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Trusts criticise ‘completely chaotic’ covid-19 supply response

Several trust procurement leads have expressed frustration with the government’s response to covid-19, with HSJ being told of shortages of crucial personal protective equipment, unpredictable deliveries and a lack of clarity from the centre

NHS Supply Chain, which procures common consumables and medical devices for trusts, has been “managing demand” for an increasing number of PPE and infection control products for since the end of February to ensure “continuity of supply”. Some products, like certain polymer aprons, are unavailable altogether because of the increased demand and disrupted supply caused by the covid-19 outbreak. 

One procurement lead told HSJ: “They aren’t supplying enough, they aren’t fulfilling orders. It’s completely chaotic.” Another said his trust had “just enough to manage for the time being.”

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Source: HSJ, 20 March 2020

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Trusts could get new CQC ratings without inspection

The Care Quality Commission (CQC) could regularly change its ratings of health and care providers without inspectors visiting them, under new plans from the watchdog.

The CQC has said it wants to “move away from using comprehensive, on-site inspection as the main way of updating ratings” and instead use other sources like data and feedback from the public, to update ratings more regularly.

At present — under the tough ratings regime introduced in 2014 in the wake of the Mid Staffs inquiry findings — it cannot change a provider’s score without carrying out a full inspection.

It said in a recently published consultation that inspections “will remain an important part of how we assess quality,” but this will mostly be through more “targeted” inspections linked to significant risks to people’s safety, and the rights of vulnerable people.

During the covid pandemic, CQC has targeted its on-site inspections at services where potential risks are identified, or where improvements are needed.

Professor Ted Baker, the CQC’s chief inspector of hospitals, told HSJ the regulator wanted to move away from its current “fairly rigid” timetable of inspections in favour of a more “flexible” approach.

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Source: HSJ, 2 February 2021

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Trusts and NHSE ‘neglecting whistleblower training’

Trusts and NHS England are failing to prioritise training for senior leaders on listening to whistleblowers — despite repeated findings of serious concerns going unheard — the National Guardian’s Office has said.

The Guardian’s Office — set up by the government to ensure whistleblowers and other staff raising concerns are properly listened to — made the claim in its written evidence to an inquiry into NHS leadership, performance, and patient safety.

The Commons health and social care committee is considering regulation of NHS leaders and managers, among other issues, including progress made on the 2022 report for ministers by General Sir Gordon Messenger. 

The NGO’s evidence, published on Wednesday, said: “In our opinion, there has been little progress on recommendations from the Messenger Review to date…

“The NGO has developed, in collaboration with [NHSE], three e-learning modules (Speak Up, Listen Up, Follow Up) which are freely available for anyone who works in healthcare. We have recommended to the sector that these modules should be a minimum standard for all staff and be made mandatory.

“Although accessible to all, many organisations have not adopted them, and NHS England has not prioritised these across the system.”

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Source: HSJ, 18 April 2024

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Trusts and ICBs asked to give ‘honest’ assessment of their ‘improvement culture’

Trust leaders have been asked to “self-assess” the quality of their “improvement culture” as part of an initiative launched by NHS England chief executive Amanda Pritchard in the spring to lead the service's new improvement drive.

The call came from NHS Impact, led by former Modernisation Agency chief David Fillingham, who along with NHS Impact’s deputy chair – University Hospitals Coventry and Warwickshire Foundation Trust CEO Andy Hardy – has written to service leaders, setting out the first stage in the improvement drive.

They have asked the boards and CEOs of trusts and integerated care boards to “engage directly” with a new self-assessment tool and maturity matrix created by NHS Impact. This is designed to gauge their progress on adopting the five practices that NHS IMPACT claim “form the DNA of an improvement culture”.

Those five practices are:

  • A shared purpose and vision which are widely spread and guide all improvement effort.
  • Investment in people and in building an improvement focused culture.
  • Leaders at every level who understand improvement and practise it in their daily work.
  • The consistent use of an appropriate suite of improvement methods.
  • The embedding of improvement into management processes so that it becomes the way in which we lead and run our organisations and systems.

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Source: HSJ, 29 September 2023

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Trusts admit ‘severe’ harm to children

Children have suffered severe harm at two further hospital trusts as a result of failures in paediatric audiology, HSJ has revealed.

HSJ reported in July that three children at Croydon Health Service Trust may have come to “severe harm” – meaning they may have suffered permanent damage – following failures in the trust’s processes in audiology.

Now East and North Hertfordshire Trust and North West Anglia Foundation Trust have also confirmed a small number of cases of severe or serious harm; while some trusts have yet to confirm findings from case reviews they have carried out.

Major problems emerged earlier this year, initially in Scotland, of poor quality checks missing children with hearing problems who should have received support, and of a failure to inspect the services.

NHS England ordered a review of data from the national newborn screening programme which, alongside other review work, identified six English trusts as having likely failures in their service: Croydon, East and North Herts, North West Anglia, Warrington and Halton Hospitals, North Lincolnshire and Goole, and Worcestershire Acute Hospitals.

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Source: HSJ, 14 September 2023

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Trusts abandon renewable electricity commitment

Around half of the largest trusts are not buying all their electricity from renewable sources despite a national requirement to do so, as prices of this type of energy rocket.

NHS England previously committed to the service purchasing only renewable energy from April 2021, as part of efforts to meet its target to be net zero for emissions it can control–including electricity–by 2040.

However, NHSE information seen by HSJ shows that nine of the largest 20 trusts have not been buying 100 per cent renewable electricity this financial year, amid soaring costs. Several trusts told HSJ they had abandoned previous decisions to only use electricity which was “guaranteed” to be renewable.

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Source: HSJ, 15 February 2023

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Trusts ‘rationing’ crisis support as only seven ICSs achieve service expansion

Only a handful of integrated care systems have so far managed to implement a key expansion in their support for patients in mental health crisis.

Internal NHS England documents, seen by HSJ, suggest that only 7 out of 42 health systems have begun offering enhanced mental health crisis support through the 111 helpline.

This was a key target set out by the NHS long term plan in 2019, to be fully rolled out by next year. Some areas of the country have implemented the expansion, but others are lagging well behind, the document suggests.

Currently, all areas offer separate 24/7 all-age crisis lines run by individual mental health trusts, offering brief psychological interventions and advice.

But HSJ has been told of national problems affecting the existing helplines, with callers facing long waits. In a recent review, Healthwatch England said the services are having to “pick and choose” who to help because of high demand, which in effect led to “service rationing”.

Siân Balsom manager for Healthwatch York, said: “People are overwhelmingly positive about the NHS. But there’s an acceptance that crisis support is not going to be there for people. That feels like a really bad place to be in.

“We know people in the voluntary sector feel like they are holding people they don’t have the skills and experience to support. [They] feel they are holding people in the wrong service because the right service is not there for them.

“People are trying to do a good job, but the system is more under pressure than it has ever been and there are clearly a lot of people who are experiencing significant mental illness who are not able to get support right there and then.”

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Source: HSJ, 3 October 2022

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Trusts ‘could be sued’ under new strike law

Ambulance chiefs have warned a controversial piece of legislation could lead to legal action against their trusts by patients denied an ambulance.

The Strikes (Minimum Service Levels) Bill, which is currently going through Parliament, would enable the health and social care secretary to set minimum levels of staffing for ambulance call centres and crews. Employers would be able to issue “work notices” compelling staff to provide cover during any strike.

But, in its response to the government consultation on how the system would work, the Association of Ambulance Chief Executives has said it does not support the legislation in its current form as it does not believe it will deliver an improvement for patients, or offer a practical means of delivering minimum service levels.

It said the proposed legislation appears to pass responsibility for the service levels to employers, which could leave them “exposed to patient liability risks to a greater extent than before”.

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Source: HSJ, 22 May 2023

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Trusts ‘coping better with strikes’ and on track to eliminate 78-week waits, says NHSE director

Trusts are getting better at coping with industrial action and are still on track to hit the national target of eliminating the backlog of 78-week waiters, an NHS England director has told staff.

Paul Doyle, NHS England’s programme director for elective recovery, said: “We continue to make really good progress [on elective recovery]… we are very much in the end game now of meeting the 78-week ambition for the end of March.”

There have been concerns about the impact of recent strike action on eliminating the 78-week backlog, but Mr Doyle praised managers’ handling of the strikes and said administrative staff were doing an “incredible job”.

He added: “Most organisations affected have got better and better as time has gone on about making sure that there are as few cancellations as possible and that cancellations are rebooked quickly or that clinical time is put to good use such as doing virtual outpatient appointments or doing validation of waiting list.”

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Source: HSJ, 30 January 2023

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Trust’s treatment of Muslims heavily criticised by board director

A board director has publicly criticised his trust for its treatment of Muslim staff and patients.

Mohammed Hussain posted on social media that some board members at Bradford Teaching Hospitals “are not heard and listened to”, and that there is a “dissonance” between its espoused values and the “lived experiences” of minority ethnic staff.

Mr Hussain, a non-executive director since 2019, was responding to a post by CEO Mel Pickup, who had said the trust had a “variety of support offers for colleagues observing Ramadan”.

He said there are “many examples” of Muslim families experiencing poor responses to complaints to the trust, while claiming that “outstanding” Muslim staff are having to “move out of the area to progress because they are not promoted internally”.

The trust said its launching an investigation into the concerns raised by Mr Hussain. 

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Source: HSJ, 12 March 2024

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Trust’s pension fix refusal risks wave of doctor resignations

A ‘significant flurry’ of senior doctors will look to retire after a trust rejected a scheme designed to avoid higher taxes on their pensions, according to internal emails.

Emails from senior doctors suggest Liverpool University Hospitals Foundation Trust has rejected proposals to introduce “pension recycling”, a scheme endorsed nationally to avoid the tax rules.

Government policy changes in 2016 reduced tax relief on higher earners’ pension contributions. This has discouraged clinical consultants from taking on extra shifts, and in some cases, prompted people to retire earlier than planned.

Last month, NHS England’s chief executive Amanda Pritchard suggested this was a continuing problem for hospitals as they seek to increase elective activity.

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Source: HSJ, 29 April 2022

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Trust’s directors scapegoated psychiatrist over patient’s death, tribunal finds

A mental health trust ‘scapegoated’ a psychiatrist over the death of a patient amid systemic issues, an employment tribunal has found.

Judges called the conduct of two senior directors — one of whom is a current NHS trust medical director — into question after ruling they had colluded to scapegoat Bernadette McInerney for issues that would have damaged the trust’s reputation.

Nottinghamshire Healthcare Foundation Trust was found unanimously to have unfairly sacked and victimised Dr McInerney, a former consultant forensic psychiatrist at Rampton secure hospital, in a decision published last week.

The judgement was critical of both Chris Packham, a GP at Rampton hospital, and NHFT’s then-executive medical director Julie Hankin, but it also strongly condemned the trust’s former executive director for forensic services Peter Wright. Dr Hankin is now medical director at Cambridgeshire and Peterborough FT.

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Original source: Health Service Journal

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Trust’s A&E ‘effectively running primary care service’, says chair

An acute trust chair has said its emergency department is effectively operating as a primary care service. 

Hattie Llewelyn-Davies, who has chaired The Princess Alexandra Hospital Trust since late 2021, told HSJ: “We’ve done an awful lot of changes in the way we run out A&E and same day emergency care service to try and get the flow through working better…

“We have particular problems with the Princess Alexandra because we are right in the middle of Harlow. And we have a GP service and primary care service which is under massive pressure. We have very high levels of deprivation in Harlow.

“When somebody is sick in Harlow and can’t get a doctor’s appointment on the spot, they walk into us. We have a very high level of people coming in, so a very high level of footfall but a very low level of admissions.

“We are therefore running effectively a primary care service through our A&E.”

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Source: HSJ, 15 May 2023

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Trust with record covid deaths sees high rate of hospital acquired infection

The proportion of patients confirmed as infected with COVID-19 after admission to East Kent hospitals is running at twice the national rate, according to figures seen by HSJ.

The discovery comes as the Care Quality Commission confirmed to HSJ that it has sought and received further information from East Kent Hospitals University Foundation Trust on the high covid death rate at the trust. It is now deciding whether to take further action over the issue.

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Source: HSJ, 31 July 2020

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Trust with record covid deaths asks NHSE for help

The hospital trust which has been recording the largest number of covid deaths for several weeks has asked NHS England and NHS Improvement for help with infection control.

East Kent Hospitals University Foundation Trust is also getting help from the Kent and Medway Clinical Commissioning Group, including a senior infection control and prevention nurse who is now working with the trust.

It has seen persistently high numbers of covid deaths at a time when most other trusts have seen them dwindle to nothing or almost nothing. In the week to 10 July, it had 18 deaths – 9.5% of the national total. 

In a statement to HSJ yesterday the trust said it had “recently asked for support from NHS England and NHS Improvement to strengthen our infection prevention and control resource”. 

It said it had also introduced “a strict ‘front door’ policy, limiting the number of people on site, taking temperature checks before people enter the building, providing face masks and hand washing facilities”; begun testing asymptomatic staff; and regularly testing asymptomatic patients.

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Source: HSJ, 16 July 2020

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Trust was sent ‘unfit’ ventilators at height of pandemic

A trust was supplied with ventilators that were not ‘fit for NHS purposes’ by two suppliers at the height of the first Covid wave, HSJ  has revealed.

Guy’s and St Thomas’ Foundation Trust has now received a refund for both contracts, which were signed in March 2020 just as the pandemic began to hit the NHS.

The service rushed to secure the equipment in response to fears that existing ventilator capacity would be inadequate to deal with the rising number of seriously ill Covid patients. At the time, the use of ventilators was the only effective therapy for the sickest Covid patients. 

Minutes published by the trust at its most recent board meeting revealed the issue. GSTT then told HSJ in a statement: “Two contracts for ventilators were in dispute. In one case, the trust has already received a refund. In the other, which involved equipment we do not assess as fit for NHS purposes, the trust was reimbursed by central funding.”

The trust would not confirm the number of ventilators involved, the cost or the issue that meant they were not “fit for NHS purposes”.

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Source: HSJ, 23 June 2022

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Trust warned by regulator after cluster of never events

The Care Quality Commission has ordered immediate improvements to a trust after it reported six never events inside eight months.

The watchdog has issued a warning notice to Royal Cornwall Hospitals Trust after it carried out an announced inspection which focused on the trust’s surgical care group – where six never events had occurred between February and October last year.

In November, HSJ reported that a total of eight never events had been recorded in 2020, with trust chief executive Kate Shields saying it had raised fears the trust had not fully embedded safety improvements initiated as part of the special measures regime.

The inspectors visited three of the trust’s sites where the never events had happened. These were: Royal Cornwall Hospital in Truro, St Michael’s Hospital in Hayle and West Cornwall Hospital in Penzance.

The inspectors reported that governance processes were “not effective enough” to ensure that changes were made across the trust, and that lessons from incidents and near misses were “not shared with the whole team and wider service to ensure patient safety”.

Their report also stated the trust’s safety checklist for surgical procedures had improved but was not fully compliant with the World Health Organisation’s standards.

However, the CQC found staff apologised and provided patients with information when things had gone wrong, and that there was an open culture in which staff felt able to raise concerns.

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Source: HSJ, 17 February 2021

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Trust warned by CQC sees fourth inpatient death following ‘humongous’ problems

A fourth suspected suicide has occurred at a mental health trust which was recently warned by the Care Quality Commission after three other similar inpatient deaths in quick succession, HSJ can reveal.

All four deaths at Devon Partnership Trust had common themes, including the use of ligatures, and occurred amid a year-long delay to the trust’s plan to reduce ligature risks.

Figures obtained by HSJ under freedom of information laws also reveal the trust took nearly a year to investigate the first two deaths. The target is 90 days.

The trust told HSJ it had faced “humongous” problems addressing ligature risks and had been too “patient” with another trust which was helping to investigate the deaths.

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Source HSJ, 27 October 2020

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Trust warned by CQC over staff sleeping on duty

A mental health trust has received a warning from the Care Quality Commission over staff sleeping on duty and other serious concerns.

Essex Partnership University Foundation Trust was sent a “letter of intent”, which warns the CQC is considering taking urgent enforcement action, following an unannounced visit in November, according to a board report last week.

The trust is already subject to a high-profile inquiry into hundreds of patient deaths.

Natalie Hammond, executive nurse, said this would be “a fine tuning of our health roster which will be an early warning system that will determine and flag all staff members that may be at risk of working too much or their hours of working might perform a pattern that means they are at risk more of falling asleep on duty.”

She added: “We’ve done learning lessons and videos that link the importance of being fit and alert for work and how when you’re not, what mitigation and what steps you should undertake and what risk there is to patient safety.”

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Source: HSJ, 1 February 2023

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Trust warned after CQC’s ‘serious concerns’ for patients

Safety inspectors have ordered a mental health trust to make immediate improvements after visiting two inpatient wards where three patients died inside six months.

The Care Quality Commission this week warned Devon Partnership Trust it would take “urgent action” over “serious concerns about patients” unless the trust made the required improvements swiftly.

The watchdog inspected the trust’s Delderfield and Moorland wards in June following concerns about three patient deaths in September, October and March, along with “a number of” patient safety incidents - including ligature incidents.

The CQC also highlighted poor patient observation routines and a lack of learning from previous incidents, amid delays in completing investigations into safety incidents.

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Source: HSJ, 21 August 2020

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Trust underplayed ‘catastrophic’ IT outage

A major London trust has been criticised for ‘underplaying’ the problems caused by a ‘catastrophic’ IT outage, a new report has revealed.

The Guy’s and St Thomas’ Foundation Trust report also noted one patient suffered “moderate harm” and several others “low” level harm after last July’s incident, which was caused by a combination of a heatwave and ageing infrastructure. 

However, the trust said there was no evidence the “underplaying” of issues was deliberate.

The report identified one incident of “moderate” patient harm, in which a patient was unable to receive a pancreas transplant due to staff being unable to safely monitor critical observations. The patient has since had a successful operation, the trust’s report stated.

Another 20 “low” harm incidents were reported, which included delays in patients receiving their test results and/or medicines, while the report added the trust could not rule out that “further harm events may be identified” amidst an ongoing harm review.

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Source: HSJ, 27 January 2023

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Trust top team was ‘least cohesive I’ve ever joined’, says new CEO

A review into how a reporting error came about has uncovered tension among an ambulance trust’s previous senior leaders, including that its new CEO felt it was ‘the least cohesive team I have ever joined’.

Management consultancy Verita was commissioned by London Ambulance Service Trust to carry out a review of how it came to be misreporting category 1 (the most serious) response times.

The report, published in board papers on Thursday, said it was caused by a contractor’s programming error going unnoticed and concluded it was “impossible to typify the events of August 2020 as other than an avoidable failure of governance and process”. 

Daniel Elkeles, who joined the trust as CEO in August 2021, told the review that when he joined the senior team it was “the least cohesive team I have ever joined” and said the organisation was not “psychologically safe” for those who wanted to speak up.

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Source: HSJ, 26 May 2023

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Trust told to pay more than £200k over dementia patient’s death

A hospital trust has been told to pay almost a quarter of a million pounds after pleading guilty to failing to provide safe care to a patient with advanced dementia who fatally injured himself. 

The Care Quality Commission (CQC) brought the prosecution against University Hospitals of Derby and Burton Foundation Trust after an incident in July 2019, when a patient died after absconding from the hospital.

Peter Mullis – who had advanced dementia – was admitted to Queen’s Hospital Burton emergency department and absconded twice. When he tried to a third time, he was followed by trust staff.

The CQC described how, despite being followed, Mr Mullis was able to climb over a barrier, fall down a grass bank and hit his head on concrete at the bottom. He was airlifted to the local trauma centre, but died of multiple traumatic injuries.

The CQC said UHDB did not take “reasonable steps” to ensure safe care was provided and that failure exposed Mr Mullis to “significant risk of avoidable harm”.

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Trust told it ‘lacks skills or integrity’ to carry out suicides review

A senior clinician has raised fundamental concerns about a trust’s probe into dozens of suicide cases, which was sparked by his allegations that staff had tampered with the notes of a patient.

Cambridgeshire and Peterborough Foundation Trust announced in July there would be an internal review of 60 suicide cases dating back to 2017.

But a key whistleblower told HSJ he fears it could be a “whitewash” and it should be carried by an external, independent investigator rather than led by the trust.

The suicides review was prompted by allegations staff had added a care plan into the patient record of Charles Ndhlovu, a day after the 33-year-old had died by suicide in 2017.

The allegations, not contested by the trust, were based on the findings of an internal investigation in 2021 of the trust’s conduct around Mr Ndhlovu’s case.

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Source: HSJ, 6 September 2023

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Trust to move people with learning disabilities up waiting lists

A hospital trust has decided to prioritise people with learning disabilities for elective treatment, after analysis showed they were disproportionately affected by lengthy waits for care, along with some people who have a minority ethnic background.

The decision forms part of wider analysis at Calderdale and Huddersfield Foundation Trust of how the impact of covid, and work to recover from it, can exacerbate health inequalities and how this can be addressed.

The FT said in a board paper it would “initially prioritise [people with a learning disability] for treatment after cancer and urgent patients”.

Papers said it wanted to prioritise patients “around health inequalities and need based” rather than chronologically, as part of its covid elective recovery work.

It made the decision about people with a learning disability as they have a shorter average life expectancy “and therefore the impact of waiting for treatment can both further reduce this as well as disproportionately impact on their quality of life whilst waiting,” according to trust board papers.

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Source: HSJ, 4 June 2021

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