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HEE tells trusts to prioritise training, or services will suffer

The quality and performance of services will suffer if medical training is not ‘prioritised and funded’ by trusts, Health Education England (HEE) has warned.

HEE has set out actions in its “Covid training recovery interim report” that must be done alongside NHS England, the Department of Health and Social Care and others to protect post-covid workforce recovery.

At the beginning of the pandemic, junior doctors’ training was severely disrupted because thousands of staff were redeployed to covid wards, while most routine elective operations and diagnostic procedures were stopped.

HEE says training has still not returned to pre-covid levels, and fears there could be further disruptions over winter if significant volumes of elective care are cancelled.

According to its report, if medical training is not “prioritised and funded”, the “long-term costs to service are significantly greater”.

“If delivery recovery is prioritised over training recovery there will be an initial increase in service delivery time and value, but this will be followed swiftly by a reduction in service delivery time and value,” it warned.

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Source: HSJ, 13 October 2021

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Hospitals trigger emergency measures as patients wait 13 hours in the back of ambulances

An NHS trust has spent more than two weeks running on emergency measures after skyrocketing demand since mid-September, while others have kept people waiting for more than a dozen hours in the backs of ambulances.

The Independent has learnt one patient in the West Midlands spent 13 hours waiting to be handed over to staff at the Shrewsbury and Telford Hospitals Trust.

Gloucester Hospitals Trust declared its internal incident on 19 September and only stood it down on 5 October, while London’s Barnet Hospital took similar extraordinary action on Monday due to high demand. And at North Middlesex Hospital staff saw more than 200 patients crowd into the emergency department on Monday afternoon.

Declaring an internal incident is designed to activate measures that help hospitals deal with a sudden peak of demand and should only last for a short time.

Such pressures are being felt across the country with NHS managers seriously concerned about what the coming months will look like as temperatures dip. One said they had not seen things as bad in more than a decade.

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Source: The Independent, 13 October 2021

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COVID-19: Government’s handling of pandemic had “big mistakes,” MPs say

The government’s actions in dealing with the COVID-19 pandemic have received a mixed review from MPs in a report that set out the successes and failures of the UK response.

Although the joint report from the House of Commons’ Science and Technology Committee and Health and Social Care Committee  praised the UK’s covid vaccination programme as highly effective, it also condemned serious errors, especially delayed lockdowns and how a test, trace, and isolate system was set up.

Overall, the MPs’ inquiry found that some government initiatives were examples of global best practice but that others represented “serious mistakes.” 

The UK’s pandemic planning was based too narrowly on a flu model that had failed to learn the lessons from the SARS, MERS, and Ebola epidemics, said the MPs, which meant that its covid planning was worse than in other countries.

Delays in establishing an adequate test, trace, and isolate system hampered efforts to contain the outbreak, said the MPs, and the government’s initial decision to delay a comprehensive lockdown had revealed its then “fatalistic” assumption that it was impossible to suppress the virus, which amounted, in practice, to accepting that herd immunity by infection was inevitable.

The report said that many thousands of deaths could have been avoided if the government had not let hospitals discharge people into care homes in the initial phase of the pandemic and that this showed the “longstanding failure” to give social care sufficient priority and the same attention as the NHS.

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Source: BMJ, 12 October 2021

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NHS faces beds crisis as care homes stop taking patients from hospitals

The NHS faces a mounting beds crisis as care homes suffering unprecedented staff shortages are forced to stop taking patients from hospitals, health and care leaders have warned.

Ministers are desperately trying to free up space in the NHS to tackle a backlog of 5.6 million people – equivalent to almost 10% of people in England – awaiting treatment.

But efforts to speed up the discharge of hospital patients into the community are being hampered by care worker shortages. Britain’s largest not-for-profit care home provider, MHA, has already had to close 1 in 10 of its homes to admissions from hospitals, its chief executive, Sam Monaghan, told the Guardian.

The warning comes as a comprehensive assessment on Wednesday reveals that care homes in England are facing the biggest staff shortage on record, with 105,000 positions unfilled according to the 2021 State of the Adult Social Care Sector and Workforce report by Skills for Care, an industry body.

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Source: The Guardian, 13 October 2021

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What those living with dementia want people to know

Across the UK, 850,000 people are living with dementia - and soon, if predictions are correct, there will be a million.

Some of them, and their families, share their tips with BBC News for living with the condition, how to talk to people with dementia and how they have learned to adjust to their changing brains.

Tommy Dunne, who has Alzheimer's disease, says: "If someone said to me, 'How would you communicate with a person with dementia?', I'd say the first thing you want to do is talk to the person, not the dementia. The second thing you want to do is get down to the person's level - if the person is sitting on the couch, don't stand over them and talk down, get down to the person's level, maintain eye contact. Speak in short sentences. Don't ask multiple questions at once - you know like, 'Who, what, why, where and when?' all in the one question - because we can't process that."

Marion says: "[dementia]... affects my vision and my spatial awareness. I have yellow painted on the doorframes - and that helps me so I know where I am. Everything was painted white before - and if everything is white, for me, I don't know where the door stops and the wall starts. The colour yellow stands out very well."

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Source: BBC News. 13 October 2021

Read our hub interview with dementia leads at Sussex Community NHS Foundation Trust on keeping patients with dementia safe.

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Northern Trust radiologist review finds 66 discrepancies

A review of the work of a former locum consultant radiologist in the Northern Trust has identified major discrepancies in 66 images.

The trust has concluded a review of 13,030 scans and x-rays. The review was launched in June after the General Medical Council raised concerns about the locum consultant radiologist's work.

The highest level of hospital investigation will be carried out into the cases of 17 patients.

More than 9,000 patients were contacted as part of the review.

The review identified six images at level one - a major discrepancy where errors or omissions in reporting could have had an immediate and significant clinical impact for the patients concerned. A further 60 images were level two - a major discrepancy with a probable clinical impact.

"Most of the images categorised as having Level 1 and Level 2 discrepancies are CT scans but some are MRI scans, chest x-rays and other x-rays," said the trust's medical director, Seamus O'Reilly.

"That detailed clinical assessment, which has resulted in 69 patients being called back, was to determine whether any clinical harm occurred as a result of the discrepancies found in the lookback review," 

"I can confirm that following careful consideration, the clinical assessment group has determined that 17 patients should now be part of a Level 3 Serious Adverse Incident (SAI) review."

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Source: BBC News, 13 October 2021

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Scotland records worst A&E waiting times performance yet

The percentage of patients visiting A&E who are seen within four hours has hit a “terrifying” new low in Scotland, latest figures show, with ministers urged to “get a grip” on the growing crisis.

The figure has been declining since the summer amid high demand, staffing shortages and a lack of patient flow through hospitals.

In the week to 3 October, just 71.3% of patients were seen within four hours, a five percentage point drop on the previous week, according to a data published by Public Health Scotland. The figure is the lowest since records began in 2015, with the Scottish Government target set at 95%.

With 25,000 visits to A&E in that week, it means more than 7,000 patients waited longer than four hours. Some 1,782 people waited more than eight hours, while a record 591 patients waited longer than 12 hours.

Last week, Scotland’s Health Secretary, Humza Yousaf, warned that Scotland’s NHS faces an “incredibly difficult winter” despite announcing a £300 million funding boost.

But opposition parties have now accused him of “overseeing a scandalous situation” and leaving A&E departments “beyond breaking point”.

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Source: The Scotsman, 12 October 2021

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One in four women under 40 have never checked themselves for breast cancer

One quarter of women under 40 have never checked themselves for breast cancer – believing they are too young, or they don’t think it will affect them, or they are just too busy.

And half of all women do not regularly check their breasts for signs of cancer.

The study of 2,000 women found those aged 18 to 39 are the least likely to look for signs of cancer, with a tenth believing they are not old enough to suffer the illness. But a quarter admit they do not have the confidence to inspect themselves, while 1 in 10 put it off in case they find a lump.

It also emerged women from South Asian backgrounds are the least likely to examine themselves compared to other ethnicities, with 40% admitting to never checking at all. This drops to 27% of black women and just 13% cent of those of other ethnicities.

Of the South Asian women polled who don’t check themselves for signs of breast cancer, more than a third said they forget or don’t know what they are looking for. While more than 1 in 20 (7%) don’t feel comfortable checking themselves due to cultural reasons.

Barriers to going to the doctor when noticing a lump or change in breasts vary – from not wanting to waste their doctor’s time, the fear of not being taken seriously, concerns that a female doctor won’t be available, and not wanting to know what caused the change.

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Source: The Independent, 11 October 2021

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Changes to be made to blood donations to become more inclusive

From the end of 2021, a question on sexual activity of partners in areas where HIV is widespread will be removed from the donor safety check form, in an effort to increase inclusivity among donors.

The changes will particularly improve the ease to donate blood for Black African donors.

Currently, prospective donors are asked if they have recently had sex with a partner who may ever have been sexually active in an area where HIV is endemic, which includes most of sub-Saharan Africa. If they have, the donor will then be deferred for three months after the last sexual contact with that partner. This can often mean Black African and other potential donors in long-term relationships have been unable to donate blood.

Now, the UK Government has outlined plans to remove the question from those asked in the donor safety check, opening the door to a greater number of donations.

Increasing blood donor inclusivity for those who are Black African, Black Caribbean, and of Black mixed ethnicity is particularly important because they are more likely to have the rare blood sub-group, such as Ro, that many Black sickle cell patients need.

The change, making it easier for people from these groups to donate, will create greater opportunities to meet the ongoing need for rarer blood types and help improve and save lives in the UK.

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Source: National Health Executive, 11 October 2021

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Covid response ‘one of UK’s worst ever public health failures’

Britain’s early handling of the coronavirus pandemic was one of the worst public health failures in UK history, with ministers and scientists taking a “fatalistic” approach that exacerbated the death toll, a landmark inquiry has found.

“Groupthink”, evidence of British exceptionalism and a deliberately “slow and gradualist” approach meant the UK fared “significantly worse” than other countries, according to the 151-page “Coronavirus: lessons learned to date” report led by two former Conservative ministers.

The crisis exposed “major deficiencies in the machinery of government”, with public bodies unable to share vital information and scientific advice impaired by a lack of transparency, input from international experts and meaningful challenge.

Despite being one of the first countries to develop a test for Covid in January 2020, the UK “squandered” its lead and “converted it into one of permanent crisis”. The consequences were profound, the report says. “For a country with a world-class expertise in data analysis, to face the biggest health crisis in 100 years with virtually no data to analyse was an almost unimaginable setback.”

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Source: The Guardian, 12 October 2021

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Muckamore Abbey Hospital: Inquiry into alleged patient abuse begins

A public inquiry into allegations of abuse of patients at Muckamore Abbey Hospital is under way.

The hospital is run by the Belfast Health Trust and provides facilities for adults with special needs.

With the terms of reference agreed, the inquiry panel will begin trying to establish what happened between residents and some members of staff, and also examine management's role.

Seven people are facing prosecution. There have been more than 20 arrests.

It was announced in June 2021 that the inquiry will be chaired by Tom Kark QC, who played a key role in the 2010 inquiry into avoidable deaths at Stafford Hospital in England.

Speaking on Monday, Mr Kark said it was a "significant date for all those patients and families who have been affected by the issues under examination by the inquiry, many of whom have campaigned very hard to ensure this inquiry takes place".

"I want to reassure you that a thorough and impartial investigation will be carried out by the Muckamore Abbey Hospital Inquiry," he added.

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Source: BBC News, 12 October 2021

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Minister refuses to apologise for pandemic failings which ‘cost thousands of lives’

A cabinet minister has refused to apologise for the government’s handing of the COVID-19 pandemic despite a new report finding that errors cost “thousands of lives”.

Cabinet Office minister Stephen Barclay defended the government’s decision making to Sky News, saying: “We followed, throughout, the scientific advice. We got the vaccine deployed extremely quickly, we protected our NHS from the surge of cases.”

His comments come as family members who lost loved ones to COVID-19 described the MPs’ report as “laughable” for failing to take evidence from the bereaved.

The COVID-19 Bereaved Families for Justice group criticised the parliamentary report as being “more interested in political arguments about whether you can bring laptops to Cobra meetings that it is in the experiences of those who tragically lost” family members to COVID-19.

When asked, for a second time, if he would apologise by presenter Kay Burley, Stephen Barclay replied: “Well no, we followed the scientific advice, we protected the NHS, we took the decisions based on the evidence before us.”

He made these comments despite the report finding that the delayed decision to lock down in spring last year was one of the “most important public health failures the United Kingdom has ever experienced”.

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Source: The Independent, 12 October 2021

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Nursing crisis sweeps wards as NHS battles to find recruits

Ministers are being warned of a mounting workforce crisis in England’s hospitals as they struggle to recruit staff for tens of thousands of nursing vacancies, with one in five nursing posts on some wards now unfilled.

Hospital leaders say the nursing shortfall has been worsened by a collapse in the numbers of recruits from Europe, including Spain and Italy.

The most recent NHS figures reveal there are about 39,000 vacancies for registered nurses in England, with one in 10 nursing posts unfilled on acute wards in London and one in five nursing posts empty on mental health wards in the south-east.

Thousands of nursing shifts each week cannot be filled because of staff shortages, according to hospital safe staffing reports seen by the Observer.

Patricia Marquis, England director for the Royal College of Nursing (RCN), said: “There just aren’t enough staff to deliver the care that is needed, and we now have a nursing workforce crisis. We should never have got into a position where we were so dependent on international nurses. We are on a knife-edge.”

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Source: The Guardian, 9 October 2021

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Pharmacists 'to be given right to prescribe so GPs have more time with patients'

Pharmacists will be allowed to write prescriptions under plans reportedly being considered by England's Health Secretary Sajid Javid.

Mr Javid last month vowed the Government will "do a lot more" to ensure GPs see more patients face-to-face following complaints from the public.

The proposals would see more prescriptions provided through pharmacies and hospitals for routine illnesses to allow doctors more time to see patients in person, according to The Sunday Times.

GPs will also reportedly be able to pass off bureaucratic processes such as providing supporting medical evidence to the Driver and Vehicle Licensing Agency (DVLA) over a patient's fitness to drive.

The plans are expected to include sanctions for doctors who do not increase the number of face-to-face appointments with patients, the paper added.

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Source: 11 October 2021, Medscape

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Muckamore Abbey Hospital abuse inquiry to begin

An inquiry into allegations of abuse at Muckamore Abbey Hospital officially begins on Monday.

The Co Antrim facility treats patients with severe learning difficulties and mental health problems.

Allegations of abuse at Muckamore Abbey Hospital - which is run by the Belfast Trust and located on the outskirts of Antrim - first came to light in 2017.

Police said they reviewed thousands of hours of CCTV footage as part of a major investigation.

At present seven people are to be prosecuted and more than 20 have been arrested for a range of offences, including alleged ill-treatment and wilful neglect.

The core objectives of the inquiry are "to examine the issue of abuse of patients at Muckamore Abbey Hospital (MAH), to determine why the abuse happened and the range of circumstances that allowed it to happen and ensure that such abuse does not occur again at MAH or any other institution providing similar services in Northern Ireland".

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Source: Belfast Telegraph, 11 October 2021

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Nearly one in five of most critically ill Covid patients are unvaccinated pregnant women

Unvaccinated pregnant women accounted for nearly a fifth of the most severely ill coronavirus patients in England in recent months, according to health officials.

Between July and September, 17% of COVID-19 patients who required a special lung bypass machine while in intensive care were mothers-to-be who had not received their first vaccine dose, NHS England said.

Extracorporeal membrane oxygenation (ECMO) is used when a patient’s lungs are so damaged by Covid-19 that a ventilator cannot maintain oxygen levels.

While just six per cent of the women aged 16 to 49 who needed ECMO at the start of the pandemic were pregnant, nearly a third of women among that age group who required the lung bypass in recent months were unvaccinated mothers-to-be.

The National Childbirth Trust (NCT) called the statistics a “damning indictment of the lack of attention given to this vulnerable group as restrictions have eased”.

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Source: The Independent, 11 October 2021

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Life expectancy gap in England ‘a growing chasm’ exacerbated by Covid

England’s richest people are living for a decade longer than the poorest, and the life expectancy gap between them has widened to “a growing chasm”, research has revealed.

The difference in expected lifespan between some of the wealthiest and poorest areas has more than doubled since the early 2000s, an analysis of official data by the King’s Fund shows.

“There is a growing chasm in health inequalities revealed by the data,” said Veena Raleigh, a fellow at the thinktank who specialises in the stark differentials in rich and poor people’s health.

“Our analysis shows that life expectancy has continued to increase in wealthier areas but has virtually stagnated in deprived areas in the north with the result that the gap in life expectancy between the richest and poorest parts of the country has grown by almost two-and-a-half years over the last two decades.”

The analysis underlines the scale of the challenge facing the health secretary, Sajid Javid, who in a recent keynote speech in Blackpool on “levelling-up” in health, pledged to tackle “the disease of disparity” – dramatic differences in outcomes based on geography, ethnicity and income.R

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Source: The Guardian, 10 October 2021

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Plans to hand over NHS data to police sparks warning from government adviser

Plans to force the NHS to share confidential data with police across England are “very problematic” and could see patients giving false information to GPs, the government’s data watchdog has warned.

In her first interview, Dr Nicola Byrne, the national data guardian for England told The Independent she has serious concerns over Home Office plans to impose a responsibility on the NHS to share patient data with police which she said “sets aside” the duty of confidentiality for clinicians.

She also warned that emergency powers brought in to allow the sharing of data to help tackle the spread of Covid-19 could not run on indefinitely after they were extended to March 2022.

She also told The Independent she had raised concerns with the government over clauses in the Police, Crime, Sentencing and Courts Bill which is going through the House of Lords later this month. The legislation could impose NHS bodies to disclose private patient data to police to prevent serious violence and crucially sets aside a duty of confidentiality on clinicians collecting information when providing care.

Dr Byrne said doing so could “erode trust and confidence, and deter people from sharing information and even from presenting for clinical care”.

She added that it was not clear what exact information would be covered by the bill: “The case isn’t made why as to why that is necessary. These things need to be debated openly and in public.”

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Source: The Independent, 10 October 2021

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New Heart Age Test prevents heart attack and stroke deaths

A new study by Staffordshire University shows that people who understand their ‘heart age’ are more likely to make healthy lifestyle changes.

50 preventable deaths from heart attack or stroke happen every day and Public Health England’s online Heart Age Test (HAT) allows users to compare their real age to the predicted age of their heart.

The tool aims to provide early warning signs of cardiovascular disease (CVD) risk, encouraging members of the public to reduce their heart age through diet and exercise and to take up the offer of an NHS Health Check.

CHAD Research Associate Dr Victoria Riley, who led the study, said: “Deaths from heart attack or stroke are often preventable and so addressing health issues early is incredibly important. Our findings show that pre-screening tests, such as the HAT, can encourage individuals to evaluate their lifestyle choices and increase their intentions to change behaviour.”

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Source: Brigher Side of News, 10 October 2021

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‘People are being very angry with us’: A&E doctor on abuse of NHS staff

Dr Katherine Henderson, a senior A&E consultant in London and President of the Royal College of Emergency Medicine, says physical and verbal attacks have increased in recent months.

Speaking to the Guardian, she says: “It is a sad reality that in recent months there has been a rise in abuse directed towards healthcare workers, but this abuse is not something new to frontline staff or emergency departments. It was bad before the pandemic, but there’s a changed atmosphere now.

“During the pandemic people were being very positive about healthcare workers. But now the public are frustrated that services aren’t getting back to normal. Maybe people who weren’t the source of abuse before are now being the source of abuse. Abuse may be physical or verbal, it may be through social media, or it may be racial or misogynistic.

“People are being angry – very angry – with us. They are angry about long waits, about having to stand outside emergency departments in queues, about delays in ambulances coming, including to take their relative home from hospital. The public haven’t really caught up with how struggling the whole NHS is."

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Source: The Guardian, 10 October 2021

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WHO report highlights global shortfall in investment in mental health

The World Health Organization’s (WHO) new Mental Health Atlas paints a disappointing picture of a worldwide failure to provide people with the mental health services they need, at a time when the COVID-19 pandemic is highlighting a growing need for mental health support.

The latest edition of the Atlas, which includes data from 171 countries, provides a clear indication that the increased attention given to mental health in recent years has yet to result in a scale-up of quality mental services that is aligned with needs. 

Issued every three years, the Atlas is a compilation of data provided by countries around the world on mental health policies, legislation, financing, human resources, availability and utilization of services and data collection systems. It is also the mechanism for monitoring progress towards meeting the targets in WHO’s Comprehensive Mental Health Action Plan.

“It is extremely concerning that, despite the evident and increasing need for mental health services, which has become even more acute during the COVID-19 pandemic, good intentions are not being met with investment,” said Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization. “We must heed and act on this wake-up call and dramatically accelerate the scale-up of investment in mental health, because there is no health without mental health.”

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Source: WHO, 8 October 2021

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Ambulance handover delays at A&E are putting patients at risk

Between April 2020 and March 2021 there were approximately 185,000 ambulance handovers to emergency departments throughout Wales. However, less than half of them (79,500) occurred within the target time of 15 minutes.

During that period there were also 32,699 incidents recorded where handover delays were in excess of 60 minutes, with almost half (16,405) involving patients over the age of 65 who are more likely to be vulnerable and at risk of unnecessary harm.

Data published by the Welsh Government highlighted that in December 2020 alone, a total of 11,542 hours were lost by the ambulance service due to handover delays. This figure has been rising sharply and has now reached pre-pandemic levels once again.

Inspectors said these delays have consistently led to multiple ambulances waiting outside A&E departments for excessive amounts of time, unable to respond to emergencies within their communities.

"These delays have serious implications on the ability of the service to provide timely responses to patients requiring urgent and life-threatening care," the report stated.

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Source: Wales Online, 7 October 2021

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Major NHS trust downgraded by care watchdog amid safety fears

One of the largest hospital trusts in England has been downgraded by the care watchdog amid safety fears and criticism that bosses did not act on staff concerns.

The Care Quality Commission (CQC) said it found bedpans covered in faeces, urine and hair during 10 visits to wards at University Hospitals Birmingham Trust in June.

Staff in A&E told inspectors they were put under pressure to nurse patients in corridors. At one stage 20 ambulances were queuing outside Heartlands Hospital with patients waiting outside.

The CQC said staff felt “disconnected from leaders” who didn’t show an understanding of the pressures they were under.

Consultants to the regulator staff were experiencing fatigue and they felt executives at the trust “were no longer interested in staff welfare”.

In its inspection report, the CQC said staff did not always clean equipment and said labels for when items were last cleaned were being applied incorrectly.

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Source: The Independent, 8 October 2021

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'Life-saving' continuity of care at risk in the UK, GPs warn

Continuity of care in general practice reduces use of out-of-hours care, acute hospitalisations and mortality, researchers have shown - as GP leaders warned staff shortages and heavy workload means it is becoming harder to deliver in the UK.

Long-lasting personal continuity with a GP is 'strongly associated with reduced need for out-of-hours services, acute hospitalisations, and mortality', according to a study by researchers in Norway.

An association lasting more than 15 years between a patient and a specific GP reduces the probability of any of these factors by 25-30%, the study published in the British Journal of General Practice found.

The researchers said 'promoting stability among GPs' should be a priority for health authorities, and warned that continuity of care was under pressure.

The findings come as general practice in the UK faces intense pressure amid a shortage of GPs and intense workload after more than 18 months of the COVID-19 pandemic.

Responding to the findings, RCGP chair Professor Martin Marshall said: "Continuity of care is highly valued by patients and GPs and our teams alike. It is what allows us to build relationships with our patients, often over time, and this study builds the strong evidence base of its benefits for patients and the NHS."

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Source: GP Online, 4 October 2021

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Flu deaths could hit 60,000 in worst winter for 50 years, say experts

Flu deaths could be the worst for 50 years because of lockdowns and social distancing, health chiefs have warned, as the NHS launches the biggest ever flu vaccination drive.

More than 35 million people will be offered flu jabs this winter, amid concern that prolonged restrictions on social contact have left Britain with little immunity.

Officials fear that this winter could see up to 60,000 flu deaths – the worst figure in Britain since the 1968 Hong Kong Flu pandemic – without strong uptake of vaccines.

There is also concern about the effectiveness of this year’s jabs, because the lack of flu last year made it harder for scientists to sample the virus and predict the dominant strains.

Health chiefs said the measures introduced over the past 18 months to protect the country against coronavirus would now put the public at greater risk of flu.

The NHS has already begun the rollout of flu jabs and COVID-19 boosters. Health chiefs will urge everyone eligible to take up their chance, with the launch of a major campaign today to drive take-up.

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Source: The Telegraph, 8 October 2021

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