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Third of UK carers with bad mental health have thoughts of self-harm, survey finds

A third of carers with poor mental health have considered suicide or self-harm, data shows.

Figures given to the Liberal Democrats by Carers UK reveal that many of the UK’s millions of carers who look after relatives have bad mental health, with some “at breaking point”.

In a survey of nearly 11,000 unpaid carers, the vast majority said they were stressed or anxious, while half felt depressed and lonely. More than a quarter said they had bad or very bad mental health. Of these, more than a third said that they had thoughts related to self-harm or suicide, while nearly three-quarters of those felt they were at breaking point.

Helen Walker, the chief executive of Carers UK, said: “Unpaid carers make an enormous contribution to society, but far too regularly feel unseen, undervalued and completely forgotten by services that are supposed to be there to support them.

“Not being able to take breaks from caring, being able to prioritise their own health or earn enough money to make ends meet is causing many to hit rock bottom.”

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Source: The Guardian, 22 November 2023

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Third of region’s ICUs exceed ‘maximum safe capacity’

More than a third of critical care units in the East of England are either at or have exceeded their maximum surge capacity, information leaked to HSJ reveals, and all but one are above their normal capacity.

Data from the region’s critical care network shows that as of 11 January, seven of the region’s 19 critical care units were either at 100% of, or had exceeded, what is known as ”maximum safe surge” capacity. This represents the limit of safe care, mostly based on available staffing levels. The units have opened more beds, but they require dilution of normal staffing levels.

Across the East of England, 482 of the region’s current 491 intensive care beds, after the opening of surge capacity, were occupied. This included 390 patients in intensive care with confirmed covid-19, six with suspected covid and 86 non-covid patients.

It gives a regional occupancy rate of 91 per cent against total “safe surge” capacity.

Published government figures show the rapid increase in demand for intensive care in the East of England in the last two weeks — the number of patients with covid in mechanical ventilation beds is more than double what it was just after Christmas.

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Source: HSJ, 11 January 2021

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Third of frail hospital leavers in England find post-discharge care lacking

Problems with hospital discharges in England, highlighted in the largest annual patient survey, reinforce the need for greater integration between health and social care, the sector regulator has said.

The Care Quality Commission inpatient survey found that a majority of patients were positive about their hospital care but a significant minority experienced problems on discharge.

A third of respondents who were frail said the care and support they expected when they left hospital was not available when they needed it. Three in 10 frail people said they had not had discussions with staff about the need for further health and social care services they might require post-discharge.

Four in 10 of all patients surveyed left hospital without printed or written information about what they should or should not do after discharge, and the same proportion said their discharge was delayed.

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Source: The Guardian, 2 July 2020

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Third of BAME staff in NHS mental health services face racist abuse at work

NHS leaders are being urged to tackle racist abuse of staff as new figures reveal that a third of black, Asian or minority ethnic workers in mental health trusts in England have experienced harassment, bullying or attacks by patients, relatives or members of the public.

One in three (32.7%) BAME staff in mental health settings have experienced abuse, according to analysis by the Royal College of Psychiatrists. For BAME workers across the NHS, the rate is more than one in four (28.9%).

One medical director told the Guardian that hot tea had been thrown at them “because of the colour of my skin”. A psychiatrist told how they were left traumatised after they were racially abused – then threatened with a knife.

The college is calling on health leaders to take a stand against discrimination by setting up better processes in NHS trusts to record and understand data about bullying and harassment.

Dr Adrian James, president of the Royal College of Psychiatrists, said the findings were deeply concerning. He said: “NHS leaders and local health bosses must tackle this head-on.”

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Source: The Guardian, 9 September 2021

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Think tank claims NHS waiting list could reach 10 million by April

Waiting lists for NHS surgery in England could hit 10 million by April, a think tank has claimed while calling for NHS hospitals to use more private sector capacity to reduce delays for patients.

In a new report the right-wing think tank Reform said the worst case scenario for patient waits could see one in six people in England waiting for treatment by April. It said the impact of coronavirus had turned the NHS into a “national Covid service” with six million fewer referrals for treatment in 2020.

It warned the delays in treatments could have dire consequences for patients with an estimated 1,660 additional lung cancer deaths.

But NHS bosses have hit back at the report saying it is inaccurate to say the NHS focused only on Covid, and that despite widespread cancellations it has continued to treat other patients.

Predictions that the NHS waiting list would hit 10 million were made last year and proved wrong after hospitals ramped up routine services during the summer – although the second wave of the virus has again led to widespread cancellations including for surgery patients.

The new Reform report claims capacity in private sector hospitals, where NHS England has secured new contracts to take on additional work during the Covid surge, have not been effectively used.

The think tank wants NHS England to mandate the publication of ‘waiting list recovery plans’ by NHS trusts setting out how each hospital will use the private sector.

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Source: The Independent, 17 February 2021

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They bite, they hit, they spit: patients assault staff at Nottingham hospital

“I’ve seen patients take swings at doctors because they’re not happy with the time it’s taken or the doctor’s diagnosis. I’ve seen fire extinguishers set off and thrown at people, computers lifted and thrown across the emergency department and people run out of cubicles and punch other patients – people they don’t know – for no reason.”

Roger Webb, a security supervisor at the Queen’s Medical Centre hospital in Nottingham, is recalling some of the more unsavoury incidents he has witnessed in the course of his work.

“I’ve been struck in the groin, had scratches all over my arms where people have dug their nails in. I’ve been bitten and I’ve been spat at while trying to deal with situations. The spitting is the most depressing of those, though, because it’s so contemptuous and so horrible. And legally it’s assault.”

Like staff across the NHS, those at the QMC have seen a rise in abusive, threatening and intimidatory behaviour by patients and their relatives in recent years. In 2021-22, Nottingham University hospitals (NUH), the NHS trust that runs the QMC and its sister City hospital, recorded 1,237 incidents of aggression, violence and harassment. But it had many more – 1,806 – during the following year, 2022-23.

Last year brought another increase. In the six months between April to September alone, NUH recorded another 1,167 incidents, leaving 2023-24 likely to be the worst ever on record.

Staff have been hit, spat at, threatened, verbally abused and racially abused during this roll call of unpleasant incidents. Racially aggravated harassment has increased notably.

Some of the incidents have led to perpetrators being charged and convicted. Worryingly, in a growing number of cases, the patient has been responsible for several incidents while receiving one single episode of care.

Care delays are the main trigger for abuse at the QMC. But such incidents also arise when staff are treating drunks, rival gangs, people who are high on drugs and those with mental health problems.

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Source: The Guardian, 25 February 2024

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Thérèse Coffey scraps promised paper on health inequality

Thérèse Coffey is ditching the government’s long-promised white paper on health inequalities, despite the 19-year gap in life expectancy between rich and poor, the Guardian has been told.

The health secretary has decided to not publish a document that was due to set out plans to address the stark inequalities in health that the Covid-19 pandemic exposed.

It was meant to appear by last spring and be a key part of then prime minister Boris Johnson’s declared mission to level up Britain. It was due to set out “bold action” to narrow the wide inequalities in health outcomes that exist between deprived and well-off areas, between white and BAME populations, and between the north and south of England.

"It’s dead. It’s never going to appear. The white paper is being canned,” said one source familiar with the situation.

Health experts reacted with dismay to reports of the paper being scrapped. “We expect the government to keep its commitment to addressing health disparities in an upcoming white paper and would have grave concerns if this long-planned paper were delayed or shelved,” said Dr Habib Naqvi, director of the NHS Race and Health Observatory.

“We need to see priorities and an action plan set out to address a number of serious and longstanding health inequalities. This should be a priority, particularly given the cost of living crisis and the impact this is having on diverse communities.”

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Source: The Guardian, 29 September 2022

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Therese Coffey could abolish four hour A&E wait targets under ‘emergency’ NHS plan

Therese Coffey is considering abolishing four-hour A&E waiting time targets as part of her “emergency plan” to tackle the NHS.

The new health secretary is understood to be looking at a range of measures to address the growing crisis in the NHS, understood to be announced next Thursday.

But a source close to the discussions told The Independent getting rid of the four-hour waits – first suggested in March 2019 – would have to be given the green light by the new prime minister Liz Truss.

The announcement will focus on the health secretary’s “ABCD” priorities – standing for “ambulances, backlog, care, dentists and doctors” – with improvements to mental health services as an addition.

Policies also being looked at include more call handers for ambulances, more diagnostic community centres, speeding up the hospital building programme, reducing “bureaucratic” burdens on GPs, improving direct access to counselling services for patients and “robust” management of the national dentists’ contract.

There is concern among those involved that the move would see the four-hour wait replaced by a new target, which could be as difficult as the current target to achieve.

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Source: The Independent, 18 September 2022

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There's no proof the Oxford vaccine causes blood clots. So why are people worried?

Stories about people getting blood clots soon after taking the Oxford/AstraZeneca vaccine have become a source of anxiety among European leaders.

After a report on a death and three hospitalisations in Norway, which found serious blood clotting in adults who had received the vaccine, Ireland has temporarily suspended the jab. Some anxiety about a new vaccine is understandable, and any suspected reactions should be investigated. But in the current circumstances we need to think slow as well as fast, and resist drawing causal links between events where none may exist.

As Ireland’s deputy chief medical officer, Ronan Glynn, has stressed, there is no proof that this vaccine causes blood clots. It’s a common human tendency to attribute a causal effect between different events, even when there isn’t one present: we wash the car and the next day a bird relieves itself all over the bonnet. Typical. Or, more seriously, someone is diagnosed with autism after receiving the MMR vaccine, so people assume a causal connection – even when there isn’t one. And now, people get blood clots after having a vaccine, leading to concern over whether the vaccine is what caused the blood clots.

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Source: The Guardian, 15 March 2021

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There is no greater priority for the Royal College of Nursing than the safety, security and wellbeing of its members and staff.

The RCN has today launched a new independent and confidential help and support line for any members or staff who have been affected by the issues relating to the reports received.  

Pat Cullen, General Secretary and Chief Executive, said: "Anyone can be affected by sexual harassment. It’s not restricted to any gender, age, ethnicity, sexuality or role. If you have been affected, it is important that you are listened to, supported, and helped to work through any actions you wish to take. This 0800 number will allow members or staff to discuss any concerns about sexual harassment related to RCN activity. 

“All staff and members have a right to feel safe and we are taking all necessary steps to provide that security. We must tackle the issues and behaviours that have no place in our College. We must demand better, for members and for the profession.”  

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Source: RCN, 02 September 2021

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There is a shocking silence over the thousands of people with disabilities who have died during the pandemic

Figures released by the Office for National Statistics show that about two-thirds of fatalities from this disease during its peak from start of March to mid-May were people with disabilities. That is more than 22,000 deaths.

Then dig down into the data. It indicates women under 65 with disabilities are more than 11 times more likely to die than fellow citizens, while for men the rate is more than six times higher. Even for older people the number of deaths was three times as high for women and twice as high for men. There are some explanations for such alarming figures, although they tend to reveal other profound concerns.

Yet the report showed even when issues such as economic status and deprivation are taken into account, people with disabilities died at about twice the rate of their peers. So where was the fury over this obvious and deep inequality, even in death? Where was the fierce outcry over persistent failures that left many citizens and their families at risk, lacking even the most basic advice, support or protection from the state?

Chris Hatton, the dedicated professor of public health and disability at Lancaster University, delved into all available data. He found people with autism and learning disabilities were in reality at least four times more likely to die at the peak of pandemic than other citizens.

They also died at far younger ages. “Information released about deaths of autistic people and people with learning disabilities has been minimal, grudging and seems deliberately designed to be inaccessible,” he says.

This adds up to one more shameful episode in the scandal of how Britain treats such citizens.

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Source: iNews, 5 July 2020

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There are so many Covid patients, younger this time. But my hospital is full

"There can be no debate: this is now much, much worse than the first wave", says a NHS consultant.

"Truly, I never imagined it would be this bad.

Once again Covid has spread out along the hospital, the disease greedily taking over ward after ward. Surgical, paediatric, obstetric, orthopaedic; this virus does not discriminate between specialities. Outbreaks bloom even in our “clean” areas and the disease is even more ferociously infectious. Although our local tests do not differentiate strains, I presume this is the new variant.

The patients are younger this time around too, and there are so many of them. They are sick. We are full."

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Source: The Guardian, 7 January 2020

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Therapy could be offered to women suffering menopause symptoms

Women experiencing hot flushes, night sweats, depression and sleep problems could be offered therapy to help reduce their menopause symptoms, under new guidelines.

But menopause champions warned that those suffering with symptoms could have long waits for mental health support and stressed that the new draft guidance to GPs from the National Institute for Health and Care Excellence (NICE) must not distract from “ongoing challenges” of getting HRT.

A NICE evidence review found that cognitive behavioural therapy (CBT) can help make night-time sweats less severe and frequent and should be considered “alongside or as an alternative to HRT”.

The guidance is not mandatory but GPs will be expected to take the new guidance “fully into account”, said Nice.

Caroline Nokes, chair of the Commons’ women and equalities committee, welcomed the new guidance saying there was no “one size fits all” to help women going through the menopause, but said it must not be used to fob off women, some of whom were still facing drug shortages.

A major HRT drug shortage last year resulted in 22 restrictions being put in place, pushing some women to turn to the hidden market or meet up with other women to buy, swap or share medicines.

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Source: The Guardian, 17 November 2023

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Theatre staff 'deliberately slow down' operations, review finds

Theatre staff at a major hospital “deliberately slowed down” elective activity to limit the number of operations that could be done each day, an NHS England review has been told.

The culture in theatres at the William Harvey Hospital in Ashford, run by East Kent Hospitals University Foundation Trust, was a “significant issue” according to an education quality intervention review report into trauma and orthopaedic training at the hospital.

The review, dated October and made public by NHSE in December 2023, was launched after concerns were raised by staff at the trust in the General Medical Council’s national training survey, published every July.

Problems raised by junior doctors and their supervisors to the NHSE review included perceptions that juniors were made to feel uncomfortable by the trauma theatre team and that there was also “animosity” from the trauma theatre team towards surgeons.

The review said trauma theatre staff were heard “bragging” about their behaviour towards surgeons and that they resisted the number of cases scheduled on a list, claiming it was “unrealistic".

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Source: HSJ, 19 January 2024

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The Valproate Families: The stories of the families affected by Sodium Valproate in Ireland

Major concerns are being raised about the Irish State’s failure to set up an inquiry into a drug that caused serious birth defects and developmental delays in at least 1,200 Irish babies.

Sodium valproate, a drug used to treat epilepsy and bipolar disorder, has been estimated to have caused major malformations in up to 341 Irish children between 1975 and 2015 after it was taken by their mothers during pregnancy.

The drug, which is sold in Ireland as Epilim, is also believed to have caused neuro-developmental delays in 1,250 children.

Many women were never warned of the risks that taking the drug during pregnancy would pose to their babies.

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Source: The Irish Independent

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The US Senate can save lives by removing ban on unique patient identifier

The US Senate has an unprecedented opportunity to remove a ban that has stifled efforts to establish a nationwide unique patient identifier. 

In June, the U.S. House of Representatives passed an amendment that would remove a ban that has stifled efforts to establish a nationwide unique patient identifier. Now, it is up to the US Senate to move this issue forward by rejecting inclusion of outdated rider language in their appropriations bill that prohibits the U.S. Department of Health and Human Services from spending any federal dollars to promulgate or adopt a national patient identifier.

According to a 2016 study of health care executives, misidentification costs the average health care facility $17.4 million per year in denied claims and potential lost revenue. More importantly, there are patient safety implications when data is matched to the wrong patient and when essential data is lacking from a patient’s record due to identity issues. 

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Source: The Hill, 11 September 2019

 

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The US is trying to fix medical devices’ big cybersecurity problem

Medical devices are one major weak point in health care cybersecurity, and both the US Congress and the Food and Drug Administration took steps towards closing that gap this week —Congress with a proposed bill and the FDA with new draft guidelines for device makers on how they should build devices that are less likely to be hacked.

Devices like infusion pumps or imaging machines that are connected to the internet can be targets for hacks. Those attacks can siphon off patient data or put their safety directly at risk. Experts consistently find that devices in use today have vulnerabilities that could be exploited by hackers.

The new document is still just a draft, and device makers won’t start using it until it’s finalised after another round of feedback. But it includes a few significant changes from the last go-around — including an emphasis on the whole lifecycle of a device and a recommendation that manufacturers include a Software Bill of Materials (SBOM) with all new products that gives users information on the various elements that make up a device. An SBOM makes it easier for users to keep tabs on their devices. If there’s a bug or vulnerability found in a bit of software, for example, a hospital could easily check if their infusion pumps use that specific software.

The FDA also put out legislative proposals around medical device cybersecurity, asking asking Congress for more explicit power to make requirements. “The intent is to enable devices to be that much more resilient to withstand the potential for cyber exploits or intrusion,” Schwartz says. Manufacturers should be able to update or patch software problems without hurting the devices’ function, she says.

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Source: The Verge, 8 April 2022

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The trusts set to have at least a third of beds filled by covid patients on 31 Dec

There are 14 hospital trusts on course to have at least a third of their beds filled by covid patients on New Year’s Eve.

HSJ analysed current occupancy and growth at each general acute trust in the seven days to 21 December. Projecting the same rate of growth forward, the number of trusts with at least a third of their bedbase likely to be taken by covid patients would increase from 5 at present to 14.

Three of the four acute trusts in Kent are projected to have covid bed occupancy of over 40%.

Another two trusts are in areas covered by tier two restrictions. They are Queen Elizabeth in Norfolk, and Countess of Chester. A third, East Sussex, has one of its two general hospitals in “tier four” (St Leonards), and the other in Eastbourne, which is outside the Sussex “tier four” zone.

There are also 27 trusts not in tier four areas which had more than 50 covid patients on 21 December, and where the number of covid patients grew by at least 20 per cent in that week. These include Liverpool University Hospitals and Sheffield Teaching Hospitals.

HSJ last week projected that, if trends continued, English hospitals would have just short of 19,000 covid patients on New Year’s Eve in total — almost exactly the same as the 12 April first wave peak. Current projections put that number at over 20,000.

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Source: HSJ, 23 December 2020

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The trusts making least progress in improving maternity services

The trusts that have made the most and least progress on urgent recommendations set out by the Ockenden review have been revealed

Published in December 2020, the interim Ockenden review set out 12 immediate and essential actions for all trusts with maternity provision, grouped into seven themes, and in its latest board papers NHS England has set out the progress they have made.

The actions which trusts are struggling with most include “risk assessment throughout pregnancy” and clearly describing pathways of care in written information and posted on the trust websites.

According to the data, Sheffield Teaching Hospitals Trust is the least compliant provider in England to date, as it is only fully compliant on one action.

Last summer Sheffield’s maternity service plunged to “inadequate” from “outstanding” following a Care Quality Commission inspection, with concerns raised about staffing numbers, training and a lack of an open culture.

Mid and South Essex Hospitals and York and Scarborough Teaching Hospitals were compliant on five actions each. MSE is rated “requires improvement” by the CQC for maternity care, whereas YSTH is “good”.

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Source: HSJ, 20 May 2022

 

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The three vital lessons Italian hospitals have learned in fighting COVID-19

Protection for staff, clean covid-negative wards, and enforcing social isolation are the three take home messages from Italy’s fight against COVID-19, according to rapid findings shared exclusively with HSJ.

By 6 March 2020, Italy had recorded 4,636 cases and 197 deaths attributable to COVID-19. On 20 March, two weeks later, the UK announced 3,983 cases and 177 deaths due to the novel coronavirus.

Models put us two weeks behind Italy and on the same trajectory. PanSurg.org, an international collaborative created at Imperial College London, organised a series of webinars to rapidly share experiences and learning around the pandemic amongst the global healthcare community. Nearly 1,000 healthcare professionals from around the world took part in these events, and several important messages emerged.

1) Protect your staff: full PPE (including, FFP3 masks) for COVID-19 suspected or COVID-19 positive areas. This is both for them and to keep your workforce numbers intact.

2) Treat everyone as if they could haveCOVID-19, as they may do and “fear the covid negative ward”.

3) Enforce social isolation and contact tracing and place a significant focus on testing.

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Source: HSJ, 25 March 2020

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The third wave hit to elective care

Elective activity levels were significantly lower in January than were achieved before Christmas, according to provisional NHS data seen by HSJ.

In the three weeks to 20 December, the NHS was reporting around 110,000 day cases and 18,000 ordinary admissions each week. But during January these totals dropped to around 85,000 day cases and 10,000 ordinary admissions per week. This equates to a reduction of 23% and 44%, respectively.

Regions that were more severely impacted by the third wave of coronavirus saw steeper reductions as covid pressures forced staff working in routine care services to be redeployed.

In London and the South East, day case activity reduced by around 40 per cent between the same periods, while ordinary admissions fell by around 57%.

Data for the Christmas fortnight was discounted, as activity always falls dramatically in this period.

However, the activity levels in January appear to be significantly higher than those reported in the first wave of coronavirus in the spring.

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Source: HSJ, 10 February 2021

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The targets the NHS no longer has to meet

NHS England has shelved priorities on Long Covid and diversity and inclusion – as well as a wide range of other areas – in its latest slimmed down operational planning guidance, HSJ analysis shows.

NHSE published its planning guidance for 2023-24, which sets the national “must do” asks of trust and integrated care systems, shortly before Christmas.

HSJ has analysed objectives, targets and asks from the 2022-23 planning guidance which do not appear in the 2023-24 document.

The measures on which trusts and systems will no longer be held accountable for include improving the service’s black, Asian and minority ethnic disparity ratio by “delivering the six high-impact actions to overhaul recruitment and promotion practices”.

Another omission from the 2023-24 guidance compared to 2022-23 is a target to increase the number of patients referred to post-Covid services, who are then seen within six weeks of their referral.

Several requirements on staff have been removed, including to ”continue to support the health and wellbeing of our staff, including through effective health and wellbeing conversations” and ”continued funding of mental health hubs to enable staff access to enhanced occupational health and wellbeing and psychological support”. 

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Source: HSJ, 4 January 2022

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The stubborn regional variation in early cancer detection

The gap between the areas with the best and worst records on the early detection of cancer has remained almost unchanged over the past five years, new NHS England data indicates.

The proportion of cancers detected at stages one and two – when they are more curable – has improved by 2.7 percentage points to 58.1% nationally, but this masks significant regional variation.

In the 12 months to February 2019, the percentage point difference between the top performing cancer alliance – Thames Valley (63.1%t) – and the worst performing – Lancashire and South Cumbria (51.6%) – was 11.5.

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Source: HSJ, 27 June 2023

 

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The Shrewsbury scandal proves what women tell me every day – NHS maternity care is in crisis

As many as one in three women in the UK are traumatised by their birth experiences, and one in 25 of those will go on to develop full-blown PTSD. 

Following the most recent scandal at Shrewsbury, Milli Hill, the founder of the Positive Birth Movement, talks to The Independent about why we need to bring human connection back into maternity services, as well as continuing to invest in the research and technology that can save the lives of those most at risk and, why, above all, we need to start listening to women. If we don’t do these things, history will only repeat itself.

Milli says: "We cannot continue to see scandals like Shrewsbury and Morecambe Bay as isolated, instead we must be brave enough to view them as symptomatic of a wider problem of a maternity system that has become completely dehumanised and unable to listen to women."

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Source: The Independent, 20 November 2019

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The shocking stories of the patients who were failed by Devon Doctors

A damning report into Devon’s NHS 111 and out of hours GP service has revealed shocking stories of patients who have either had their health put at risk or tragically died due to the service being in need of urgent improvement.

Devon Doctors Limited, which provides an Urgent Integrated Care Service (UICS) across Devon and Somerset, was inspected by independent health and social care regulator the Care Quality Commission (CQC) in July, after concerns were raised about the service.

They included the care and treatment of patients, deaths and serious incidents, call waits, staff shortages, and low morale. Inspectors found 'deep rooted issues'. The CQC concluded it was not assured that patients were being treated promptly enough and, in some cases, they had not received safe care or treatment.

It is calling for the service to make urgent improvements which will be closely monitored.

Since August 2019, the report stated Devon Doctors had received 179 complaints. Nine had been identified by the service as incidents of high risk of harm and six had been identified by the service as incidents of moderate risk of harm.

These had been recorded on the service’s significant event log. However, on review, the CQC identified an additional 30 events from the complaints log which could also have been classed as either moderate or high risk of harm.

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Source: Devon Live, 15 September 2020

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