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Trusts told to treat more COVID-19 patients at home

Hospitals should ramp up their treatment of COVID-19 patients at home to free up more beds during the peak of the pandemic, under plans announced by NHS England/Improvement.

All NHS trusts will receive up to 300 oximeters, which measure oxygen saturation levels and can be used to monitor COVID-19 patients in their own homes, rather than in hospital beds.

NHSE has “recommended” that all areas of England “pursue immediate roll-out” given the “intense pressure on hospital beds right now”, according to a letter from medical director Steve Powis and two other national directors.

Currently, nearly 60 trusts have COVID-19 patients in at least a third or more of their beds, and the total number of COVID-19 patients is peaking at around 37,000. There have been particular strains on hospital discharge, particularly of covid patients, whom many care homes are unable or unwilling to receive.

The scheme, dubbed “covid virtual wards”, has been used at some trusts since the pandemic’s first wave.

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Source: HSJ, 19 January 2021

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Trusts told to test staff who are in quarantine

Acute trusts have been told to set aside 15% of their daily coronavirus tests for NHS key workers who are quarantining at home with others.

New guidance for NHS trust chief executives on covid-19 testing has been published after NHS England chief executive Sir Simon Stevens announced hundreds of frontline staff would be given antigen tests from next week.

The guidance from NHSE said acute trusts should prioritise testing staff working in critical care, emergency departments and ambulance services, along with “any other high priority groups you determine locally”.

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Source: HSJ, 30 March 2020

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Trusts told to appoint board director with responsibility for reducing racism

Mental health trusts will be expected to appoint a board member responsible for improving racial equality and to develop individual plans to eliminate systemic racism, according to new draft NHS England guidance seen by HSJ.

The draft guidance says all providers will be required to draw up their own Patient and Carer Race Equality Framework by March 2024. These blueprints will outline how trusts plan to improve access, experience and outcomes for racialised communities, covering all services from talking therapies through to secure inpatient services.

PCREFs were a key recommendation in the 2018 Mental Health Act review which identified disproportionate applications of the act in racialised groups and are part of NHSE’s wider mental health equalities strategy.

Black people are 10 times more likely to receive a community treatment order after being an inpatient and their rate of detention under the act is four times as high as the rate for white people.

The guidance follows HSJ last month revealing the “staggering” rise in restraints of black people in NHS care.

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Source: HSJ, 5 January 2023

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Trusts to stop routine Covid tests for new patients amid ‘brutal’ NHS pressures

Overstretched hospitals are stopping routine Covid tests for new patients as “brutal” pressures mount on doctors and nurses, The Independent understands.

On Monday there were 1,702 new Covid admissions to hospitals in England as of 9 April – with 16,442 positive patients occupying beds – the NHS leaders warn their ability to tackle the backlog in planned care is at risk.

Despite pleas from NHS chiefs to measures such as mask-wearing back into force, ministers said there were no plans to change guidance.

The Independent understands at least two major hospitals, in Newcastle and York, have dropped testing of all patients without symptoms in order to alleviate pressure on beds – raising fears that Covid could spread on unchecked wards. Other hospitals are also likely to do the same as bed pressures worsen.

Sources have told The Independent some trusts have begun to drop “red” Covid only wards, while some are considering not separating patients in A&E.

One expert, critical care doctor Tom Lawton, who analyses hospital-acquired infection data, said that stopping patient testing in hospitals was “worrying” and that the NHS would be putting “blinkers on” just as in-hospital infections were “as high as they’ve ever been”.

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Source: The Independent, 11 April 2022

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Trusts to ‘run out of gowns this weekend’

London trusts have been warned not to expect deliveries of gowns from the national supply chain for at least the next few days, HSJ understands.

Without central deliveries, providers risk running out of gowns ahead of the Easter weekend. Trusts will have to rely on existing supplies and any new stock they procure independently. 

Staff performing or assisting aerosol-generating procedures on confirmed or suspected covid-19 patients should wear gowns, according to the latest guidance from Public Health England.

But supplies have been an issue for weeks, with trust procurement leads raising concerns about dwindling gown stocks last month. It recently emerged that gowns were not included in national pandemic stockpiles, unlike other forms of personal protective equipment like masks and gloves.

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Source: HSJ, 9 April 2020

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Trusts that declared ‘no RAAC concrete’ now admit they have it

Thirteen more NHS hospitals have identified a potentially unsafe form of concrete in their buildings, causing closures and disruption to wards.

The government has updated its list of hospitals that have confirmed reinforced autoclaved aerated concrete on their sites, with the total now at 54.

This includes at least two trusts – Sheffield Teaching Hospitals and Hampshire Hospitals – which in September said their sites did not contain the material, after the sudden closure of schools with the concrete sparked a wave of headlines over it.

The material was used widely between the 1960s and 1980s and can be prone to collapse.

The impact and risk of the concrete identified varies greatly between sites. HSJ has asked trusts who run the newly identified sites where it has been found, as well as the risks and impact from the discovery.

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Source: HSJ, 29 February 2024

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Trusts team up for weekend surgery drive to cut paediatric waiting times

Three acute trusts have teamed up to carry out surgical procedures on hundreds of children over several weekends as part of plans to tackle waiting lists in the region.

Trusts across the Bath and North East Somerset, Swindon and Wiltshire Integrated Care System are pooling resources to tackle long waits in paediatric oral and ear, nose and throat services.

The initiative began on the April bank holiday weekend. Thirty-eight of the longest waiters from Royal United Hospitals Bath Foundation Trust, who had been waiting up to 74 weeks for oral surgery, were treated by Salisbury FT. The other trust involved in the plans is Great Western Hospitals FT. 

More than 400 children are expected to be treated over a series of joint surgery weekends. The next, which will also focus on both oral and ENT surgery, will take place over the early May bank holiday. 

RUH’s chief executive Cara Charles-Barks told HSJ the joint surgery plans will have a “huge impact” on the region’s elective waiting lists.

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Source: HSJ, 21 April 2021

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Trusts struggle with growing backlog of uninvestigated incidents

The backlog of serious clinical incidents that need investigating is building up throughout the NHS, due to the impact of coronavirus and emergency service pressures.

Concerns have been raised by commissioners in some areas over the delays. Meanwhile, patients and families who have been harmed are waiting longer to see their cases resolved and the organisations involved are not learning the lessons taught by care failures as quickly as they should. 

Staff redeployment or absences due to COVID-19 are among the reasons why many investigations are being delayed. As result, trusts are attempting to recruit additional investigators to manage their backlogs.

Tina Ivanov, the trust’s director of quality governance, said: “Learning from serious incidents when they occur is an important part of our improvement culture.

“We are increasing the number of trained investigators at the trust and have brought in additional resource to help complete the outstanding investigations. The reasons for the increase in outstanding serious incidents include staff absences and clinical pressures.”

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Source: HSJ, 27 September 2021

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Trusts spending £1m+ a year on settlement deals with gagging clauses

Trusts are still spending at least £1m a year on settlement agreements with staff containing ‘gagging clauses’ despite a crackdown on these conditions in recent years, HSJ research reveals.

Freedom of information responses reveal 214 settlement agreements with confidentiality conditions worth £4.6m across three years

NDAs — which are also known as “confidentiality clauses” or “gagging clauses” and prevent parties to a settlement agreement from disclosing its details — also seem to be becoming less popular. HSJ’s FOIs revealed 119 settlement agreements with an NDA with a total value of £2.16m, in 2018-19. In 2019-20, this fell to 87 such agreements with a total value of £1.5m. In 2020-21, there were 41 settlement agreements with such a clause, with a total value of £1.04m.

A source with knowledge of confidentiality agreements in the NHS said: “Following some high-profile whistleblowing cases a few years ago… NHS organisations have been far more cautious in imposing confidentiality obligations in settlement agreements.”

Numerous health secretaries have issued warnings about NDAs potentially being used to silence staff. In 2019, former health and social care secretary Matt Hancock said: “Settlement agreements that infringe on an individual’s right to speak out for the benefit of patients are completely inappropriate.”

In 2013, then health secretary Jeremy Hunt said he would ban clauses in compromise agreements — as settlement agreements were then known — preventing NHS staff from raising patient safety concerns. After the Mid Staffordshire report was published, he wrote to all trust chairs, asking them to review the confidentiality clauses they were using.

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Source: HSJ, 1 November 2021

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Trusts should seek extra funding to be ready for major incidents, says inquiry

Ambulance trusts should review their ability to respond to mass casualty incidents and press commissioners for any additional resources they need, the report into the Manchester Arena bombing has said.

Only 7 of the 319 North West Ambulance Service Trust vehicles available on the night of the attack, in 2017, were able to deploy immediately, the report said. It said experts believed that “such a situation would almost inevitably be replicated if a similar incident were to occur again anywhere in the country”, given current resources and demand.

Ambulance trusts are now hugely more stretched than in 2017, with response times having significantly lengthened due to lack of resources.

The second volume of the report from the inquiry, chaired by Sir John Saunders, published today, is critical of the emergency services’ response to the bombing which killed 22 people. NWAS “failed to send sufficient paramedics into the City Room [an area adjoining the Arena]” and did not use available stretchers to remove casualties in a safe way, it says. A key role for managing the incident – that of ambulance intervention team commander – was not allocated for half an hour.

But it also raised issues of ambulance capacity and availability for major incidents involving mass casualties. “Around the UK, ambulance services are always ’playing catch up,’” it said, with no spare frontline capacity.

With demand doubling over the last 10 years, the inability to respond to such incidents is only going to get worse – and lives will be lost if they do not attend the scene quickly and in sufficient numbers, the report said.

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Source: HSJ, 3 November 2022

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Trusts reveal thousands of new 12-hour waits

Several trusts have now started reporting thousands of 12-hour waits in their emergency departments, representing a huge difference to the numbers published nationally under a slightly different measure.

This year, trusts have started submitting data to NHS England on the number of patients waiting over 12 hours from time of arrival in ED, until discharge, admission or transfer. Many trusts are now reporting these statistics in their public board reports.

This is a slightly different measure to the publicly reported “trolley wait” figures, which count waits of over 12 hours from decision to admit until admission.

Experts have long argued the trolley wait measure does not capture the true problem of ED overcrowding and delayed care. The new data captures a far higher number of patients and has not been published nationally by NHSE.

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Source: HSJ, 2 August 2022

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Trusts resist visiting rule after ‘Javid threatens to call CEOs’

Local clinical leaders are continuing to question pressure from government and NHS England to relax Covid-19 visiting restrictions. 

Visitors, and people accompanying patients, have been restricted throughout covid, and in recent months there has been substantial local variation.

Ministers and NHSE, as well as other politicians and some patient groups, have been pressing for more relaxed restrictions for some time and in recent weeks have stepped up their instructions.

National visiting guidance was eased in March, and other infection control guidance, including requiring the isolation of covid contacts, was relaxed last month. Last week, the Daily Telegraph reported health and social care secretary Sajid Javid planned to “name and shame” trusts not implementing the changes, and to call hospital chief executives directly about it.

Meanwhile, chief nursing officer Ruth May reiterated the visiting rules last month, saying on Twitter: “We must not underestimate the important contribution that visiting makes to the wellbeing and personalised care of patients and make it happen.”

However, an NHSE online meeting for clinical leaders on Friday was told that while “a great number of trusts have returned to previous visiting policies… we know there are trusts which haven’t implemented this fully”.

One said: “It is very difficult to safely return to pre-covid visiting as some hospital’s estate can’t safely support visitors in already over-crowded [emergency departments] and increasingly busy [outpatient departments].

“Surely local risk assessment is key and should be supported rather than increasing pressure to simply blanketly return to pre-pandemic arrangements everywhere?”

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Source: HSJ, 9 May 2022

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Trusts pressured to meet ‘political’ target by diverting staff to less sick patients

Hospitals are being pressured to shift their resources to treating patients with less serious conditions to meet a “politically motivated” target, according to multiple senior sources.

The pressure appears to be coming through NHS England’s regional teams, with local sources saying they are being told to focus energies on patients in their emergency departments who do not need to be admitted to a ward.

These cases are typically faster to deal with, and therefore shifting resources to this cohort could significantly improve performance against the four-hour target.

However, experts in emergency care repeatedly warn that admitted patients are the most likely to suffer long waits and harm.

The NHS has been tasked with lifting performance against the four-hour target to 76% in 2023-24, but has failed to meet that in any month this year. Performance in December was 69%.

Some trust leaders told HSJ they would ignore the instructions, saying they would continue to focus resources on reducing the longest waits.

One chief executive in the north of England said: “It’s a complete nonsense and just politically motivated. We’re getting a very clear message to hit 76 per cent which is hugely problematic because it will drive non patient focussed behaviour. We have said ‘no, we are focussing on long waiters and ambulance delays’… in other words doing the right thing for patients.”

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Source: HSJ, 5 February 2024

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Trusts offering controversial trauma ‘treatment’ to new mums

Several NHS trusts are offering a ‘treatment’ for birth trauma which uses a technique which lies outside national guidelines and which is criticised by specialists as potentially causing ‘more harm than good’.

The ‘Rewind’ technique is promoted as a fast treatment for post-natal post-traumatic stress disorder (PTSD) – also known as birth trauma - which involves the “reprocessing” of painful memories.

HSJ has learned of several trusts, including East and North Herts Trust, Chelsea and Westminster Hospital Foundation Trust and James Paget University Hospital FT, where the therapy is being offered. It is thought there are other trusts which are providing it or have explored it. Typically, it is provided by midwives who have undergone training in the technique.

But Nick Grey, a clinical psychologist who was on the National Institute for Health and Care Excellence panel which looked at PTSD, said it was “absolutely clear cut” that it was bad practice to offer the technique as a branded therapy for PTSD, although he said it could be embedded as part of other treatments.

He told HSJ: “It should not be offered to mothers with PTSD… they are being done a disservice if they are not given evidence-based treatment. There is no evidence that this [provides] treatment for sub-clinical PTSD or trauma,” he said.

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Source: HSJ, 11 November 2020

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Trusts offered up to £4m to make last-ditch attempt on A&E target

NHS England has confirmed new financial incentives for trusts to deliver strong performance against the four-hour emergency target this month.

National leaders are desperate for the NHS to hit the four-hour target in 76% of cases in March, telling trusts earlier this month that it was necessary to restore confidence in the health service.

They took the unusual step at the start of the month of asking local leaders to sign a commitment to deliver the necessary performance. The recent pressure has come under criticism for encouraging hospitals to prioritise four-hour performance over caring for the sickest patients.

It was also indicated there would be new financial incentives for those delivering the best performance.

In a letter, NHSE confirmed a significant expansion to the criteria for trusts to claim a share of a £150m incentive fund, by improving their headline accident and emergency performance.

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Source: HSJ, 12 March 2024

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Trusts need hundreds of millions to stop hospitals’ roofs collapsing

Trusts need hundreds of millions of pounds to remediate dangerous roofs.

A series of freedom of information requests submitted by New Civil Engineer has revealed five of the worst affected trusts have applied for £331.9m of additional funding to be spent on fixing reinforced autoclaved aerated concrete planks during the next three years.

In response to NCE’s freedom of information investigation, Liberal Democrat deputy leader and health spokesperson Daisy Cooper said “patients are paying the price for years of neglect” by successive governments.

“It is truly shocking that patients are being treated in crumbling buildings that could be at risk of collapse. The NHS is crying out for the funds to fix creaking roofs so that patients can be treated safely. The public needs to know that the funds to fix this are on the way as soon as possible.”

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Source: HSJ, 17 October 2022

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Trusts may no longer be fined for missing quality standards

Trusts may be spared financial penalties if they fail to meet care quality standards under new proposals from NHS England. 

NHSE is looking at “pausing” the financial element of the Commissioning for Quality and Innovation scheme from next year according to information seen by HSJ. This states “a wider review of incentives for quality” is also under way.

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Source: HSJ, 30 October 2023

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Trusts lose out on cash after safety ‘mis-declarations’

Three trusts have lost out on more than £1m in rebate from the maternity clinical negligence scheme (CNST) after they ‘mis-declared’ that they were compliant with safety requirements.

University Hospitals Sussex Foundation Trust, University Hospitals Morecambe Bay FT and Doncaster and Bassetlaw FT have all received a small amount of funding to implement their action plans but a much larger rebate on the NHS Resolution maternity section of the clinical negligence scheme for trusts has been withheld.

This amounted to a loss of close to half a million pounds for Doncaster and Bassetlaw and is likely to be more for the other two trusts, which had made bigger contributions to the maternity section of the CNST.

Western Sussex had mis-declared its compliance on five safety actions, BSUH on seven, Doncaster and Bassetlaw on five and UHMB on seven.

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Source: HSJ, 26 May 2022

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Trusts given five years to achieve safe midwife staffing

NHS trusts have been given until 2027-28 to employ enough midwives to meet safe staffing requirements, NHS England’s new maternity delivery plan has said.

The three-year delivery plan for maternity and neonatal services sets out to “make maternity and neonatal care safer, more personalised and more equitable for women, babies and families”.

It says: “Trusts will meet establishment [requirements] set by midwifery staffing tools and achieve fill rates by 2027-28, with new tools to guide safe staffing for other professions from 2023-24.”

The plan follows a series of high-profile maternity scandals in the NHS at Shrewsbury and Telford, East Kent, Morecambe Bay and an ongoing independent review by Donna Ockenden into Nottingham University Hospitals Trust. The Care Quality Commission has highlighted a string of other concerns across the NHS.

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Source: HSJ, 31 March 2023

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Trusts given 20 days to book in all 78-week waiters

Trusts have been told today by NHS England that they must book appointments by the end of this month for all patients who have been waiting longer than 78 weeks. A letter from NHS England sent to trust leaders set out the new orders and represents system leaders’ attempt to ramp up progress on this cohort of patients, which the NHS and government elective recovery plan commits to eliminating by March.

The appointments must be issued this month, and be dated before the end of March, for these pathways, of which about 48,000 are recorded nationally. The letter also warns trusts that, while NHSE will accept some inpatient cancellations are unavoidable, cancelling outpatient appointments — even during strike action — is viewed as less acceptable.

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Source: HSJ, 12 January 2023

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Trusts fear ‘fragmentation’ of specialised services under Health Bill reforms

Providers fear 'fragmentation' of specialised services as NHS England begins delegating specialised services budgets to integrated care systems under reform plans.

One leader of a specialist trust told HSJ: “There is a real risk of fragmentation. You can already see some of the conversations around various services around how people want to keep patients within their own ICS. There is the potential there for systems to buck the trend of centralising specialist services. Rather than bringing expertise and quality together, systems looking after budgets will look to set up their own specialist services.” 

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Source: HSJ, 17 August 2021

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Trusts fall far short of NHSE discharge target

NHS trusts have been unable to get anywhere close to the target for reducing delayed discharges set by NHS England last month ahead of the omicron wave.

The latest NHSE data shows that, in the week beginning 27 December, there were on average 9,857 medically fit for discharge adult patients occupying hospital beds.

This is just 836 fewer than the average of 10,693 in the week of 13 December. This was when NHSE told trusts to discharge at least half of their medically fit patients to free up beds ahead of a surge in Covid patients.

The news follows ministers announcing £300m would be invested into the adult social care workforce to fund community placements to aid discharges. However, in the letter on 13 December, NHSE said “a significant proportion of discharge delays are within the gift of hospitals to solve”.

Meanwhile, ambulance handover delays remained a near record high levels last week as the urgent and emergency care system showed clear signs of pressure, including massive demand on NHS 111.

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Source: HSJ, 7 January 2022

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Trusts failing to report ‘concerning’ numbers of hospital-acquired covid cases

Some acute trusts have failed to report large numbers of hospital-acquired covid infections as patient safety incidents, despite NHS England describing this as ‘fundamental’. 

HSJ examined the numbers of “infection control” patient safety incidents reported to the national reporting and learning system in 2020-21, and compared this to separate NHS England data on covid infections most likely to have been acquired in hospital.

The number of incidents reported to the NRLS in the 12-month period should in theory be higher, as it covers all types of hospital-acquired infections, while the NHSE data only covered covid infections in the last seven months of the year. 

This appears to hold true nationally, with almost 59,000 incidents reported to the NRLS, compared to around 36,000 likely hospital-acquired covid infections suggested by the NHSE data. But for around a third of trusts, the incident numbers reported to the NRLS were smaller, with some appearing to report very low numbers.

Helen Hughes, chief executive of patient safety charity Patient Safety Learning, said: “The scale of the under-reporting set out in these findings is particularly concerning.”

“As this data informs assessment of performance at both organisational and national levels, it is possible that this could create a false assurance about the extent of harm in this period,” Ms Hughes said.

“Where organisations are now retrospectively completing serious incident reports, there are obvious questions as to whether key insights will have been lost as memories of incidents fade over time and their causes.”

“However, they rely on the capacity and commitment of staff behind them. The pandemic has placed an enormous strain on the health service and we have heard from staff the time constraints this has put on them to report patient safety incidents,” she added. 

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Source: HSJ, 15 October 2021

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Trusts failing on waiting list ask told to ‘get act together’

Trusts have been told to ‘get their act together’ on health inequalities, after HSJ research suggested only a small minority have so far published data on disparities in waiting times between different patient groups.

Planning guidance issued by NHS England in September 2021 said trusts’ board performance reports should include a disaggregation of waiting lists by ethnicity and deprivation group.

Through freedom of information and media requests, HSJ attempted to obtain such data from the 20 trusts with the largest waiting lists, but only three currently appear to have met the requirement in full.

The remainder either said they were still undertaking the work, were thinking about how to publish it, or failed to respond.

Roger Kline, an academic researcher and former director of NHSE’s workforce race equality standard, said trusts should have been collecting and publishing the data for years.

He said: “We know there are issues around health and healthcare of some groups of people, most notably in poor working class communities and black and minority ethnic communities. It shouldn’t be seen as an optional extra, this should be part of good public health work and good equitable healthcare provision."

“This data should be on the trust website. It should be an active part of the conversations with local communities. Well done to the trusts that are pushing this forward. The ones that are not need to get their act together.”

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Source: HSJ, 3 May 2022

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Trusts face threat of legal action due to new quality standards

Trusts could be exposed to increased negligence claims as a result of new NHS England guidance for a rare spinal condition, a royal college has claimed.

The Royal College of Emergency Medicine (RCEM) has said updated national guidance on treating cauda equina syndrome could also lead to greater “inequity of access” due to issues accessing timely MRI scans at many accident and emergency departments.

An NHS Resolution report in 2022 found delayed MRI scans were a significant factor in high-value clinical negligence claims, particularly those relating to management of spinal conditions. 

The guidance issued by NHSE’s Getting It Right First Time programme national pathway guidance says emergency MRIs for suspected CES should be taken within four hours of requests to radiology, and where this is not possible, “standard operating procedures” involving local spinal and radiology services should be in place for urgent out-of-hours scanning. Local provision for this “must be in place by June 2024,” the guidance says.

NHSE said the GIRFT guidance has been endorsed by 11 clinical and patient bodies, including the Royal College of Radiologists and the Spinal Injuries Association.

But RCEM, understood to be the only clinical body not to endorse the guidance, has issued a position statement last month stating that “few EDs, outside of tertiary centres, have access to 24/7 MRI scanning”.

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Source: HSJ, 3 April 2024

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