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‘Get stuck into ICSs’, Hewitt tells local leaders

NHS leaders ‘who might be hesitating about whether or not to really commit’ to their local integrated care system should ‘put aside all of those doubts [and] get stuck in’, Patricia Hewitt has claimed.

Ms Hewitt, Norfolk and Waveney Integrated Care Board chair and former health secretary, was speaking at the NHS ConfedExpo conference, the day after government responded to her recent review of ICSs.

The Department of Health and Social Care rejected or ducked several of its most eye-catching recommendations, but did state its support for ICSs and system working; while Labour has also said it would maintain ICSs should it come to power.

Ms Hewitt said the government response was more positive than she had feared at some points, and it “would have been a complete miracle” if ministers had backed all her recommendations.

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Source: HSJ, 15 June 2023

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‘Get on with it’: patient champion demands epilepsy drug redress

Ministers must begin paying compensation to the families of children disabled by the epilepsy drug sodium valproate by next year, a report will say this week.

The report’s author, Dr Henrietta Hughes, England’s patient safety commissioner, says valproate is “a bigger scandal than thalidomide, in terms of the numbers of people affected”.

She will back calls for financial redress for the thousands of children left physically and mentally disabled. Every month, three babies are still being born who have been exposed to the drug.

Speaking before the report’s launch, Hughes, 54, a GP, said the state had failed pregnant women by not telling them about key information regarding the drug’s risks. “These families have already been betrayed, because they weren’t given the right information to be able to make decisions to keep themselves and their family safe,” she said.

“There are senior politicians of every stripe who have expressed their sincere sympathy and support for patients who have been harmed. I take the view that people who seek high office need to also accept the responsibility that comes with that high office.

“The time for redress is now. The government is responsible. I’ve been asked to give them options for redress and I’ve done that. They have the recommendations, they have the advice, they have everything they need. Get on with it.”

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Source: The Times, February 2024

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‘Get a lift to hospital,’ ambulance trust tells patients with suspected heart attacks

Ambulance trusts have begun asking patients with heart attacks and strokes to get a lift to hospital with family or friends instead of waiting for an ambulance, because of high covid absences and ‘unprecedented’ surges in demand, HSJ has learned.

An internal note at North East Ambulance Service Foundation Trust said that where there was likely to be a risk from the delay in an ambulance reaching a patient, call handlers should “consider asking the patient to be transported by friends or family”.

This applies to calls including category two, which covers suspected strokes and heart attacks, according to the note seen by HSJ.

It said call handlers should “consider all forms of alternative transport” for patients. 

The note from medical director Mathew Beattie gives the example of a person with chest pain who would normally get a category 2 response – with a target of reaching them within 18 minutes – but where the ambulance response time would be two hours.

In the message to staff, Dr Mathew Beattie said: “To manage [current] unprecedented demand, we have no other option than to try and work differently which I am aware will not sit comfortably but is absolutely essential if we are to sustain a service to those who need it most."

“We need to weigh up the risk of delays for ambulances against alternative disposition or transport options. Where such risks are considered, I want you to be aware that the trust will fully support you in your decision-making under these circumstances.”

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Source: HSJ, 4 January 2022

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‘Gaslit by doctors’: UK women with endometriosis told it is ‘all in their head

Women with endometriosis who have endured years of excruciating pain are being “fobbed off” by doctors and told their symptoms are “all in their head”, leading them to give up seeking NHS treatment, new research has found.

A study carried out by academics at Manchester Metropolitan University found women with the disease felt “gaslit” by doctors due to their lack of understanding of the condition.

The paper, due to be published in the Journal of Health Communication later this month, also found that treatment was subject to a postcode lottery. Patients in rural areas reported travelling for hours to access a specialist with full training in the complex gynaecological condition.

Endometriosis is a painful condition in which tissue similar to the lining of the womb grows around other organs inside the abdomen. It affects 1.5 million women in the UK. The study looked at the experiences of treatment and diagnosis of 33 patients and revealed how doctors’ lack of understanding of the symptoms meant women often spent years in pain before their condition was diagnosed. During this period participants were told they were exaggerating their symptoms, or their pain was dismissed as psychological.

As one 27-year-old participant reported: “I feel a lot of mistrust towards the healthcare system in general, simply because I have been told that the pain was in my head, that I must have a low pain threshold or that I was in pain because I was fat.”

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Source: The Guardian, 21 January 2024

Share your experience of endometriosis: The Guardian newspaper would like to hear how you have been affected by endometriosis and your experience of being diagnosed and treated.

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‘Fundamental’ changes to London’s NHS in wake of COVID-19

The NHS in London is planning to “fundamentally shift the way we deliver health and care” in the wake of coronavirus, according to documents obtained by HSJ.

The plans from NHS England and Improvement’s London office say leaders should:

  • Plan for elective waiting times to be measured at integrated care system level, rather than trust level.
  • Accept “a different kind of risk appetite than the one we are used to”.
  • Expect decisions from the centre on the location of cancer, paediatric, renal, cardiac, and neurosurgical services.
  • Plan for a permanent increase in critical care capacity.
  • Transform to a “provider system able to be commissioned and funded on a population health basis”.
  • Work towards “a radical shift away from hospital care”.
  • Expect “governance and regulatory landscape implications” plus “streamlined decision-making”.

The document, titled Journey to a New Health and Care System, says there are three “likely” phases, with the final new system in place “from November 2021”.

The preceding two phases are “action programmes” over the next 12 to 15 months which will be about reconfiguring services to deal with “immediate covid, non-covid and elective need”, and “transition” when the move to new configurations is evaluated and “public consent” sought.

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Source: HSJ, 11 May 2020

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‘Free’ NHS makes people ‘lazy’ says pharmacy chief

The director of a leading pharmacy chain invited to advise the prime minister on healthcare reform has claimed the NHS makes people too “lazy” to take responsibility for their health.

Day Lewis director Sam Patel also said the fact the NHS was “free” meant there was little “jeopardy” discouraging people from becoming ill, and encouraged people to accept a lower level of care.

Mr Patel’s fellow Day Lewis director Jay Patel was one of the private healthcare leaders invited to Rishi Sunak’s Downing Street health summit this January. The company has more than 250 branches concentrated in London and the south of England.

Speaking at an event organised by strategy advisory firm Global Counsel last week, Mr Patel said: “Having an NHS fundamentally makes too many people lazy about taking care of their own health.

“Anything that’s free we just accept a lower level of care…. [We should be] making sure we’re taking good care of ourselves with vitamins, minerals, supplements, staying fit."

”... the jeopardy of feeling ill is not that bad because you get taken care of. In other countries, even in emerging markets like India where my parents originally come from, people spend vast amounts to make sure they don’t get ill because there is jeopardy in doing so. We need to change the population’s mindset to take care of themselves.”

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Source: HSJ, 3 April 2023

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‘Four-hour rush’ continuing at top A&Es

Hospital trusts are still treating many patients just before the four-hour A&E target deadline, whose proposed abolition was reversed by government last week, HSJ analysis has revealed. 

Several of those still treating large proportions of attenders in the 10 minutes before the cut-off are among the top performers on the target.

NHS England’s 2019 clinical review of standards had proposed to scrap the four-hour target, claiming it was no longer the most appropriate or effective measure. NHSE had planned to replace it with a new bundle of measures, such as the average time spent in emergency departments. It has been trialling these at 14 trusts for more than two years, with enforcement of the four-hour target by NHSE being substantially wound down.

The move to end use of the four-hour target was never officially endorsed by government, but both Matt Hancock and Sajid Javid indicated they backed the idea. However, their successor as health and social care secretary, Therese Coffey, announced that she would not be abolishing it.

Royal College of Emergency Medicine president elect Adrian Boyle warned this “target-associated” patient flow could be “diverting clinicians away from more sick cases to people with lower acuity”. He added “the scrutiny and managerial grip that used to go with [the target]” has been “taken away”.

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Source: HSJ, 27 September 2022

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‘Four in five Britons concerned about patient safety during NHS strikes’

Four out of five Britons are worried about the NHS’s ability to provide safe care for patients during strikes by nurses and ambulance workers, a new poll has found.

While around half of those surveyed said they support the planned industrial action, the majority expressed concern about the impact on patient safety.

The Ipsos poll of 1,100 adults found that 80% were very or fairly concerned about the ability of the NHS to provide safe care for people during the nurses’ strike, which began on Thursday.

Meanwhile, 82% of those questioned in the survey said they are very or fairly concerned about patient safety during the ambulance workers’ industrial action, with the first strike planned for 21 December.

The new poll comes as the NHS continues to face high demand and widespread staffing gaps, with health leaders fearing this winter will be the most difficult in the health service’s history.

Ambulances have been struggling to meet response times targets, while new data published on Thursday shows handover delays at hospitals in England have hit a new high.

But the Ipsos survey suggests that, nevertheless, more people are supportive of the industrial action than are opposed to it.

Some 50% of those questioned said they either strongly support or tend to support the industrial action by nurses, while 47% are supportive of the ambulance worker strikes.

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Source: The National, 15 December 2022

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‘Flurry’ of whistleblowers raise concerns at troubled trust

A ‘flurry’ of whistleblowers have raised concerns about the culture within an NHS trust which is grappling with finance and governance problems, its directors were told today.

Staff at Cornwall Partnership Foundation Trust have reported a “command and control” culture at the trust, which last week apologised to its employees for overtime payments made to board members for extra hours worked during the first peak of the pandemic.

It comes as the trust’s new chair and interim chief executive both pledged to communicate “openly and honestly” with staff.

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Source HSJ, 12 April 2021

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‘Fit-notes’ from nurses and physios to ease GP pressure

Nurses and physiotherapists can now provide ill patients with “fit-notes” to stay off work in an attempt to ease pressure on GP services. A range of health staff including pharmacists and occupational therapists are certifying illness sign-offs under moves to free up doctors to tackle the treatment backlog.

NHS Grampian has successfully completed a pilot scheme at a GP practice which staff described as “really positive” and a step in the right direction.

David Cooper, a GP from Old Machar Medical Practice in Aberdeen, said: “It is a more efficient way for us to work as a practice. For the nurses, physiotherapists and others who are working closely with a patient, it makes sense for them to be able to work on fit-notes without having to refer back to a GP for sign off. “We have found it works particularly well for those with chronic, long-term conditions or illness and the process behind the scenes is also now electronic so it saves paper, time and energy.”

Paul Gray, a physiotherapist at Old Machar, said: “It makes the patient’s journey easier and it is better for people to access them from those who are assessing your physical capabilities."

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Source: The Times, 6 April 2023

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‘First of its kind’ guidance sees BMA set out PA ‘scope of practice’

Physician associates should never see ‘undifferentiated’ patients in a GP setting, the BMA has declared in new ‘first of its kind’ guidance.

Today, the union has published a national scope of practice laying out how physician associates (PAs) and anaesthesia associates (AA) should work safely in GP practices and secondary care. 

According to the BMA, the guidance is different from what it describes as the current ‘piecemeal or fragmented approach’ whereby individual organisations set their own guidelines for how PAs should be supervised.

In general practice, the guidance said a GP ‘should first triage’ all patients and ‘decide which ones a PA can see’, suggesting annual health checks as an appropriate contact. 

The union is also clear that PAs ‘must not make independent management decisions for patients’ and must be clear in all their communications that ‘they are not doctors’. 

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Source: Pulse, 7 March 2024

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‘Fifth of UK hospitals cancelled operations’ during three days of 2022 heatwave

A fifth of UK hospitals were forced to cancel operations during the three days in July last year when temperatures soared, research suggests.

The findings, published in a letter to the British Journal of Surgery, are based on surveys from surgeons, anaesthetists and critical care doctors working during the heatwave from July 16-19 2022, when temperatures reached as high as 40C in some parts of the country.

The researchers received 271 responses from 140 UK hospitals – with one in five (18.5%) reporting elective surgeries being cancelled due to the heatwave.

The respondents also said surgical services were poorly prepared for heatwaves, with 41% of operating theatres having no means to control ambient temperature, while more than a third (35.4%) reported making changes to maintain routine surgical activity during the period.

These include delayed discharge of high-risk patients, changes to surgical teams, selecting lower-risk patients to have surgery, and restricting surgical activity to day cases.

Other measures included longer staff breaks, extra fluids to patients, and surgeries earlier in the morning when temperatures were lower.

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Source: The Independent, 23 March 2023

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‘Feminist approach’ to cancer could save lives of 800,000 women a year

Health experts are calling for a “feminist approach” to cancer to eliminate inequalities, as research reveals 800,000 women worldwide are dying needlessly every year because they are denied optimal care.

Cancer is one of the biggest killers of women and ranks in their top three causes of premature deaths in almost every country on every continent.

But gender inequality and discrimination are reducing women’s opportunities to avoid cancer risks and impeding their ability to get a timely diagnosis and quality care, according to a new Lancet Commission on women, power and cancer.

The largest report of its kind, which studied women and cancer in 185 countries, found unequal power dynamics across society globally were having “resounding negative impacts” on how women experience cancer prevention and treatment.

Gender inequalities are also hindering women’s professional advancement as leaders in cancer research, practice and policymaking, which in turn perpetuates the lack of women-centred cancer prevention and care, the report adds.

It is calling for a new feminist agenda for cancer care to eliminate gender inequality.

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Source: The Guardian, 26 September 2023

 

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‘Failure to act with candour’ over unsafe gas, report finds

There was an “unacceptable delay” and “failure to act with candour” in how a trust responded to a serious risk from staff nitrous oxide exposure, an independent investigation has found.

Mid and South Essex Foundation Trust found levels of nitrous oxide far above the workplace exposure limit at Basildon Hospital’s maternity unit during routine testing in 2021. However, staff were only notified and a serious incident declared more than a year later.

The exposure related to a mixture of nitrous oxide and oxygen, commonly known as gas and air, used during births. While short-term exposure is considered safe, prolonged exposure to nitrous oxide could lead to potential health issues.

Chief executive Matthew Hopkins has apologised, after a report by the Good Governance Institute said: “The inquiry found that there was an unacceptable delay in responding to and mitigating a serious risk that had been reported… As a result of this failure to act on a known risk, midwives and staff members on the maternity unit were exposed to unnecessary risk or potential harm from July 6 2021 to October 2022."

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HSJ, 14 February 2024

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‘Exploited’ foreign doctors worry about risk to UK patients

Doctors recruited from some of the world's poorest countries to work in UK hospitals say they're being exploited - and believe they're so overworked they fear putting patients' health at risk.

A BBC investigation has found evidence that doctors from Nigeria are being recruited by a British healthcare company and expected to work in private hospitals under conditions not allowed in the National Health Service.

The British Medical Association (BMA) has described the situation as "shocking" and says the sector needs to be brought in line with NHS working practices.

Dr Jenny Vaughan of the Doctors Association UK said, "This is a slave-type work with… excess hours, the like of which we thought had been gone 30 years ago. It is not acceptable for patients for patient-safety reasons. It is not acceptable for doctors. "

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Source: BBC News, 11 October 2022

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‘Excess deaths’ due to A&E delays rise by nearly a third in one year

Long waits in A&E departments may have caused around 30,000 ‘excess deaths’ last year, according to new estimates.

Using a methodology backed by experts, HSJ analysis of official data has produced an estimate of 29,145 ‘excess deaths’ related to long accident and emergency delays in 2022-23, up from 22,175 in 2021-22, and 9,783 related deaths in 2020-21.

For the first time, the analysis has also produced estimates of excess mortality related to long A&E delays for every acute trust.

The data suggests the rate of excess deaths from 2022-23 has so far continued into 2023-24.

The analysis followed a methodology used in a peer-reviewed study published in the Emergency Medicine Journal, which found delays to hospital admission for patients of more than five hours from time of arrival at A&E were associated with an increase in all-cause mortality within 30 days.

Data scientist Steve Black, one of the authors of the EMJ study, said: “Long waits in A&E should never happen and 12-hour waits should be something like a never event. They should be intolerable anywhere. If we want to fix them it’s helpful to know which trusts have the worst problems with long waits.”

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Source: HSJ, 7 November 2023

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‘Exceptionally urgent’ to secure kit used to treat critically ill covid patients

The availability of dialysis equipment used to treat more than a quarter of ventilated COVID-19 patients has reached “critical” levels, HSJ has learned.

Concerns are growing over an “exceptional shortage” of specialist dialysis machines used to treat intensive care patients with acute kidney failure.

Although hospitals are able to deploy alternative machines which are not typically used in intensive care, this is logistically challenging and can carry increased risks for patients.

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Source: HSJ, 22 April 2020

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‘Every chemist has a backroom’: the rise of secret FGM in Kenya

In Kisii town, south-west Kenya, a rundown roadside building houses a pharmacy. Like many others in the area, the pharmacy doubles as a clinic.

Lilian Kemunto (not her real name), a former surgical nurse, set it up after she retired in 2018. She mainly does health check-ups but has also offered female genital mutilation (FGM) services on request.

Kemunto has performed cuts since the 90s, after receiving training in basic surgical techniques from male colleagues in the local hospital where she worked. She would do the cuts in the hospital at night, but it was risky, she says, because management didn’t approve. “They would tell us: ‘Just do it, but if you’re caught, you’re on your own.’”

She preferred cutting girls in a private home, in the middle of the night, saying it was much easier: “By 6am, the girls are back in their own homes, like nothing happened.”

In Kisii county, medicalisation is standard. Two out of three cases of cutting are performed by health practitioners, in contrast to much of the country, where 70% of FGM cases are performed by traditional practitioners.

Kemunto says she tries to avoid mishaps, and at a minimum requires some anaesthesia, a surgical blade, sterile towels, and cleaning solution to proceed.

She also claims to use a non-invasive procedure: a small incision of the clitoris that practitioners call a “signature”. Kisii’s FGM practice is considered less severe than other areas, and anti-FGM campaigners are concerned that there’s a growing acceptance of the practice as more safe, hygienic and cosmetic.

FGM rates in Kenya have gone down significantly over the past decade. The country passed strong laws in 2011, imposed hefty fines on practitioners, and stepped up surveillance and enforcement. But medicalisation is posing a new challenge for the east African nation, which has a 15% medicalisation rate: one of the highest in Africa.

Earlier this month, Kenyan president William Ruto backed the country’s chief justice who said that FGM “should not be a conversation we are having in Kenya in the 21st century”, and reiterated his administration’s commitment to eradicating the practice.

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Source: The Guardian, 15 December 2022

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‘Enough is enough’: Open letter calls for end to Covid-related abuse against health workers

An open letter has been published calling for the end of Covid-related abuse against healthcare staff, with leading health organisations coming together to unite against the rising tide of violence against nurses and other NHS staff.

The letter was signed by nine representatives including the Royal College of Nursing and Royal College of Midwives and warned of the “unacceptable behaviours”, a move that comes after he chief executive and general secretary of the RCM, Gill Walton, received online threats after she supported a national appeal for pregnant women to get the Covid-19 vaccine.

“To those who issue death threats or incite violence against us, we say enough is enough”, Ms Walton has said. 

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Source: The Nursing Times, 4 August 2021

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‘Drug policy isn’t working... we need to try a completely different approach’

In a recent interview in The Times, former Chief Medical Officer, Professor Sir Harry Burns considers the symptoms of the country’s drug deaths epidemic. The total of 1,187 fatalities in 2018 represents 218 drug deaths per million of the population and a 27% year-on-year rise. The death rate is three times higher than in the UK as a whole and worse than that of the United States. Politicians should listen to people working on the front line to tackle rising deaths, according to Sir Harry. The trouble is, he says, “public policy tends to be made because someone has a clever idea which then gets picked up by a politician. Very few outcomes in society are determined by one thing.” He believes that health and social benefit on a national scale comes with incremental change over an extended period of time. 

When asked what one thing would you do to improve the health of the nation, Sir Harry said "Scotland has made enormous strides in improving patient safety using the concepts of improvement science in which front line staff have tested many different ideas and applied at scale the changes which they have seen work. It’s the principle of marginal gains that has been successful in sport. I would use this approach to improve wellbeing across society."

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Source: The Times, 20 July 2019

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‘Dr. Checklist’ Peter Pronovost gets chance to transform University Hospitals

The ghosts of medical errors haunt Dr. Peter Pronovost. Two deaths, both caused by mistakes. First, his father’s, who died as the result of a cancer misdiagnosis. Then a little girl, a burn victim who succumbed to infection and diagnostic missteps at the hospital where Pronovost worked early in his career.

Those deaths led Pronovost to pursue a medical career dedicated to patient safety, and to create the medical checklist he has become known for worldwide.

Now, he’s implementing his second act, at University Hospitals in the USA, as its Chief Transformation Officer, a job he has held since late 2018. His goal: To transform a $4 billion health care system by reducing shortcomings in medical care and increasing the quality of treatment.

The challenge fits Pronovost, says one of his former Johns Hopkins University professors, Dr. Albert Wu. “He’s one of the few people for whom the title might be appropriate, because his work has led to significant changes and innovations in how we deliver health care in the United States.

“He’s a once-in-a-generation guy.”

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Source: Cleveland.com, 9 February 2020

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‘Don’t overwork staff’, says trust with just one 52-week waiter

Allowing staff enough rest has been ‘the key’ to elective recovery for an acute trust which has the lowest number of 52-week waiters in England, it has said.

Maidstone and Tunbridge Wells (MTW) Trust currently has just one patient who has waited 52 weeks or more on its lists, compared with a high of 976 at one point in April 2021.

MTW is one of a handful of trusts with very few long waiters. All are relatively small trusts – and are not regional centres for specialist/tertiary patients – but their 52-week-waiters also represent less than 1% of their total list.

MTW chief of service for the surgery division Greg Lawton told HSJ its success in tackling long waiters was down to “attention to detail” in tracking each patient, and not expecting staff to run too many extra sessions.

“Any problems patients are having getting through their pathways are identified early and addressed,” he said. "Treatment had been prioritised on the grounds of clinical need, he added, with cancer treatments still going ahead and cancer targets being met."

The trust, in the South East, has put on extra operating sessions to clear some of its backlog of patients but these had been limited in number, Dr Lawton said.

“What we have never done is try to run too many and I think that may be the key. If you try to do too much you will burn staff out,” he said. The trust had “been mindful that staff need a break,” he added. “Morale is very important.”

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Source: HSJ, 16 February 2022

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‘Do not resuscitate’ orders caused potentially avoidable deaths, regulator finds

Do-not-resuscitate orders were wrongly allocated to some care home residents during the COVID-19 pandemic, causing potentially avoidable deaths, the first phase of a review by England’s Care Quality Commission (CQC) has found.

The regulator warned that some of the “inappropriate” do not attempt cardiopulmonary resuscitation (DNACPR) notices applied in the spring may still be in place and called on all care providers to check with the person concerned that they consent.

The review was prompted by concerns about the blanket application of the orders in care homes in the early part of the pandemic, amid then prevalent fears that NHS hospitals would be overwhelmed.

The CQC received 40 submissions from the public, mostly about DNACPR orders that had been put in place without consulting with the person or their family. These included reports of all the residents of one care home being given a DNACPR notice, and of the notices routinely being applied to anyone infected with Covid.

Some people reported that they did not even know a DNACPR order had been placed on their relative until they were quite unwell.

“There is evidence of unacceptable and inappropriate DNACPRs being made at the start of the pandemic,” the interim report found, adding that the practice may have caused “potentially avoidable death”.

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Source: The Guardian, 3 December 2020

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‘Disproportionate’ infection control holding back electives, say NHS bosses

Infection control rules in hospitals are ‘now disproportionate to the risks’ posed by covid and should be relaxed, some of the NHS’s most senior leaders have warned.

The government rules – such as not allowing covid-positive staff to work, and separating out services for covid, non-covid and covid-contact patients – make a big dent in hospital capacity and slows down services.

Glen Burley, who is chief executive of three Midlands trusts and involved in national-level discussions on elective matters, told HSJ: “Pretty much every pathway has a covid and non-covid route, which slows down flow and staff productivity.

“There is a growing argument that these rules are now disproportionate to the risks. With covid cases in the community also rising now, we may have to question again the relative risks of continuing to isolate staff.”

NHS Confederation director of policy Layla McCay told HSJ: “Healthcare leaders are concerned the current [IPC] measures are having a serious knock-on effect on capacity and that the measures in their current form are reducing efficiency and capacity within healthcare settings.

“We need more clarity on if and how current measures can be safely adjusted so [the NHS] can further increase bed capacity and patient throughput, as well as the ability to transport patients more quickly and efficiently.”

But NHS Providers, which has previously said relaxing the IPC guidance would not enable a “rapid” increase in the NHS’ capacity to tackle the elective care backlog and could pose significant “risks”, remains more cautious.

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Source: HSJ, 21 March 2022

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‘Disingenuous’ wait times on NHS App will be half those patients have to face

Next week’s launch of the ‘Wayfinder’ waiting time information service on the NHS App will give patients “disingenuous” and “misleading” information about how long they can expect to wait for care, senior figures close to the project have warned.

Briefing documents seen by HSJ show the figure displayed to patients will be a mean average of wait times taken from the Waiting List Minimum Data Set and the My Planned Care site.

However, it was originally intended that the metric displayed would be the time waited by 92% of relevant patients. This is more commonly known as the “9 out of 10” measure.

Mean waits are likely to be about “half the typical waiting time” measured under the 9 out of 10 metric, according to the waiting list experts consulted by HSJ.

Ahead of The Wayfinder service’s launch on Tuesday, NHS trusts and integrated care boards have been sent comprehensive information on how to publicise it, including a “lines to take” briefing in case of media inquiries. This mentions the use of an “average” time but does not provider any justification for this approach.

HSJ’s source said the mean average metric was “the worst one to choose” as it would be providing patients with “disingenuous” information that will leave them disappointed. They added that the 92nd percentile metric would be a “far more realistic” measure “for a greater number of people”.

They concluded that “using an average” would create false expectations “because in reality nobody will be seen in the amount of time it is saying on the app.”

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Source: HSJ, 26 January 2024

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