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A&E target missed despite tough line from NHSE

The headline A&E target was missed in March despite NHS England’s controversial last-ditch attempts to deliver it.

Four hours A&E performance was 74.2 per cent in March—1.8 percentage points lower than NHSE’s 76 per cent threshold—but up from 71.5 per cent in the same month last year.

NHSE’s attempts to improve four hours performance ahead of a year-end deadline—which included new cash incentives, asking directors to sign personal commitments, and encouraging trusts to focus on less sick patients—saw March performance 3.3 percentage points higher than 70.9 per cent in February.

Around a third of acute trusts (38 of 119) met the 76 per cent target in March–more than double the number of trusts above the threshold in February (15).

An interim ambulance response time for category 2 incidents, set at 30 minutes, was also missed in 2023-14—despite some improvement, and despite the government providing significant extra funding.

The average response time across the year was 36m 23s—better than 2022-23 when it was 50m—but much worse than the pre-covid average of 21m 47s in 2018-19 and 23m 50s in 2019-20.

Many ambulance trusts have continued to struggle with delays in handovers to A&E departments and South Western Ambulance Service Foundation Trust – which has seen some of the worst delays over the winter—averaged 45m 54s for category 2 incidents in March.

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Source: HSJ, 11 April 2024

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Hospital patient spent nine days in locker room

A woman who feared she was having a heart attack said she spent nine days in a hospital staff room because of a shortage of beds. Zoe Carlin, 23, was admitted to Altnagelvin Hospital in Londonderry in March after experiencing severe chest pain.

She said she spent more than a week in a “locker room” where she had to use a hand bell to call staff during what she described as a “dehumanising” ordeal. The Western Health and Social Care Trust (WHSCT) said it faced "extreme pressures" in its hospital emergency departments but could not comment on individual cases due to confidentiality.

“For the full nine days I was in this alcove,” she told BBC Radio Foyle’s North West Today programme. “It’s basically the nurses' locker room. You can see the nurses’ lockers with their names on them. They [staff] just said there’s not enough beds,” she added. A privacy screen did not fully cover the room’s doorway and she had no access to a private bathroom. She said she was forgotten about at meal times on three occasions.

A spokesperson for WHSCT said, "We are acutely aware of the continuing challenges and extreme pressures not just in our emergency departments but across both of our acute hospital sites with full escalation of beds on all wards and departments. In the Western Trust, when we learn of examples where care falls below the standard we expect, we review the circumstances and explore ways to improve care in the future."

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Source: BBC News, 11 April 2024

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Adult transgender clinics in England face inquiry into patient care

Adult transgender clinics in England are facing a Cass-style inquiry into how they treat patients after whistleblowers raised concerns about the care they provide.

NHS England has announced that it is setting up a review of how the seven specialist services operate and deliver care after past and present staff shared misgivings privately during a previous investigation.

As a first step, NHS England will send “external quality improvement experts” into each of the clinics to gather evidence about how they care for patients, to help guide the inquiry’s direction.

The move follows the publication on Wednesday of a landmark review by Dr Hilary Cass, a former president of the Royal College of Paediatrics and Child Health, which recommended sweeping changes in the way that the health service treats under-18s who are unsure about their gender identity.

In a letter responding to Cass’s report, which NHS England sent on Tuesday to the seven trusts that host adult gender dysphoria clinics (GDCs), it told them: “We will be launching a review into the operation and delivery of the adult GDCs, alongside the planned review of the adult gender dysphoria service specification.”

Robbie de Santos, director of campaigns and human rights at Stonewall, an LGBT rights charity, said: “Gender healthcare for adults in the UK is, simply put, not fit for purpose. Many trans adults are being forced to go private at great personal expense to avoid waiting lists in excess of half a decade. We would welcome a review aimed at tackling this unacceptable state of affairs and building capacity into the system.”

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Source: Guardian, 10 April 2024

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Deaths inquiry extended to last three years

A statutory inquiry into deaths of mental health patients will now cover fatalities that took place as late as December 2023.

The inquiry’s investigations are focused “on the trusts which provide NHS mental health inpatient care in Essex”. This includes: “Essex Partnership University Foundation Trust, and the North East London Foundation Trust and their predecessor organisations, where relevant.”

NELFT was not specifically mentioned in the original terms of reference although the inquiry told HSJ it had been within the original scope. The inquiry will also now cover deaths of NHS patients from Essex who died when under the care of private sector providers.

The inquiry’s previous terms of reference covered a period ending in 2020. However, the inquiry’s chair, Baroness Kate Lampard, proposed extending the inquiry’s scope last year due to “ongoing concerns” over services at EPUFT. 

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Lampard Inquiry: Terms of reference

Source: HSJ, 11 April 2024

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The four-hour A&E target is a sham. Hospitals are gaming the numbers and the sickest are left at risk

In the next few days, once the data has been collected, the Government will come out and say that, thanks to its policies, the situation in A&E is improving.

Despite estimates released recently by the Royal College of Emergency Medicine that soaring waits for A&E beds led to more than 250 needless deaths a week in England alone last year, the Government will point to declining numbers of patients who breached the four-hour target this March.

The four-hour target means we're meant to see and either discharge or admit patients within four hours of their arriving in A&E.

But it's a sham, writes Professor Rob Galloway in the Daily Mail. Because, for the past month, the four-hour data has been manipulated, the result of two policies introduced earlier in the month by the Government.

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Source: Daily Mail, 3 April 2024

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The ICSs ‘diverting’ the most GP referrals through controversial model

There is huge regional variation in the rate at which health systems are preventing patients joining the elective waiting list through “advice and guidance” to GPs, according to analysis by HSJ.

Some systems – including Northamptonshire – have managed to ramp up these “diverts” to such an extent that they now report around one A&G case to every 3.5 cases cleared from the waiting list through treatment or seeing a consultant.

This contrasts with others, such as Lancashire and South Cumbria, which only reports one A&G case for every 16 cleared from the waiting list.

Advice and guidance involves GPs consulting specialists before making direct referrals and around half the time this results in a referral being avoided. The model is set to be a cornerstone of NHS England’s new outpatient transformation strategy, which is due imminently.

Victoria Tzortziou-Brown, vice chair of the Royal College of GPs, said the analysis “confirms reports we’ve heard from our members – that there is too much regional variation in the use of the ‘advice and guidance’”.

She added: “Some GPs report that when advice and guidance is properly resourced and well implemented, it can be a helpful tool for improving communications with their colleagues in secondary care.

“[But] it is clear that more time, funding and capacity needs to be dedicated to allow clinicians to communicate efficiently and effectively whilst respecting professionalism.”

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Source: HSJ, 9 April 2024

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Man suffered psychosis after Trust failed to inform him of steroids side-effects

A man who suffered a psychotic episode which lasted for weeks was not fully informed about potential extreme side-effects of taking steroids medication, England’s health service Ombudsman has found.

Andrew Holland was prescribed steroids in early January 2022 by Manchester Royal Eye Hospital after losing vision in his left eye and suffering a severe infection in his right eye.

The 61-year-old from Manchester was given the medication as treatment for eye inflammation, but soon began suffering from disrupted sleep and severe headaches.

These side-effects developed into more serious ones, including becoming aggressive, psychotic, and inexplicably wandering the street at different times of the day and night.

After several hospital visits due to his symptoms, Andrew attended Manchester University NHS Foundation Trust’s emergency department in mid-January with a severe headache and later became an inpatient.

He was diagnosed with steroid induced psychosis, with symptoms including hallucinations, insomnia and behaviour changes.

Though no failings were found with Manchester University NHS Foundation Trust in prescribing Andrew with steroids for the eye condition, the Ombudsman discovered a missed opportunity to fully inform him of potential extreme side-effects. He was therefore unable to make a fully informed decision about whether to take them or not.

The Trust apologised for an ‘unsatisfactory experience’. However, the Ombudsman found relevant guidelines were not followed. Moreover, there had been no acknowledgement of mistakes in communication about the side-effects. Nor was any attempt made to correct them.

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Source: PSHO, 10 April 2024

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Thousands of children unsure of gender identity ‘let down by NHS’, report finds

Thousands of vulnerable children questioning their gender identity have been let down by the NHS providing unproven treatments and by the “toxicity” of the trans debate, a landmark report has found.

The UK’s only NHS gender identity development service used puberty blockers and cross-sex hormones, which masculinise or feminise people’s appearances, despite “remarkably weak evidence” that they improve the wellbeing of young people and concern they may harm health, Dr Hilary Cass said.

Cass, a leading consultant paediatrician, stressed that her findings were not intended to undermine the validity of trans identities or challenge people’s right to transition, but rather to improve the care of the fast-growing number of children and young people with gender-related distress.

But she said this care was made even more difficult to provide by the polarised public debate, and the way in which opposing sides had “pointed to research to justify a position, regardless of the quality of the studies”.

“There are few other areas of healthcare where professionals are so afraid to openly discuss their views, where people are vilified on social media, and where name-calling echoes the worst bullying behaviour. This must stop.”

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Source: The Guardian, 10 April 2024

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England falls short on early cancer diagnosis goals

The ambition to diagnose cancer in its earliest stages in England is “seriously off target”, according to a new report by QualityWatch, a research programme by the Nuffield Trust and The Health Foundation

A rise in urgent referrals in recent years has contributed to delays, along with patients finding it difficult to raise concerns about cancer with GPs. Inequalities in diagnosis, particularly among young people, those in deprived areas, and patients from ethnic minorities, was also highlighted by researchers.

Experts said that while family doctors are “highly trained” to identify cancers, the issue remains a challenge in primary care because some symptoms can be vague.

The NHS Long Term Plan said the health service is aiming to diagnose 75% of cancer patients when the disease is in its early stages by 2028.

However, analysis of NHS data by QualityWatch said “our current course shows we are seriously off target”.

More than 320,000 people in England were diagnosed with cancer in 2021 – the equivalent of some 900 a day – the report said, with the number of urgent cancer referrals rising since 2009 to more than two million in 2020/21.

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Source: Medscape, 24 April 2024

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Rats and cockroaches among thousands of pests found at English hospitals

Thousands of pests including rats, cockroaches and bedbugs have been found at NHS hospitals in England as the health service buckles under a record high repair bill.

Hospital bosses are having to spend millions of pounds on pest control after discovering lice, flies and rodents in children’s wards, breast clinics, maternity units, A&E departments and kitchens, in the most graphic illustration yet of the dismal and dangerous state of the NHS estate.

NHS bosses have repeatedly warned ministers of the urgent need to plough cash into fixing rundown buildings in order to protect the safety and dignity of patients and staff. The maintenance backlog now stands at £11.6bn in England.

Figures obtained under freedom of information laws and reviewed by the Guardian suggest the NHS is struggling to cope with an army of pests plaguing decrepit hospitals.

There were more than 18,000 pest incidents in the last three years, the NHS data reveals. There were 6,666 last year, equivalent to 18 a day. The figures also show NHS bosses are having to spend millions of pounds calling out pest control and dealing with infestations, with £3.7m spent in the last three years.

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Source: The Guardian, 9 April 2024

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One in three health workers suffering ‘burnout’ amid NHS staffing crisis

Almost one in three NHS employees have had to take time off work suffering poor mental health in the past year, new research suggests.

The Unison union said its survey of 12,000 health workers shows the impact of a staffing crisis, with many suffering “burnout”.

Panic attacks, high blood pressure, chest pains and headaches are among the physical signs of stress reported by nurses, porters, 999 call handlers and other NHS staff who completed the survey.

The news comes as more than half of the mental health hubs launched for NHS workers after the pandemic have closed since last year, according to the British Psychological Society.

Unison said workforce pressures are taking a huge toll as staff tackle a waiting list backlog, with many struggling to look after their wellbeing.

Of those who were off with mental health problems, one in five said they did not tell their employer the real cause of their absence, mainly because they did not feel their manager or employer would be supportive.

The union said staff feel undervalued and frustrated, with many quitting for less stressful jobs that pay more.

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Source: The Independent, 8 April 2024

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Urology inquiry: Waiting lists greatest source of harm

A former consultant at the Southern Health Trust has told an inquiry into urology services that waiting lists are the "greatest source of patient harm".

The inquiry was established in 2021 and is examining the trust's handling of urology services prior to May 2020.

Aidan O'Brien became a consultant urologist in Craigavon Area Hospital in July 1992.

His work is at the centre of the inquiry.

Giving evidence on Monday, he said waiting list figures highlighted what "myself and my colleagues [have said] for decades" and described it as a "grossly inadequate service".

"If you look at four-and-a-half years for urgent surgery, it is appalling," he told the inquiry.

"I don't have a magic solution to the current situation, which is dire."

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Source: BBC News, 8 April 2024

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Sexual harassment of NHS staff widespread

NHS staff including ambulance workers, porters, nurses and cleaners have been shown pornographic images, offered money for sex, and assaulted at work, according to new research.

The widespread incidents of sexual harassment are revealed in a wide-ranging survey published by the Unison union on the first day of its annual health conference in Brighton.

In the study of more than 12,200 health workers, one in 10 reported unwanted incidents including being touched or kissed, demands for sex in return for favours, and derogatory comments.

Royal College of Nursing chief nurse Professor Nicola Ranger said: “These figures paint an incredibly disturbing picture."

In the survey, sexual assault was reported by 29% of respondents who had experienced harassment, while half said they have been leered at or been the target of suggestive gestures.

One in four who had been harassed said they have suffered unwelcome sexual advances, propositions or demands for sexual favours.

Half the staff had not reported sexual harassment to their employer, amid concerns of being considered “over-sensitive” or feeling complaints would not be acted on.

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Source: BBC News, 8 April 2024

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Black people who spot cancer symptoms are taking twice as long to be diagnosed

Black and Asian people who spot cancer symptoms are taking twice as long to be diagnosed as white people, a shocking new study shows.

Research by Bristol Myers Squibb (BMS) and Shine Cancer Support shows that people from minority ethnic backgrounds face an average of a year’s delay between first noticing symptoms and receiving a diagnosis of cancer.

These groups report more negative experiences of cancer care than white people, limited knowledge about the diseases and lack of awareness of support services, which all contribute to later diagnostic rates.

“In a year that’s revealed that the UK’s cancer survival lags behind comparable countries, I am saddened but unsurprised that people from minority ethnic groups face additional hurdles that delay their diagnosis.” said Ceinwen Giles, co-ceo of Shine Cancer Support.

“We know that catching cancer earlier saves lives, yet with year long waits for some people, collaborative efforts between health leadership, advocacy groups and the pharmaceutical industry are required.”

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Source: The Independent, 9 April 2024

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Plans for Royal Mail delivery cuts could risk patient safety, NHS leaders warn

NHS leaders have warned that Royal Mail’s plans to cut second-class deliveries to two days a week could risk patient safety.

The changes are part of wider measures announced by Royal Mail’s parent company, International Distributions Services (IDS), including cuts of up to 9,000 routes, which could take more than two years to implement, saving £300m a year. IDS has assured the Royal Mail workforce that there will be no compulsory redundancies and they will request only 100 voluntary redundancies.

In a letter sent to the Telegraph, executives from the NHS, Healthwatch England, the Patients Association and National Voices said the Royal Mail proposals would increase the cost of missed appointments, which already exceeds £1bn.

The letter said: “Provisional Healthwatch data suggest that more than 2 million people may have missed medical appointments in 2022-23 due to late delivery of letters, and this will only deteriorate under the proposed new plans.”

Sir Julian Hartley, the chief executive of NHS Providers, said the proposed delays were “extremely unhelpful”.

“It’s really important that patients be updated at the earliest opportunity on developments in their care and treatment,” he said.

“An efficient, punctual postal service remains a key part of that process. At a time when far too many patients already face long delays – the last thing any trust leader wants – anything that adds to that uncertainty, and possibly the worsening of conditions, would be extremely unhelpful.”

Jacob Lant, the chief executive of health charity National Voices, said: “The proposals being consulted on risk further delaying vital communications and worsening digital exclusion, therefore unfairly widening health inequalities. NHS mail must remain a priority service.”

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Source: The Guardian, 6 April 2024

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Long Covid blood clues could prompt future trials

People with long Covid have evidence of continuing inflammation in their blood, which could help understanding of the condition and how it may be treated, a UK study suggests.

It found the presence of certain proteins increased the risk of specific symptoms, such as fatigue, in people sick enough to need hospital treatment.

It is unclear whether milder cases of Covid have the same effect on the body.

A test remains a long way off - but the findings may prompt future trials.

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Source: BBC News, 8 April 2024

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New CQC inspections put on hold by ministers

The Care Quality Commission’s assessments of integrated care systems (ICSs) have been put on hold at the last minute, as the government declined to sign off on the process.

They were due to begin this month, following pilots in Birmingham and Solihull and Dorset ICSs, but the Care Quality Commission (CQC) has put the brakes on assessments elsewhere until it receives government approval.

Under the legislation brought in when ICSs were set up in 2022, the CQC can review and assess systems, but ministers must approve its methodology.

Interim chief inspector of adult social care and integrated care James Bullion wrote to integrated care board chiefs this week stating that, following discussions with the Department of Health and Social Care, the CQC had agreed to a “short delay… to allow for further refinements to our approach”.

He added: “In particular we have been working with NHS England on their strengthened approach to performance evaluation and rating of the ICB elements of the ICS which we will take into account as evidence for our scoring and reporting approach.”

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Source: HSJ, 8 April 2024

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Fire warnings yet to be fully dealt with at eight hospitals

Eight hospitals in England have fire safety warnings attached to them, with half in place since 2022 or earlier, HSJ can reveal.

All are enforcement notices issued by fire brigades when serious risks are not being managed. Issues raised include risk assessments, maintenance, and emergency routes.

There were more than 1,300 fires across the NHS trust estate in 2022-23, according to official estates data, which was an increase of 18% on the year before.

NHS Providers deputy chief executive Saffron Cordery said the figures highlighted the “urgent need” to address maintenance backlog – which includes fire safety – across the NHS estate. The overall backlog figure has been growing yearly and is approaching £12bn.

Ms Cordery said: “Greater capital investment is essential to enabling a safe environment for patients and staff.”

Rory Deighton from NHS Confederation said more than a decade of underinvestment was behind the “dilapidated” state of the NHS estate.

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Source: HSJ, 5 April 2024

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NHS testing initiative to eliminate hepatitis C in England by 2025

Thousands of people who are unknowingly living with hepatitis C in England could be identified and treated due to an expanded NHS testing initiative.

The initiative includes new liver scanning and portable testing units to be rolled out in communities where people may be at a higher risk of contracting the infection.

Also included in the initiative are testing events happening at GP surgeries and community outreach at drug and alcohol support services.

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Source: Guardian 8 April 2024

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Tenfold rise in A&E patients waiting more than 24 hours for a bed

More than 150,000 patients had to wait a day in A&E before getting a hospital bed last year, according to new data.

Freedom of information data compiled by the Liberal Democrats from 73 hospital trusts – about half the total – found that the number of patients forced to wait more than 24 hours in A&E before a bed could be found for them has increased by tenfold since 2019. The majority of those forced to wait were elderly or frail, with two-thirds of the patients over the age of 65.

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Source: Guardian 8 April 2024

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Black women in England suffer more serious birth complications, analysis finds

Black women are up to six times more likely to experience some of the most serious birth complications during hospital delivery across England than their white counterparts, with the figures being described as “stark” and disheartening”, according to analysis.

Black women made up 26% of women who experienced the birth complication pre-eclampsia superimposed on chronic hypertension during delivery, despite making up just 5% of all deliveries across England, according to a Guardian analysis of NHS figures for 2022-23.

They were six times more likely to experience this pregnancy complication than their white counterparts, who made up 47.2% of these cases despite making up 70% of all deliveries.

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Source: Guardian, 8 April 2024

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‘I had no idea my baby was at risk’: The fight to raise awareness of pre-eclampsia

Pre-eclampsia affects between 1% and 5% of pregnant women, but more can be done to inform people about its dangers.

While pregnant with her son in 2015, Chipiliro Kalebe-Nyamongo’s pregnancy was generally smooth – until she reached about 33 weeks. She started to develop high blood pressure, and was admitted to hospital to be monitored. It was during this period that Kalebe-Nyamongo became concerned when she didn’t feel her baby’s movements as usual.

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Source: Guardian, 8 April 2024

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Spire Healthcare: Death of NHS-funded private patient raises safety concerns

A woman died when a major private healthcare provider failed to transfer her to NHS intensive care quickly enough after she became critically ill.

Sabrina Khan said Spire Healthcare staff "should have known something was wrong" with her mother, Nafisa.

The BBC also obtained testimony from doctors - contracted by the company to work up to 168 hours a week - who say long hours could put patients at risk.

Spire Healthcare has apologised for failings in Nafisa Khan's care.

The death of Mrs Khan from east London is one of several deaths following surgery at Spire Healthcare, looked at by BBC Panorama.

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Source: BBC News, 8 April 2024

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Firefighters rescue gran, aged 83, after seven-hour ambulance delay

A gran was left lying outside in the cold facing a seven hour wait for an ambulance following a fall before finally being rescued — by firefighters. Betsy Hulme, 83, was left in agony with a broken hip when she tumbled in her back garden in Leek, Staffordshire.

Son Steve, 60, a former ambulance technician, dialled 999 only to be told it would be several hours until paramedics could get to them due to long handover delays. After a further three hours of Betsy waiting on cold concrete slabs while soaked in rain water, desperate Steve decided to drive to a nearby fire station to ask for help.

Fire crews then came to rescue to lift gran-of-four Betsy into her son's car who took her to hospital where she remains after undergoing a hip repair operation. Dad-of-two Steve, of Leek, has now branded emergency response times as “absolutely disgusting”.

He said: "It’s opened my eyes if I’m honest. It’s absolutely disgusting. I’m so grateful and thankful to the fire service - but it really isn’t their job. I can't remember in my time working as an ambulance technician going to someone and saying, 'I’m sorry it’s taken us twelve hours to get here'."

“It was never anywhere near those ridiculous times when I worked there until 2000 and something has gone drastically wrong since. I can't speak highly enough of the boys and girls who work in the NHS, it's the people above them. Its systemic change that's needed."

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Source: Wales Online, 4 April 2024

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USA: Hospitals' safety culture gap

Healthcare workers' perceptions of safety at their organisations is improving, though a gap still remains between senior leaders and front-line workers, according to a Press Ganey report.

Press Ganey surveyed more than 1 million employees from 200 health systems in the USA in 2023. The poll included 19 questions related to safety culture across three domains: prevention and reporting, pride and reputation, and resources and teamwork.

Three takeaways:

  1. Staff safety culture scores have risen from an all-time low of 3.96 (out of 5) in 2021 to 4.01 in 2023. This increase was largely driven by improvements around staff members' perceptions of resources and teamwork, including views on adequate unit staffing. "While these improvements are encouraging, there's still a lot of work to do," Press Ganey said. "Pre-pandemic rates were never the desired end state, and it’s important to note that nearly half (48.5%) of employees still have a low perception of safety culture." 
  2. Senior management reported the highest perceptions of safety culture at 4.53, while registered nurses and advanced practice providers reported the second- and third-lowest at 3.95 and 3.92, respectively. Security team members had the lowest perceptions of safety at 3.91.
  3. large gap was also seen between senior leaders and registered nurses regarding perceptions of workplace violence protections. Senior management gave their organizations a 4.30 out of 5 for having strong security measures in place to prevent violence, compared to just 3.36 for nurses. 

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Source: Becker's Hospital Review, 3 April 2024

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