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Trust in staffing crisis as eight ICU nurses quit in just two weeks

Eight highly skilled intensive care (ICU) nurses have resigned from one trust in the past two weeks and more could follow, a leading nurse has warned.

More resignations expected as working conditions remain unsustainable

Belfast Health and Social Care Trust in Northern Ireland has confirmed it is redeploying non-specialist nursing staff to fill the gaps in staffing on ICU wards, with experienced ICU nurses expected to provide supervision.

RCN Northern Ireland director Rita Devlin said the college has heard others at the trust are ‘considering their position’.

"These are highly skilled nurses who are difficult to replace and this is a very worrying situation," she said.

"Nursing staff are doing everything they can to keep services going, but it is not sustainable to work under such pressure for long periods of time without a break."

The resignations come just months after it was revealed that 182 nurses and 50 healthcare assistants had quit their jobs at the trust between January and July.

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Source: Nursing Standard, 23 November 2021

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Trust in NHS ‘poor and diminishing’ among communities hit hardest by covid

There is growing distrust for the NHS and government in communities that are of fundamental importance to the national effort to counter covid, according to research by NHSX.

People in so-called “hard to reach” communities are faced with stigma and racism due to the covid pandemic but have dwindling trust in the health service, the research found.

They are worried about how their personal data will be used by the NHS and other state bodies. They are particularly concerned that their details will be passed on to the police or immigration services.

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Source: HSJ, 20 October 2020

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Trust heavily criticised by coroner for delays to death investigations

A coroner has strongly criticised a mental health trust for failing to investigate serious incidents promptly.

Tees Esk and Wear Valleys Foundation Trust has been told that delays in probing serious incidents may “compromise the quality” of these investigations and hence “their value in preventing deaths”.

The warnings, from Jeremy Chipperfield, senior coroner for County Durham and Darlington, come amid an ongoing inquest into the death of TEWV patient Ian Darwin. Mr Darwin died aged 42 in March, and the serious incident review into his death is still ongoing.

A recently published prevention of future deaths report relating to Mr Darwin’s death said TEWV’s serious incident death investigations, “at all levels of seriousness, are routinely (if not invariably) significantly delayed and I understand there is no expectation of immediate, or any timetable for eventual rectification”.

“In permitting delay of ‘serious incident’ investigations, TEWV may permit lethal hazard to persist for longer than necessary, and compromise the quality of such investigations and hence their value in preventing avoidable deaths.”

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Trust given warning notice over rapid tranquillisation

A mental health trust has been served with a warning notice ordering improvements in its processes around rapid tranquillisation of patients.

The Care Quality Commission said the trust needed to ensure all staff at Kent and Medway NHS and Social Care Partnership Trust followed local and national recommendations to monitor and record a patient’s physical health when rapid tranquillisation was administered. Inspectors were concerned staff were not always aware of the potential impact of these medications.

Serena Coleman, CQC deputy director of operations in the south, said: “We found some staff weren’t always using the least restrictive options to make sure that people’s behaviour wasn’t controlled by an excessive use of medicines.

“As required medication, such as lorazepam and promethazine, was being used quite frequently but we couldn’t always find records to explain why these medications were necessary. There were examples where reviews hadn’t happened for long periods, meaning staff couldn’t be sure it was still appropriate to administer to people."

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Source: HSJ, 3 August 2023

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Trust focused on ‘reputation’ failed to address patient harms

A focus on “reputation management” was a factor in how an acute trust failed to properly investigate serious safety concerns in a dysfunctional department where consultants were “divided along ethnic lines”.

An external review into the urology services at University Hospitals of Morecambe Bay Foundation Trust has identified 520 cases where patients suffered “actual or potential harm”, including several cases where patients died.

The review, commissioned by NHS England, has found there were “multiple individual, team, organisational, and regulatory shortfalls which have resulted in a systemic failure to deliver good urological care at all times”.

Much of the report focuses on the trust’s failure to properly investigate concerns being raised, and to sort out poor relationships within the department which dated back 20 years.

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Source: HSJ, 24 November 2021

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Trust fined following patient’s death linked to ‘outdated’ IT system

A Norfolk hospital trust has been fined £60,000 after pleading guilty to criminal charges of exposing a 28-year-old patient who died to significant risk of avoidable harm.

Queen Elizabeth Hospital King’s Lynn Foundation Trust was sentenced on Thursday 8 December at Chelmsford Magistrates’ Court, as a result of a prosecution brought by the Care Quality Commission.

The dilapidated hospital’s “outdated” computer system, which is long overdue a major upgrade, was cited as a factor in the young patient’s death, which followed a mix-up over scans.

Lucas Allard, who was awaiting heart surgery, had attended the hospital’s emergency department on 12 March 2019 with chest pain.

He was sent home after staff determined his computerised tomography scan results meant he was fit for discharge. But two days later, a consultant discovered staff had been looking at the wrong scan, and the correct report showed significant abnormality.

Mr Allard was urgently called back to the hospital but suffered a cardiac arrest shortly after arriving, and died despite attempted resuscitation.

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Source: HSJ, 9 December 2022

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Trust fined £2.5m after deaths of two patients

An acute trust has been fined £2.5m after pleading guilty to charges of failing to provide safe care after the deaths of two patients.

The Care Quality Commission brought charges against The Dudley Group Foundation Trust earlier this year over care failings in two separate cases which the regulator said exposed two patients to “significant risk of avoidable harm”.

The trust pleaded guilty to the charges in July and was fined during a sentencing hearing today.

The cases, involving 33-year-old mother of six Natalie Billingham, and 14-year-old Kaysie-Jane Bland [also known as Kaysie-Jayne Robinson], were both in 2018 and  related to care at the trust’s Russells Hall Hospital in Dudley.

Ms Billingham was admitted to Dudley’s Russells Hall Hospital with numbness in her right foot on 28 February 2018 and died on 2 March of organ failure caused by a “time critical” infection.

The court was told she was initially thought to have a deep vein thrombosis after a three-minute triage that failed to identify "disordered" observations. The hospital then had multiple reasons to reconsider the initial diagnosis, but opportunities for review were "missed or ignored".

In the case of Kaysie-Jane, who had cerebral palsy, an "early warning score" was inaccurate, meaning a sepsis screening tool was not triggered.

The CQC said the care both patients received at Russells Hall Hospital was undermined by the Dudley Group’s failure to address known safety failings which the regulator repeatedly raised with the trust in the months before their deaths. The CQC said the trust did not take all reasonable steps to make improvements, despite its intervention. The trust has denied it did not react to the concerns raised. 

Failings included errors in the hospital’s initial assessments and monitoring of both patients, which hindered the timely escalation of concerns.

A lawyer acting on behalf of the Dudley Group NHS Foundation Trust had admitted the trust failed to provide treatment in a safe way, resulting in harm, in February and March 2018.

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Source: HSJ, 19 November 2021

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Trust fears medics will be ‘harassed’ if it publishes surgery report

Two external reviews have been carried out into a trust’s general surgery services amid concerns about whether it is a ‘safe interpersonal working environment’.

But University Hospitals Sussex Foundation Trust has refused to make the reviews – which were both completed last year – public, partly because of what it says are concerns that they could lead to “harassment” of doctors who spoke to the authors.

Both reviews were into aspects of the general surgery services at the Royal Sussex County Hospitals in Brighton. The trust has had a series of highly critical Care Quality Commission reports into some of its surgical services and a “well led” report is expected to be released in the next few weeks.

The trust has refused HSJ’s Freedom of Information Act request to release the reviews, arguing that those interviewed had been promised confidentiality, and the issues involved are “emotive and sensitive matters”.

“Disclosure could cause those involved in the reviews damage, distress and upset and could even lead to harassment,” it said.

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Source: HSJ, 27 March 2023

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Trust failed to complete 21 instructions from safety review

Only two out of 23 recommendations from a royal college review into a trust’s troubled maternity services can be shown to be fully implemented, a new investigation has revealed.

A learning and review committee, set up by East Kent Hospitals University Foundation Trust, found that 11 more of the recommendations from a 2016 review by the Royal College of Obstetricians and Gynaecologists (RCOG) were “partially” implemented.

But it said there was either no evidence the remaining 10 had been delivered, or there was evidence they were not implemented.

The original RCOG review looked at a number of cases where babies had died as well as broader issues within the maternity service at the trust.

The committee was set up after an inquest into the death of Harry Richford, who died a week after his birth in 2017 at the trust’s Queen Elizabeth, the Queen Mother, Hospital in Thanet. Many of the issues which came to light at his inquest echoed those from the RCOG report.

Committee chair Des Holden, medical director of Kent Surrey Sussex Academic Health Science Network, highlighted the difficulties in tracking evidence and action plans during a time when the trust had significant changes in leadership. But he said the committee felt cases where evidence could not be found or the standard of evidence gave concern, the recommendations could not be said to be met.

Derek Richford, Harry’s grandfather, said on behalf of the family: “We are saddened and shocked to find that over four years after the RCOG found fundamental systemic failings and made 23 recommendations, only two have been completed. It is not good enough for them to now say ‘leadership has changed’. The main board must take responsibility and be held to account.”

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Source: HSJ, 13 July 2020

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Trust failed for months to give vital medication to vulnerable inmate

A troubled NHS trust failed for months to give vital medication to a prison inmate who had a long-standing diagnosis of HIV, an inquest has found.

A jury at Essex Coroner’s Court concluded that a series of failures and neglect by Essex Partnership University Trust (EPUT) contributed to the death of Thokozani Shiri in April 2019.

The 21-year-old spent two spells as a prisoner at HMP Chelmsford, where EPUT provided some services at the time.

He was considered vulnerable due to a long-standing diagnosis of HIV for which he was receiving treatment before he went to prison, and the trust was aware he had HIV throughout both stays, the inquest heard.

The inquest jury identified that five separate failings had “probably caused” Mr Shiri’s death. These included: a failure to provide antiretroviral medication to Mr Shiri during both periods of imprisonment; a failure to refer him to an HIV clinic; the absence of an appropriate care plan and engagement with a multidisciplinary team; and inadequate management of records.

Each failing on behalf of the trust was considered by the jury to have amounted to neglect.

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Source: HSJ, 9 June 2022

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Trust execs accused of creating a ‘cult of the individual’

Regulators are probing a series of whistleblowing claims about the leadership culture of a trust which is rated ‘outstanding’ for its management, HSJ has learned.

It is understood multiple current and former staff members at Bolton Foundation Trust, including people in senior positions, have been in contact with NHS England and the Care Quality Commission in recent months.

The claims include a dramatic worsening in leadership culture at the trust, particularly around the FTSU process and people who speak up being bullied, side-lined and silenced. And investigations and meetings are stage-managed and tightly controlled by executives, with constant “sugar-coating” and positive spin on board reports, and intolerance of people who disagree.

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Source: HSJ, 22 May 2023

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Trust drops from ‘outstanding’ to ‘requires improvement’

A teaching hospital that was lauded for its culture and championed by ministers has been downgraded from ‘outstanding’ to ‘requires improvement’ by the Care Quality Commission.

CQC inspectors found multiple issues at Salford Royal Hospital during an inspection in August and September. These included nurse staffing, governance, and some cultural concerns. The trust’s urgent and emergency services were rated “inadequate” for safety.

The hospital in Greater Manchester had been rated “outstanding” since 2015, and was frequently hailed as a leader on the patient safety agenda, particularly by former health secretary Jeremy Hunt.

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Source: HSJ, 22 December 2022

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Trust declares its cancer waiting list ‘unmanageable’

One of the NHS’s biggest hospital trusts has declared its cancer waiting list is now at an ‘unmanageable size’.

Mid and South Essex Foundation Trust leaders set out the stark judgement in a  paper for its July board meeting, held last week.

The report said: “The 62-day [referral to treatment backlog as of 3 July] has increased for the second consecutive week to 1,055.

“[The cancer patient tracking list] is getting bigger and has reached an unmanageable size. Referral rates have plateaued from March 2021 [but] treatment rates have not increased in line with PTL growth.

“This points to a noisy PTL, where the hospital is extremely busy managing patients who do not have cancer.”

The paper also said NHS England had recognised the trust’s 62-day cancer target needed to be delivered “in more realistic and achievable stages”.

It highlighted particular concerns around a “serious” demand and capacity problem in its dermatology department which contributed to almost half of its 62-day backlog. The trust had 445 62-day RTT cancer breaches in dermatology alone in May, the latest data reported.

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Source: HSJ, 22 July 2022

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Trust declares critical incident over ‘relentless demand’

  • Gloucestershire Hospitals FT declares critical incident after ‘relentless demand’ on emergency care
  • Pressure comes two months after trust downgraded one of its A&Es
  • ‘Tired’ staff warned a ’Herculean effort’ is needed to reset emergency system
  • NHS 111 cited as pinch point

A trust has declared a critical incident after experiencing “relentless demand” on urgent and emergency care, months after downgrading one of its emergency departments.

The internal critical incident was raised by Gloucestershire Hospitals Foundation Trust yesterday. An internal memo said the previous three days “have seen unprecedented demand fall on the Gloucestershire urgent and emergency care system”.

Clinicians have been told that early discharges need to be identified on both its Cheltenham General and Gloucestershire Royal hospital sites, to try to free up bed-space, and that all non-essential meetings, besides those at executive level, should be cancelled.

The incident comes after the trust decided in June to downgrade the A&E department at Cheltenham General to a minor injuries unit, operating from 8am to 8pm. Previously, the unit offered a full A&E service between 8am and 8pm, with a “nurse-led” minor injuries service outside these hours.

The problems appear to be unrelated to covid-19, although infection control measures are known to have reduced capacity in many A&Es and wards.

HSJ understands that local managers believe NHS 111, run by Care UK Health Care, has been a particular cause of the problems in recent days, because it has not been directing enough people to alternative services; as well as workforce pressures and the hot weather.

Read full (paywalled) article here in the HSJ.

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Trust criticised over handling of 60-hour A&E waits

Senior staff have questioned why a major hospital did not seek support from neighbours when emergency patients were left waiting more than 60 hours to be admitted to a bed.

Cambridge University Hospitals Foundation Trust’s emergency department came under severe pressure last week, with patients being bedded down in corridors and facing very long waits to be admitted to a ward.

Senior sources told HSJ there were two cases where patients were waiting more than 60 hours last Monday, and the trust declared an internal incident.

But the sources felt the trust should have escalated its alert level to “Opel 4”, which prompts calls for external support when trusts are under the most severe levels of operational pressure. This can include diverting ambulances to other hospitals.

The trust apologised to patients who had been kept “waiting for a long time” but that the required threshold for Opel 4 had not been reached.

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Source: HSJ, 25 October 2022

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Trust criticised for ‘extreme positivity’ and drops two ratings to ‘inadequate’

Senior leaders of an ambulance trust have been told their ‘extreme positivity’ has made them appear ‘out of touch’ as the Care Quality Commission downgraded the organisation’s rating to ‘inadequate’.

The health watchdog has dropped the overall rating of South Central Ambulance Service Foundation Trust, as well as the provider’s ratings for safety, leadership and for its urgent and emergency care services, from “good” to “inadequate”.

The CQC has served SCAS with a warning notice and has criticised the trust’s board for its “extreme positivity about its performance”, which “could feel dismissive of the reality to frontline staff.” The regulator also said it saw evidence “of executive leaders attempting to discredit people raising valid concerns” and was told that serious concerns including sexual harassment had been “brushed under the carpet”.

The CQC, which published the report today, also said there was “no evidence” of action being considered by SCAS to manage risk for patients suffering long handover delays outside A&E departments, and that serious issues “had not been addressed internally”.

Will Hancock, chief executive of SCAS, said the trust had an “extensive improvement plan” and is “committed to making things better”.

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Source: HSJ (25 August 2022)

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Trust concludes former chief ‘not fit and proper’ after sexual harassment investigation

An NHS trust has concluded that its former chief executive is not a “fit and proper person” to be on an NHS board, after investigating allegations of sexual harassment and inappropriate behaviour, HSJ has learned.

HSJ understands The Robert Jones and Agnes Hunt (RJAH) Orthopaedic Hospital Foundation Trust commissioned a specialist external workplace investigation into Mark Brandreth, which considered serious allegations made about his behaviour during his time as trust chief executive between April 2016 and August 2021.

Mr Brandreth is understood to dispute the allegations as well as the investigation’s findings, and is seeking to challenge RJAH’s handling of the complaints and its process for deciding he did not meet the Fit and Proper Person Test. 

Sources with knowledge of the situation said almost 30 female RJAH staff members came forward to give information to the investigation, but it focused on 12 employees who were willing to give evidence.

HSJ has been told that as a result of the investigation, which concluded at the end of last year, the trust’s chair has informed NHSE in writing that it believes Mr Brandreth does not meet the “Fit and Proper Person Test”, implying he should be ruled out of board roles – or roles with equivalent responsibility – at English NHS organisations and adult social care providers.

However, the trust, in Shropshire, is not planning to publish its ruling and – with no professional regulation in place for health and care managers and/or board members – it is unclear how effective the conclusion will be if it is not made public. A female staff member told HSJ of her concerns that “nothing is being done”.

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Source: HSJ, 21 February 2024

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Trust chiefs speak out: NHS ‘sleepwalking’ into ‘dangerous’ junior doctors strike

Ministers and NHS England have not sufficiently warned the public of the risk to patient harm posed by next week’s junior doctors strike, some of the NHS’s most senior trust chief executives have warned.

The senior leaders contacted HSJ with their concerns after a group call between trust leaders and NHSE bosses on Thursday.

The chief executives and medical directors, who spoke to HSJ on condition of anonymity, made a series of robust criticisms which focussed on the lack of awareness of danger presented by the junior doctor’s industrial action, a lack of thorough communication of that to the public, and the insistence that trusts negotiate strike agreement with the British Medical Association at a local level.

One comment on the chat function stated: ”Public awareness of the impact of this strike seems far lower than for e.g. the ambulance strike, but from a an acute trust perspective this will have a much bigger impact on patient care and safety. Junior doctors’ are not newly qualified students - they are the backbone of day to day medical management in our services. I am concerned we might be giving false assurance about the quality of service we can offer next week.”

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Source: HSJ, 10 March 2023

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Trust chiefs sacked ‘only in extreme circumstances’, says government

The government has admitted that many ‘vulnerable’ hospitals ‘suffer with a lack of permanence of leadership’, but said that chiefs are only sacked by NHS England ‘in extreme and exceptional circumstances’.

The comments were included in the government’s response to the independent investigation into major maternity care failures at East Kent Hospitals University Foundation Trust, which highlighted how the practice of repeatedly hiring and firing leaders  had contributed to its problems.

The investigation said successive chairs and CEOs at the FT were “wrong” to believe it provided adequate care, and urged that they be held accountable. But it said senior management churn had been “wholly counterproductive”, and that it had “found at chief executive, chair and other levels a pattern of hiring and firing, initiated by NHS England” which would “never have been an explicit policy, but [had] become institutionalised”.

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Source: HSJ, 21 July 2023

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Trust chiefs resist ‘pressure’ to treat patients in corridors

Hospital leaders say they have been pressured to deliver more ‘corridor care’ as a result of efforts to ease the ambulance handover crisis.

Due to the collapse in ambulance response times over the last year, hospitals have been told to receive patients from ambulance crews more quickly, to enable those crews to respond to new incidents in the community.

This can mean patients being kept on trolley beds in corridors, with a lack of appropriate staff to care for them.

Tracy Bullock, chief executive of University Hospitals of North Midlands, told HSJ  her trust almost eradicated “corridor care” before the pandemic.

But she added: “There have been discussions about going back to corridor care, but we have resisted that, as it brought significant patient safety and staff wellbeing issues… although these never received the same airtime as ambulance waits as they are unseen and only impact on the acutes.

“The terminology has now changed and instead of corridor care it’s ‘cohorting’, and the space is not necessarily a corridor but a designated space for ambulances to drop more patients off.”

She said this only works with enough staff, “otherwise you end up with the same safety issues that we had delivering corridor care pre-pandemic”.

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Source: HSJ, 11 July 2022

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Trust chiefs predict ‘massive problem’ if centre starts elective recovery next month

The NHS should start off the next financial year focusing on staff recovery and postpone ratcheting up elective recovery efforts and other long-term priorities until the second quarter, senior figures have warned.

One trust chief executive said if there is an expectation from the centre that “April is the start point [for elective recovery], that will cause a massive problem”.

It comes with the government and NHS England still apparently locked in negotiation over NHS funding for the financial year from 1 April, and deciding what the NHS will be asked to deliver.

The CEO said: “It’s hard to think that 1 April signals a new year for the NHS. [There needs to be] a gradual decompression of our staff over the next three months as the country opens up.

“If the planning guidance gets announced in the next couple of weeks with an expectation that April is the start point, that will cause a massive problem. Staff have not recovered, the vaccine programme is still ongoing, [and] there are still covid patients in all of our beds.”

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Source: HSJ, 18 March 2021

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Trust chief calls for six-hour A&E target

The chief executive of a trust trialling the new emergency care standards being considered by the government has called for a new six-hour target to either move patients out of accident and emergency, or for them to receive treatment.

North Tees and Hartlepool Foundation Trust chief executive Julie Gillon told HSJ  a new target should be set as a “body of evidence” indicates patients are at risk of deterioration following A&E waits of six hours or more.

The proposal is likely to be broadly welcomed by many clinicians, but could prove controversial in some quarters. NHS England did not include a six-hour target in the bundle of new A&E metrics being piloted, and the proposal could be interpreted by some as a watered-down version of the existing four-hour standard.

However, Ms Gillon cited analysis by the Royal College of Emergency Medicine last year which revealed thousands of excess deaths resulting from overcrowding and long stays in A&Es.

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Source: HSJ, 4 August 2022

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Trust CEOs’ strike warning: ‘If anyone gets sick, we’re stuffed’

The leaders of acute trusts across England have told HSJ the second junior doctor’s strike ‘feels very different’ from the first stoppage, and services are much more vulnerable because of ‘thinner’ consultant coverage.

They also reported that the instruction from NHS England not to proactively cancel elective procedures and apppointments has been largely ignored by trusts.

The chief executive of a large trust in the east of England said they were “more concerned about clinical safety than at any time during covid surges”.

A trust CEO in the North West told HSJ this week’s stoppage “feels much more risky than the previous strike. We have managed to cover rotas but we are very stretched and concerned about short notice cancellation from agencies and short term sickness after bank holiday.”

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Source: HSJ, 11 April 2023

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