.

Stretched staff have described scrambling to help residents with buzzers going off and fear the squeeze on their time is dangerous.

Analysis by the Guardian revealed that staff shortages were identified as a key problem in three-quarters of all the care homes in England where the Care Quality Commission regulator had cut their rating from “good” before Covid-19 to “inadequate” this summer.

A further 10% of homes whose rankings slumped had enough staff, but failed to recruit safely, either not taking references properly, carrying out criminal records checks, or training staff adequately.

Families said the staffing shortages had reached “crisis point”.

“Older people are paying a heavy price for these failings, as poor care robs them of their dignity, breaks their will and makes them feel unsafe in their own home,” said Helen Wildbore, director of the Relatives and Residents Association. “Older people need much more than empty slogans from the next prime minister about ‘fixing social care’.”

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Source: The Guardian, 21 August 2022

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Trusts warn of continued care delay as IT outage goes on

Mental health trusts continue to suffer much disruption after a cyber attack left them unable to access their electronic patient records.

Several trusts which use Advanced’s CareNotes EPR are grappling with the system being down, although the company said on Friday some progress had been made to restore the EPR.

One source at an affected mental health trust said there had been “not much in the way of improvements”, while another said they feared it could be “months” before they can fully access the EPR.

NHS England’s mental health director Claire Murdoch is regularly raising issue nationally, HSJ was told, as response teams work with Advanced to investigate and restore IT systems, which were taken offline after the company was hit by a cyber attack two weeks ago.

Hereford and Worcestershire Health and Care Trust has told its patients they might have to “provide more detail on your medical history to ensure clinicians have the most up-to-date information”, while Oxford Health Foundation Trust warned the technical issues could cause delays to patient care.

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Source: HSJ, 21 August 2022

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Covid death payments unavailable for staff who died in most recent waves

The families of any NHS and social care staff who died from Covid in the most recent waves will not be eligible for the Covid death assurance scheme launched at the start of the pandemic, it has emerged. 

The scheme closed on 31 March, despite pleas from the Royal College of Nursing (RCN) to keep it open. Since it was set up in April 2020, it has paid out £60,000 lump sums to the estates of 688 workers. A further 42 cases have been declined and 29 applications are still being processed.

The RCN wrote to then health and social care secretary Sajid Javid on 30 March, calling for the scheme to be extended. General secretary and chief executive Pat Cullen wrote: “The over-riding principle must be that no member of nursing staff who loses their life this year should be afforded any less respect and family support than one who died in 2020 or 2021…

“With a distinct possibility of new variants at any point, staff deserve assurance that they and their loved ones will not go unnoticed should they contract and ultimately lose their life to covid.”

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Source: HSJ, 19 August 2022

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Fifth of health and care workers to leave sector due to work pressures and cost of living crisis

A study of over 1,000 health and social care workers, conducted by Florence, the tech platform providing health & social care workers access to available shifts, found that almost a third of healthcare workers admit to feeling overwhelmed at least once a week, with 17% feeling burnt-out every day. A staggering 97% believe the cost-of-living crisis has caused further stress or burnout among healthcare professionals. 

It comes after more than half of healthcare workers (56%) admit to working more than 2-3 times a week over their contracted hours, with 7% working overtime every day. Not having enough staff is causing the most pressure in their role (50%), followed by low pay (39%) and high workload (35%).   

The study revealed nine in ten NHS and social care workers state chronic staff shortages are affecting the quality of care. Analysing this deeper, three quarters of respondents stated that the quality of care is already being ‘severely’ impacted as high vacancy rates sweep across the industry.  

Dr Charles Armitage, Former NHS doctor and CEO and Founder of Florence, observed: “If you’ve got fewer people there on-shift to look after people, the quality of care decreases because the people that are there are overstretched, they’re trying to do too many things and are suffering from severe burnout. As a result, mistakes are made as they’re not able to just spend as much time with people and provide that really important patient-centred care.” 

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Source: Hospital Times, 17 August 2022

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Almost 38,000 mental health appointments miss vital 72-hour window

Nearly 38,000 vital follow-up appointments with mental health patients were missed at the time when they were most at risk of suicide, the Royal College of Psychiatrists has said.

The medical body has called for “urgent action” to ensure more people are seen for follow-ups within 72 hours of their discharge from inpatient care, to prevent them from falling “through the cracks when they are so vulnerable”.

The risk of suicide is highest on the second and third days after leaving a mental health ward, but 37,999 follow-up appointments with patients were not made within this timeframe in England between April 2020 and May 2022.

According to NHS data, of the 160,430 instances when patients were eligible for follow-up care within 72 hours after discharge from acute adult mental health care, only three-quarters (76%) took place within that period.

The Royal College of Psychiatrists is calling for more trained specialists to check on those perceived to be at risk, which they say requires more staffing and funding.

The president of the Royal College of Psychiatrists, Dr Adrian James, said: “We simply can’t afford to let people fall through the cracks at a time when they are so vulnerable. It’s vital that our mental health services are properly staffed and funded to offer proper follow-up care and help prevent suicides.

“Staff are working as hard as they can to provide high-quality care, but it’s clear that current resources are not enough to meet these targets. We need urgent action to tackle the workforce crisis and achieve the suicide prevention goals set out in the NHS long-term plan.”

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Source: The Guardian, 22 August 2022

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Energy costs risk humanitarian crisis, says NHS leaders

Rising numbers of people will fall sick and see their health worsen unless the government takes further action to limit energy price rises, the NHS says.

The NHS Confederation said the UK was facing a "humanitarian crisis". The group, which represents health bosses, said many people would face the awful choice between skipping meals to heat their homes or having to live in cold and damp conditions.

But ministers said action was already being taken and the NHS supported. This includes £400 payments to every household this autumn to help pay energy bills.

However, in a letter to ministers, NHS leaders said that rapidly rising energy prices, along with other cost-of-living pressures, will still leave individuals and families facing impossible choices.

They warn that if people are forced to live in cold homes and cannot afford nutritious food, then their health will quickly deteriorate and the NHS will be left to pick up the pieces.

Cold conditions can lead to a rise in respiratory conditions, and in older people can also increase the risk of heart attacks, strokes and falls.

Cold homes are already linked to 10,000 deaths a year, the NHS Confederation said.

The group warned the risk of ill-health linked to the energy crisis would come on top of what many expect to be one of the toughest winters on record because of the combination of flu, norovirus and Covid outbreaks.

As well as leading to more sickness and illness, the NHS Confederation said it would also have a major impact on mental health and well-being.

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Source: BBC News, 20 August 2022

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GPs to prescribe walking and cycling in bid to ease burden on NHS

GPs around England are to prescribe patients activities such as walking or cycling in a bid to ease the burden on the NHS by improving mental and physical health.

The £12.7m trial, which was announced by the Department for Transport and will begin this year, is part of a wider movement of “social prescribing”, an approach already used in the NHS, in which patients are referred for non-medical activities.

Minister for health, Maria Caulfield, said the UK is leading the way in embedding social prescribing in the NHS and communities across the country.

“Getting active is hugely beneficial for both our mental and physical health, helping reduce stress and ward off other illness such as heart disease and obesity,” she said.

Paul Farmer, chief executive of the mental health charity Mind, said he welcomed news of the extra investment, enabling the NHS to try new ways of supporting mental health, such as through social prescribing schemes.

But, he added, prescribing exercise is not a miracle cure for treating mental health problems.

“What we urgently need to see is proper investment into our country’s mental health services,” he said. “Only that will enable us to deliver support to the 1.6 million people currently sat on waiting lists, and the 8 million people who would benefit from mental health support right now but are deemed by the system not to be unwell enough to access it.”

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Source: The Guardian, 22 August 2022

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Revealed: CEO and exec turnover at each acute trust

Some acute trusts have kept more than half of their executive directors over a five-year period – whereas others have seen all of them change, according to HSJ analysis of top-level managerial stability.

HSJ looked at the number of executive directors who had been in place between April 2017 and April 2022, by examining annual reports and board papers.

One trust – Southport and Ormskirk – had five CEOs during the five year period, and three other trusts had four.

The national average was more than two different CEOs at each trust across the five years. Thirty-one trusts (out of 108 listed) had three different CEOs during the period, and just 23 trusts had one.

NHS Providers interim chief executive Saffron Cordery said: “This analysis underlines the value of long-term investment in NHS trust leadership. It highlights too the danger of chopping and changing leaders amid longstanding financial, capacity, workforce and other structural pressures on the health system.

“It is vital to invest in people alongside operational priorities. More must be done to guarantee a robust and diverse pipeline of leaders, equipped to take on crucial roles.”

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Source: HSJ, 22 August 2022

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Deaths rise as A&E crisis leads to ambulance delays

On Monday, September 20, 2021, Michael Wysockyj felt unwell and did what any gravely sick person would do: he put his life in the hands of the ambulance service. The 66-year-old from Norfolk was whisked by paramedics to the Queen Elizabeth hospital in King’s Lynn at 6.28pm. Nearly four hours later, he was still trapped inside the vehicle. The hospital was too full to take him. He died at 4.42am.

So great were the concerns of the coroner, Jacqueline Lake, that she took the unusual step of issuing a “prevention of future death” notice. “The emergency department was busy at the time and unable to offload ambulances,” she said in her report. “An x-ray cannot be carried out in an ambulance and must wait until the patient is in [the emergency department].”

This episode should be an anomaly in the failure of emergency services. It is not.

The crisis is “heartbreaking”, according to Dr Ian Higginson, vice-president of the Royal College of Emergency Medicine. “If you call for an ambulance and you’re waiting many hours for one and you have a serious condition, that is going to have an impact on your outcome. It would be reasonable to assume the long delays that patients are subjected to waiting for ambulances at the moment will filter through into excess mortality.”

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Source: The Times, 21 August 2022

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Avoid A&E, says NHS as winter crisis bites early

The NHS is to launch a campaign urging the public to avoid A&E in an echo of appeals to protect the health service during the Covid pandemic.

The head of the NHS has instructed hospitals to prepare a public awareness campaign calling for people to “minimise” pressures on urgent and emergency services.

Such an instruction has never been issued so early in the year, and comes amid concerns that hospitals and ambulance services are already facing strains usually seen in the depths of winter.

People suffering a genuine emergency will still be encouraged to go to A&E, but on Friday night there were warnings that the campaign risks exacerbating the problems caused by patients staying away from the health service during Covid.

Prof Carl Heneghan, an urgent care doctor and professor of evidence-based medicine at the University of Oxford, said the NHS needed to be very careful about trying to dissuade the public from using services.

“The NHS seems to be the only business I know that doesn’t know how to deal with demand, and work with the needs of its customers,” he said.

“As an urgent care doctor, I need to be in front of the patient to do my job. It’s often too difficult for the new mum to know when it’s appropriate to turn to emergency services. These decisions are difficult – it’s the job of a doctor.

“Too often I see elderly patients who apologise for taking my time and I say ‘don’t apologise – you could have been 24 hours away from death’.”

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Source: The Telegraph, 19 August 2022

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Let patients choose hospital with shortest wait, says former health secretary

All patients should be able to choose the hospital with the shortest waiting times, a former health secretary has said.

Alan Milburn, the Labour health secretary under Tony Blair from 1999 to 2003, called for urgent reforms and warned that the NHS was “close to breaking point” and “in the worst state I have ever seen”.

A record 6.7 million people are now on waiting lists, with the numbers waiting in Accident and Emergency departments for at least 12 hours surging by more than a third in a month.

Writing for The Telegraph, Mr Milburn called for urgent reforms to give patients more choice and control while preventing a “tsunami” of chronic diseases fuelled by unhealthy lifestyles.

In recent months, ministers have promised that those facing the longest waits will be offered treatment further away and offered travel and accommodation costs, but only around 140 patients were booked in for such surgery by June.

Mr Milburn called for the option to be offered to all patients, urging health officials to use the NHS app as a way for people to chose the hospital with the shortest wait. So far, officials have promised to ensure that the app allows patients to check the average waiting time at their local hospital for their condition and compare it with others.

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Source: The Telegraph, 17 August 2022

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Injured 90-year-old, in 40-hour ambulance wait

A 90-year-old woman waited 40 hours for an ambulance after a serious fall.

Stephen Syms said his mother, from Cornwall, fell on Sunday evening and an ambulance arrived on Tuesday afternoon.

She was then in the vehicle for 20 hours at the Royal Cornwall Hospital. It comes as an ambulance trust warns lives are at risk because of delays in patient handovers.

It was also reported a man, 87, who fell, was left under a makeshift shelter waiting for an ambulance.

South Western Ambulance Service said it was "sorry and upset" at the woman's wait for an ambulance.

Mr Syms, from St Stephen, told BBC Radio Cornwall: "We are literally heartbroken to see a 90-year-old woman in such distress, waiting and not knowing if she had broken anything.

"The system is totally broken."

He said it took nine minutes before his 999 call was answered.

"If that was a cardiac arrest, nine minutes is much too long, it's the end of somebody's life," he said.

Mr Syms said paramedics were "absolutely incredible people".

He added: "The system is not deteriorating, it's totally broken and needs to be urgently reviewed."

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Source: BBC News, 19 August 2022

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NHS England’s list of trusts with worst elective and cancer problems

Almost a third of acute trusts have been identified by NHS England as being ‘at risk’ of missing key targets for electives and cancer recovery, with some facing “periodic calls between ministers and CEOs”, HSJ can reveal.

NHS England has identified 39 acute trusts at the most risk of missing the targets of having no patients waiting 78 weeks or more for elective treatment by April 2023, and returning the 62-day cancer waiting list to pre-pandemic levels by March 2023.

HSJ can reveal the full lists of 19 trusts placed in “tier one” – the most at-risk category – and 20 in “tier two” (see lists below). 

The “at risk” trusts represent 31% of the acute providers in England, with many of them among the lowest performers in the country for elective and cancer recovery.

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Source: HSJ, 19 August 2022

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