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Keep up to date with the latest news, research and activity in patient safety.

Patients 'waiting in ambulances for 15 hours' as A&Es and Welsh Ambulance service hit crisis point

The Welsh Ambulance Service is struggling to cope as many A&E departments are full and some patients have reportedly been waiting to be offloaded from ambulances for as long as 15 hours. The service has issued a plea for the public to "use 999 responsibly" amid severe pressure.
An employee of the service said: "Nearly every A&E department is at capacity. Patients have been on ambulances for the last 15 hours. The ambulance service is only responding to red [immediately life-threatening] calls."
The service has received almost 13,000 calls to 999 since Boxing Day and there have been almost 36,000 calls to the NHS 111 Wales service.
Lee Brooks, the ambulance service’s operations boss, said: “Pent-up demand from the Christmas and New Year period, coupled with the seasonal illnesses we see at this time of year, means there are lots of people across Wales trying to access health services currently. When hospitals are at full capacity, it means ambulances can’t admit their patients, and while they’re tied up at emergency departments, other patients in the community are waiting a long time for our help, especially if their condition isn’t life-threatening.
“We’re working really hard as a system to deliver the best possible care to patients, but our ask of the public today – and in the coming days – is only to call 999 if they are seriously ill or injured, or where there is an immediate threat to someone’s life. That’s people who’ve stopped breathing, people with chest pain or breathing difficulties, loss of consciousness, choking, severe allergic reactions, catastrophic bleeding or someone who is having a stroke."
Read full story
Source: Wales Online, 3 January 2024
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NHSE claims 20% cut in long waiters before latest strikes

Trusts reduced the number of 65-week breaches by around 20% and cut the overall elective waiting list between October and mid-December, NHS England has said.
The claim is based on provisional data published by NHSE on 2 January, which came with a warning of possible “significant issues regarding the quality and completeness”.
The figures suggest the number of 65-week waiters fell from around 114,000 on 8 October to around 93,000 by 17 December. The last official “referral to treatment” figures were published last month (see table below). They reported there were around 107,000 65-week breaches in October.
Sources familiar with the provisional data, from the “waiting list minimum data set”, said while it was not as accurate as official referral to treatment statistics, it gives an accurate picture of the direction of travel and overall performance.
Read full story (paywalled)
Source: HSJ, 3 January 2024
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NHSE trying to ‘undermine’ doctors strike, claims BMA

NHS England has been accused of bowing to political pressure and trying to “undermine” the junior doctors strike.
British Medical Association council chair Philip Banfield tonight wrote to NHSE chief executive Amanda Pritchard accusing her organisation of the “weaponisation” of the process used to agree minimum services level during the strike.
Junior doctors walked out yesterday to begin a six day strike, the latest in their 10 month campaign and the longest in NHS history.
Professor Banfield’s letter claims that NHSE is not respecting the terms of the voluntary agreement to provide “derogations”. These, says the letter, “allow for junior doctors to return to work in the event of safety concerns arising from ‘unexpected and extreme circumstances’ unrelated to industrial action”.
The BMA accuses trusts of not providing the information the union needs to determine if the requests for derogations are justified. It said that the lack of information provided by trusts had led to it turning down 20 requests for derogations.
The letter states: “We are increasingly drawing the conclusion that NHS England’s change in attitude towards the process is not due to concerns around patient safety but due to political pressure to maintain a higher level of service, undermine our strike action and push the BMA into refusing an increasing number of requests; requests, we believe, would not have been put to us during previous rounds of strike action.
“The change in approach also appears to be politicisation and weaponisation of a safety critical process to justify the Minimum Service Level regulations.”
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Source: HSJ, 3 January 2024
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London gets well over ‘fair share’ of specialised services while rural areas miss out

People in some more rural areas are missing out on specialist treatments they should be getting, while Londoners are receiving a lot more than their “fair share”, new NHS England figures suggest. 
NHS England has suggested the main cause is “systematic shortfalls in access [in] remote communities”, leaving “unmet need” for specialised services in these areas.
However other factors, including coding and reporting practices, year-to-year fluctuation, and weaknesses in the formula, are also likely to be confusing the picture, sources said.
The variation is being uncovered now because NHSE is preparing to fund many specialised services via allocations to integrated care boards. These allocations will be based on estimates of their populations’ healthcare needs, rather than NHSE negotiating payments directly with provider trusts – as it has since 2013.
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Source: HSJ, 3 January 2023
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Doubling of average waits for critical stroke treatments

Stroke patients in England are waiting an average of almost seven hours for a specialist bed, double the wait reported before Covid.
National performance against key measures collected by the Sentinel Stroke National Audit Programme has nosedived, with patients in England waiting an average of almost seven hours to be admitted to a specialist unit in 2022-23, compared to three and a half hours in 2019-20.
NHS England guidance states that every patient with acute stroke should be given rapid access to a stroke unit within four hours. This time frame is considered critical, as patients can only be given clot-busting drugs, and treatments such as thrombectomy, which surgically removes a clot, within the first few hours of stroke onset.
However, this was achieved in just 40% of cases last year (2022-23), down from 61% in 2018-19.
Juliet Bouverie, CEO of the Stroke Association, urged ministers to give trusts what they needed to reverse the decline, saying: “Stroke is a medical emergency and every minute is critical.
“We are very concerned to see that, far from improving over the last year, the proportion of stroke patients being admitted to a stroke ward within the timescale for thrombolysis has continued to decline. This is putting patient recoveries at risk and strain on the rest of the health system.
“We believe that early supported discharge, when done correctly, with adequately resourced community teams, can help to alleviate capacity pressures in acute stroke units. However, this is not a silver bullet. There are longstanding workforce issues which are affecting patient flow in, through and out of stroke units and we call on DHSC to properly address these in the workforce plan.”
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Source: HSJ, 2 January 2024
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Patient safety fears as new research reveals fifth of GP appointments five minutes or less

Patients who feel fortunate to get a doctor's appointment then find they are in and out of the GP surgery in less than five minutes.
A fifth of the consultations in England last year were done within that time.
Dennis Reed, of the Silver Voices campaign group for over-60s, said: "It is hard enough to get a face-to-face appointment with a GP these days, without being shown the door before you have had a chance to take your coat off.
"The public wants the family doctor back, who knows your family history and has the time to chat about your general health and wellbeing.
"A revolving door policy, with the patient exiting after a couple of minutes clutching a prescription, is not the way to run a primary care service."
Research from the House of Commons Library, commissioned by the Lib Dems, found 22% of GP appointments between January to October 2023 lasted five minutes or less.
Lib Dem MP Wera Hobhouse said: "Seeing a GP is the most vital contact for people to address their health concerns, seek help and start treatment.
"Not having quick and easy access to a GP and not having sufficient time for patients during an appointment leads to huge problems later on, let alone the anxiety and additional pain people suffer because of delays."
Read full story
Source: The Express, 31 December 2023
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How NHS strikes put thousands of sick children in peril

Hundreds of children’s appointments – including for lifesaving operations and cancer treatments – have been cancelled on each day that NHS strikes took place over the last year, as hundreds of thousands of youngsters languish on the waiting list for treatment, The Independent can reveal.
More than 20,000 paediatric treatments and surgeries were shelved because of the walkouts, while the families of 400 children were told that their lifesaving operations had been cancelled.
With junior doctors due to stage the longest strike in NHS history this week – for six days, starting on Wednesday – the problem is set to get worse.
Dr Camilla Kingdon, president of the Royal College of Paediatrics and Child Health, warned that long waits for children can be particularly damaging, and can have a lifelong impact as treatment is often time-critical.
She said that children are seldom prioritised in national policy-making, and urged the government to put children’s needs “back on the agenda”.
Read full story
Source: The Independent, 2 January 2024
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Britons turn into ‘DIY doctors’ as poll reveals one in three have given up on seeing a GP

An alarming number of Britons are turning into “DIY doctors” because of the struggle to get an NHS GP appointment in 2023, new polling has revealed.
Some 23% of those surveyed said they could not get an appointment, while three in 10 (33 per cent) said they had given up on booking one altogether, according to a Savanta poll commissioned by the Liberal Democrats.
Many said they had resorted to “DIY” medical care or gone to A&E instead. One in seven (14 per cent) said they had been forced to treat themselves or ask someone else untrained to do so, with the same proportion seeking emergency care.
One in five people said they had bought medication online or at a pharmacy without advice from a GP, and one in three had delayed seeing a doctor despite being in pain, as pressure on the NHS mounts.
Liberal Democrat leader Sir Ed Davey described the figures as “utterly depressing” and said they should serve as an “urgent wake-up call for ministers asleep on the job”.
Read full story
Source: The Independent, 1 January 2024
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NHS bosses fear for patient safety during six-day junior doctor strike

NHS bosses fear patient safety could be compromised during this week’s junior doctors strikes if medics do not honour an agreement to abandon picket lines if hospitals become overwhelmed during the winter crisis.
Hospital bosses can ask the British Medical Association (BMA) to allow junior doctors to return to work to help if an emergency arises during their six-day strike starting on Wednesday.
But there is concern among health trust leaders that the doctors’ union could reject such “recall requests” – or take worryingly long to consider them – despite “highly vulnerable” hospitals having too few staff on duty to cope with a surge in patient numbers.
A spike in cases of flu, Covid and norovirus has left the NHS under intensifying strain in the first week of the new year, a period in which its winter crisis often bites.
On the eve of the 144-hour strike – the longest in NHS history – the NHS Confederation, which represents trusts, urged the BMA to ensure the “recall system” worked reliably if it was triggered.
“With the next round of junior doctors strikes coinciding with what is always an exceptionally busy week for the NHS, health leaders hope that escalation plans run smoothly and with a shared understanding that protecting patient safety is the most important priority,” Danny Mortimer, the confederation’s deputy chief executive, said.
Read full story
Source: The Guardian, 1 January 2024
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NHS nurses suffering shocking violence from patients, senior nurse warns

Nurses are being put in increasing danger from shocking levels of violence and aggression by patients, a senior nursing leader has warned.
Prof Nicola Ranger, the Royal College of Nursing’s (RCN) director of nursing, said the crisis in the NHS had fuelled bad behaviour by patients frustrated by worsening delays for treatment since the Covid pandemic.
Ranger said the situation was contributing to an exodus of nurses from the NHS, amid a vicious cycle of staff shortages and rising violence.
This meant that there were often not enough nurses on duty to keep colleagues safe, she added.
Calling on the government to make tackling the abuse of nurses a priority, Ranger said there was a sense of despair in the profession about their deteriorating working conditions.
“I think the public would be totally shocked if they knew how common it is for nursing staff to be on the receiving end of violence and aggression at work,” said Ranger. “Nurses are put in jeopardy, it’s become all too common for them to be threatened by patients on shift.
“We genuinely have got a nursing crisis in the UK that doesn’t seem to be being acknowledged by our government at all. Being spat at, being hit, being punched, can for some nurses just literally be the final straw."
Read full story
Source: The Guardian, 1 January 2024
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Jab for winter virus could cut baby hospitalisations by 80%, study says

Hospital admissions from a winter virus could be reduced by more than 80% if babies are given a single dose of a new antibody treatment, a study says.
Respiratory syncytial virus (RSV) usually causes mild, cold-like symptoms, but can lead to bronchiolitis and pneumonia.
More than 30,000 under fives are hospitalised with RSV in the UK annually, resulting in 20 to 30 deaths.
One British parent said her son getting RSV was "very scary" as a first-time mother.
Lorna and Russell Smith's eldest son, Caolan, got the virus when he was eight months old and was admitted to hospital twice - each time requiring oxygen.
Now aged two, he has made a full recovery.
"I hadn't heard of RSV and wasn't sure what to do. He had laboured breathing due to high temperature and was quite lethargic. It brought a lot of anxiety and stress," Lorna said.
The Harmonie study involved 8,000 children up to the age of 12 months, with half receiving a single dose of the monoclonal antibody treatment nirsevimab.
The results, published in the New England Journal of Medicine, showed that RSV-related hospitalisation was reduced by 83% in those receiving the jab and admissions for all chest infections were cut by 58%.
Side effects were similar in both groups and mostly mild.
Read full story
Source: BBC News, 27 December 2023
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NHS given warning about infection control as Covid cases rise

The Royal College of Nursing has warned of an increase risk of Covid among hospital staff and patients due to the NHS’s failure to follow World Health Organization advice about infection control during a current spike in cases.
The most recent figures showed one in 24 people in England and Scotland had Covid on 13 December, up from one in 55 two weeks before.
Last week WHO expressed concern about a new subvariant of Omicron, labelled JN.1, after its rapid spread in the Americas, western Pacific and European regions. To tackle the increase, the WHO advised that all health facilities “implement universal masking” and give health workers “respirators and other PPE”.
Now the RCN has written to the four chief nursing officers in England, Wales, Scotland and Northern Ireland asking why this guidance has not been introduced across the NHS.
The letter, seen by the Guardian, points out that existing guidance in the national infection prevention and control manual (NIPCM) does not mandate hospital staff to use masks. It also leaves decisions about respirators to local risk assessors.
The RCN says this guidance to UK hospitals is “inconsistent” with WHO advice.
The letter by Patricia Marquis, the RCN’s director for England, calls for urgent revision to the NIPCM guidance to ensure the “universal implementation” of masks and respirators for health workers.
Read full story
Source: The Guardian, 22 December 2023
Sam

Baby died of neglect after staff turned off emergency alarm, coroner rules

Hospital neglect contributed to the death of a two month old baby after staff turned off emergency alarms, a coroner has ruled.
Louella Sheridan died at Royal Bolton Hospital in on 24 April 2022 after she was admitted with bronchiolitis to the hospital’s intensive care unit before later dying from Covid and a related heart condition.
Four alarms on a monitoring machine were silenced and then switched off before the baby collapsed in a high dependency unit, it has been found.
On Wednesday coroner John Pollard ruled neglect by staff had contributed to Louella’s death after staff switched off the alarms on the monitors attached to her during the night.
Summing up his conclusion Coroner Pollard reportedly said there was a “gross failure “ to provide basic medical care to Louell and that had care been given, had the alarms been switched on to alert staff her life may have been extended at least for a short period of time.
He said turning off the alarms was a gross type of conduct.
Read full story
Source: The Independent, 22 December 2023
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Cancer and maternity patients at risk if junior doctors strike in January, NHS bosses warn

Patients have been harmed as a result of doctors striking this year, and others needing time-critical treatment will be at risk during next month’s walkout in England, hospital bosses have said.
Cancer patients and women having induced or caesarean section births will be in danger of damage to their health unless junior doctors in those areas of care abandon their plans to strike for six days in January, they said.
People awaiting urgent eye surgery risk permanent sight loss unless the British Medical Association (BMA) lets junior doctors keep working in that area, according to NHS Employers, which represents health service trusts in England.
Its intervention comes amid mounting concern in the NHS that it may prove impossible to maintain patient safety in high-risk, time-sensitive areas of treatment when tens of thousands of junior doctors stage what will be the longest strike in NHS history from 3 January, when hospitals are facing what is often the service’s busiest week of the year.
Read full story
Source: The Guardian, 21 December 2023
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Nearly 1.7 million Texans lose Medicaid as state nears end of “unwinding”

Nearly 1.7 million Texans have lost their health insurance — the largest number of people any state has removed — in the months since Texas began peeling people from Medicaid as part of the post-pandemic “unwinding.” Around 65% of these removals occurred because of procedural reasons, according to the state.
Texas’ Health and Human Services Commission has neared the end of a chaotic and overburdened process to remove people from state Medicaid insurance who became ineligible during the coronavirus pandemic. The state had not unenrolled people before this year because of federal pandemic rules, which forbid states from cutting coverage.
As a result, more than 5 million Texans had continuous access to healthcare throughout the pandemic through Medicaid, the joint federal-and-state-funded insurance program for low-income individuals. In Texas, the program’s eligibility criteria is so restrictive, it mainly covers poor children, their mothers while pregnant and post partum, and disabled and senior adults.
But the effects of speedrunning this process have reverberated: Still-eligible Texans were kicked off both in error and for procedural reasons, adding to backlogs of hundreds of thousands of Medicaid applications and pushing wait times back several months.
“The state handled this with an incredible amount of incompetence and indifference to poor people,” U.S. Rep. Lloyd Doggett, D-Austin, told The Texas Tribune. “It's really appalling.”
Read full story
Source: The Texas Tribune, 14 December 2023
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Doctors fear NHS could buckle in flu season as staff avoid vaccine

The NHS could struggle to cope with a catastrophic flu season after leading medics warned of plunging flu vaccine uptake among its frontline staff.
NHS figures show just 39% of frontline staff had a flu vaccine in November, down from 52% in November 2020.
The worrying statistics mean the already under-strain service could lose crucial staff to illnesses and risk spreading the virus during its busiest winter period.
Speaking to The Independent, Dr Adrian Boyle, president of the Royal College of Emergency Medicine said: “We are concerned about staff vaccination against flu. Post-pandemic, there is a certain lack of appetite and there is probably a degree of apathy about staff getting vaccinated against flu, and we think that’s a problem.
“We need to be doing more to get stuff vaccinated against flu.”
He added: “I think societally and as healthcare practitioners, I think we have a moral duty to get ourselves vaccinated so we don't create gaps by going off sick and we don't infect our patients.”
Read full story
Source: The Independent, 21 December 2023
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