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England has highest death rates of older patients in western world, study finds

England has the highest death rates of frail and older hospitalised patients in the western world, a landmark global study has found.
Harvard University, the London School of Economics (LSE) and the thinktank Health Foundation, all part of the International Collaborative on Costs, Outcomes and Needs in Care (Icconic), a global network of healthcare researchers, used thousands of official medical records to compare the cost and quality of care in 10 OECD (Organisation for Economic Co-operation and Development) countries.
Patient deaths are commonly used measures of performance in healthcare systems but until now there have been few sources of comparable death rates across countries.
In order to assess outcomes in frail and older patients, researchers focused on two groups that represent priority areas for the NHS and other healthcare systems: those in hospital with a hip fracture and those admitted with heart failure who have diabetes.
On both measures, England had higher mortality rates than all the other countries, which included the US, Germany, France, Sweden and Spain.
Dr Jennifer Dixon, the chief executive of the Health Foundation, said: “The findings of the Icconic study warrant urgent further investigation, particularly the finding of higher mortality among patients with hip fracture in the year after their admission for emergency treatment."
“That patients in England with hip fracture spend far longer in hospital after surgery than they would in other countries also highlights an opportunity to improve efficiency by reducing the avoidable use of hospital care. Less avoidably long stays would mean existing capacity could be better used to address the backlogs in hospital care as a result of the pandemic. This could contribute to both better outcomes for patients and, as hip fracture is the most common reason for emergency surgery, significantly improved productivity for hospitals across the country.”
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Source: The Guardian, 10 November 2021
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Lives at risk from 'unacceptable' ambulance waits

Lives are at risk because patients are facing unacceptably long waits for a 999 response, paramedics across the UK have told a BBC investigation.
Average waits for emergency callouts for problems such as heart attacks and strokes are taking more than twice as long as they should in England. Targets are being missed in the rest of UK too, with some seriously-ill waiting up to nine hours for an ambulance.
There are numerous investigations ongoing into deaths linked to delays.
The problems have forced all ambulance services to be put on their highest levels of alert - meaning patients who can make their own way to hospital are told to do so. A number of services have also brought in the military to support crews. 
The BBC has received reports of numerous serious incidents across the UK.
Margaret Root, 82, waited nearly six hours for an ambulance to come following a stroke, and she then waited for another three hours outside hospital. When she was finally admitted, her family was told it was too late to give her the drugs needed to reverse the effects of the stroke.
Her granddaughter Christina White-Smith said her grandmother had been "hugely let down".
She said she did not blame the staff because they were "amazing" when they got to her grandmother, but said she is angry the NHS is not getting the help it needs.
"I don't think people are aware of the severity of the situation."
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Source: BBC News, 11 November 2021
 
 
 
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NHS is at breaking point and putting patients at high risk, bosses warn

Patient safety in the NHS in England is being put at “unacceptably high” risk, with severe staff shortages leaving hospitals, GP surgeries and A&E units struggling to cope with soaring demand, health chiefs have warned.
The health service has hit “breaking point”, the leaders say, with record numbers of patients seeking care.
Nine in 10 NHS chief executives, chairs and directors have reported this week that the pressures on their organisation have become unsustainable. The same proportion is sounding “alarm bells” over staffing, with the lack of doctors, nurses and other health workers putting lives of patients at risk.
Sajid Javid, the health secretary, has come under fire for recently claiming, at a No 10 press conference, that he did not believe the pressure on the NHS was unsustainable.
But the survey of 451 NHS leaders in England finds the health service already at “tipping point”. The results of the poll, conducted by the NHS Confederation, which represents the healthcare system in England, Wales and Northern Ireland, show that 88% of the leaders think the demands on their organisation are unsustainable, and 87% believe a lack of staffing in the NHS as a whole is putting patient safety and care at risk.
Matthew Taylor, the chief executive of the NHS Confederation, said: “Almost every healthcare leader we’ve spoken to is warning that the NHS is under unsustainable pressure, and they are worried the situation will worsen, as we head into deep midwinter, unless action is taken. They are also sounding alarm bells over risks to patient safety if their services become overwhelmed, on top of a severe workforce crisis."
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Source: The Guardian, 10 November 2021
Sam

New patient safety chief revealed

A management coach and adviser to the Care Quality Commission has been appointed as the new ‘national guardian’ for the ’freedom to speak up’ programme.
Jayne Chidgey-Clark will take up her new role on 1 December. The national guardian’s office leads, trains and supports the network of over 700 freedom to speak up guardians in England, as well as providing “challenge and learning to the healthcare system”.
Ms Chidgey-Clark, a registered nurse, has served as a specialist adviser to the CQC since 2017. She has run her own coaching, consultancy and interim management business since 2009. She was a clincial adviser to NHS England’s new care models programme for three years until 2018 and the director of the end of life care modernisation project at Guy’s and St Thomas’ Foundation Trust between 2008 and 2011.
Her appointment comes after Henrietta Hughes announced in June she was stepping down from the role after five years.
Ms Chidgey-Clark, who is the third appointee to the position, said: “I feel excited and privileged to have been appointed as the new National Guardian for the NHS. I am passionate about, and committed to, making a real difference in people’s lives through the planning and delivery of the highest quality, effective care with excellent outcomes for people who use our health services, and their families.”
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Source: HSJ, 11 November 2021
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Alarm over ‘serious’ delays in diagnosing childhood cancer in England

Health experts have raised the alarm over “serious” delays in diagnosing children and young people with cancer, as a study reveals the number found to have the disease during the pandemic fell by almost a fifth.
The University of Oxford found a “substantial reduction in childhood, teenage and young adult cancer detection” in England last year. The research, being presented on Friday at the National Cancer Research Institute (NCRI) festival, showed a 17% drop in cases diagnosed in the under-25s last year compared with previous years.
The impact of Covid on adults with cancer is well known. However, previously little has been known about the toll on younger patients.
As well as the fall in the overall numbers of children diagnosed with cancer, researchers found that even those whose cancer was spotted last year were more likely to have been diagnosed only after being admitted to intensive care. That suggests long delays in accessing care may have made them much sicker, experts say.
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Source: The Guardian, 12 November 2021
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Black women four times more likely to die in childbirth

Black women are more than four times more likely to die in pregnancy or childbirth than white women in the UK, a review of 2017-2019 deaths shows.
The MBRRACE-UK report found women from Asian backgrounds are almost twice as likely to die as white women.
Some 495 individuals died during pregnancy or up to a year after birth, out of 2,173,810 having a child.
The charity Birthrights is concerned that overall "this bleak picture has not changed in over a decade".
University of Oxford researchers say for the vast majority of people, pregnancy remains very safe in the UK. But despite slight decreases in the maternal death rate in recent years, there have been no significant improvements to these rates since the 2010 to 2012 period.
Their current report shows heart disease, epilepsy and stroke continue to be the most common causes of death. And they say in some 37% of cases, improvements in care may have made a difference to the outcome.
Lead researcher, Prof Marian Knight, said: "Pregnant women get inequitable care for several reasons.
"Healthcare professionals often attribute their symptoms to pregnancy alone and they do not always end up getting the treatment they need because people can be incorrectly concerned about giving them medication.
"On top of that is the unconscious bias that black and Asian women can experience. It all adds up.
"We know from other studies that the disparity in death rates cannot be fully explained by socio-economic factors and other medical conditions for example. We need to look for other reasons."
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Source: BBC News, 11 November 2021
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GPs dispute Javid’s claim lack of appointments is overloading A&Es

Family doctors have reopened their bitter dispute with the government by accusing Sajid Javid of misleading MPs and the public by blaming overloaded A&Es on a lack of GP appointments.
The Royal College of GPs has told the health secretary in a strongly worded letter that there is no basis for the claim, which he made to MPs last week and which was widely covered by the media.
In it Prof Martin Marshall, the college’s chair, said that its 54,000 members “are dismayed and disappointed at the media coverage of your evidence session, which suggested that the lack of face-to-face GP appointments was placing additional strain on accident and emergency departments”.
He disputed Javid’s claim that there is evidence which links the issues.
He wrote: “You told the [health and social care select] committee you had seen data which showed that more patients were presenting at A&E departments because they were unable to access primary care. I am not aware of any evidence to suggest that this is happening and would welcome sight of any data you have.”
Tensions are simmering between GPs and the government since Javid’s edict last month that GPs in England must see any patient who wants an in-person appointment.
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Source: The Guardian, 12 November 2021
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Alder Hey NHS Trust must pay boy £27m over brain injuries

A boy who suffered "catastrophic brain injuries" when doctors failed to see he had a virus and sent him home after he had a seizure has been awarded £27m.
The boy, who cannot be identified but is now 13, suffered seizures as a toddler more than a decade ago.
Details of the settlement between the boy's father and Liverpool's Alder Hey Children's NHS Foundation Trust were published in a written ruling.
High Court judge Mr Justice Fordham said it was a "sensible settlement".
Trust bosses admitted "breach of duty" and "causation of loss and damage", the judge said.
The judgment, from the hearing in Manchester, said the boy had suffered a seizure at 17 months old on 19 September 2009 and was taken to Alder Hey Children's Hospital.
He suffered a second seizure in the accident and emergency department which was seen by medical staff. The boy was sent home and, despite going back to hospital, was not diagnosed with a virus until 24 September.
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Source: BBC News, 12 November 2021
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Shake-up of children’s cancer care after decade long arguments and cover-up claims

London’s fragmented children’s cancer services will finally be reformed following a decade of delays and allegations of cover-up by senior officials.
NHS England has said it will adopt recommendations that will see the capital’s services brought up to standards already common across the rest of the country, with children’s cancer centres needing to be based in hospitals with full paediatric intensive care units.
The changes will be imposed “with no exceptions or special arrangements permitted,” it said in a letter yesterday.
This means the Royal Marsden’s children’s service at its base in Sutton, south London, will have to move to a new hospital. Currently sick children who deteriorate at the Marsden’s site have to be rushed by ambulance to St George’s Hospital 40 minutes away.
More than 330 children were transferred from the Marsden to other hospitals between 2000 and 2015 and in one year 22 children were transferred for intensive care a total of 31 times, with some experiencing at least three transfers individually.
The changes will also affect cancer care at University College London Hospital which links with Great Ormond Street Children’s Hospital.
The world-renowned Royal Marsden trust, whose chief executive Dame Cally Palmer is also NHS England’s national cancer director, was at the centre of a cover-up scandal before the COVID-19 pandemic.
In 2019, the Health Service Journal revealed a major report, commissioned by NHS bosses in London following the deaths of several children, had been “buried” by NHS England.
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Source: The Independent, 12 November 2021
Sam

Pakistani and Bangladeshi people above the age of 30 experience the worst health out of any ethnicity in UK

Pakistanis and Bangladeshis over the age of 30 experience the same level of poor health as their white counterparts that are 20 years older.
Those from the subcontinent face stark ethnic health inequalities across the population, according to a new study.
It means the group has the worst health out of any ethnicity.
London-based Aideen Young, Senior Evidence Manager at the Centre for Ageing Better, has called on the Government to do more to address these inequalities.
She said: “This study reveals really shocking health inequalities between different ethnic groups, with some groups experiencing the rates of poor health that White people typically see at much older ages.
“It’s also depressing to see that these inequalities haven’t changed for the last 25 years. In the wake of the pandemic, we risk seeing them widen – so it’s vital that government makes tackling health inequality a priority in the recovery.
“To properly address the problem we need much better data, which is why we are calling for ethnicity data reporting to be mandatory for all official data monitoring.
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Source: My London, 11 November 2021
Sam

Blood pressure drugs could prevent type 2 diabetes, study finds

Blood pressure drugs could prevent millions of people worldwide from developing type 2 diabetes, a large study suggests.
Lowering high blood pressure is an effective way to slash the risk of the disease in the future, according to the research published in the Lancet.
Doctors already prescribe cheap blood pressure drugs to reduce the chances of a life-threatening heart attack or stroke. However, until now, the question of whether these drugs could also help fend off the threat of type 2 diabetes had been unanswered.
Now researchers have found the protective effects of the drugs are much wider than previously thought. The study shows they may directly reduce someone’s risk of type 2 diabetes, a condition that an estimated 13.6 million people in the UK are at high risk of developing.
Currently, health experts say being a healthy weight and adopting a healthy lifestyle is the best way to reduce the risk of type 2 diabetes. Researchers say existing drugs – particularly ACE inhibitors and ARBs – should now be considered for some patients who are at higher risk of the disease.
Prof Kazem Rahimi, lead researcher of the study at the University of Oxford and a consultant cardiologist, said: “Our research provides clear evidence that giving ACE inhibitors or ARBs, which are widely available and affordable worldwide, to patients at high risk could curb the growing burden of type 2 diabetes.”
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Source: The Guardian, 11 November 2021
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Nursing leaders point to ‘untenable’ health and care conditions in England

Nursing leaders have highlighted 10 pressures on health and social care services which they say have created “unsustainable, untenable” conditions.
A report from the Royal College of Nursing (RCN) said members working across health and social care in England dispute statements that the current situation in health and care is sustainable.
NHS hospital waiting times is listed as one of the 10 indicators with the report referring to this issue as “clearly a symptom of an unsustainable system”.
The report, 10 Unsustainable Pressures on the Health and Care System in England, refers to “corridor care” – time spent on trolleys in hospital corridors before being admitted to a hospital bed.
“We are clear that delivery of care within inadequate environments such as that frequently referred to as ‘corridor care’ or ‘corridor nursing’ is fundamentally unsafe and must not be normalised,” the report says.
The 10 pressures also include high COVID-19 infection rates, NHS nursing workforce vacancy rate, social care workforce vacancies and NHS elective/community waiting times.
The report says: “Action needs to be taken to retain as many nursing staff as possible in light of serious staffing vacancies, as well as high levels of exhaustion and burnout.
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Source: The Guardian, 15 November 2021
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NHS patients dying in back of ambulances stuck outside A&E, report says

People are dying in the back of ambulances and up to 160,000 more a year are coming to harm because they are stuck outside hospitals unable to be offloaded to A&E, a bombshell report has revealed.
Patients are also dying soon after finally getting admitted to hospital after spending long periods in the back of an ambulance, while others still in their own homes are not being saved because paramedics are trapped at A&E and unable to answer 999 calls, said the report by NHS ambulance service bosses in England.
In addition, about 12,000 of the 160,000 are suffering “severe harm” such as a permanent setback to their health. These include people with life-threatening health emergencies such as chest pains, sepsis, heart problems, epilepsy and COVID-19 because growing numbers of paramedics are having to wait increasingly long times to hand over a patient to A&E staff.
Labour and the Liberal Democrats said the “staggering” extent of damage to patients’ health underlined the risks posed by the deepening crisis facing NHS ambulance services.
The report, seen by the Guardian, has been drawn up by the Association of Ambulance Chief Executives (AACE) and is based on official NHS figures, which until now were secret. AACE represents the chief executives of England’s 10 regional ambulance services, all of which have had to declare an alert in recent months after being faced with unprecedented demands for help.
It concludes that: “When very sick patients arrive at hospital and then have to wait an excessive time for handover to emergency department clinicians to receive assessment and definitive care, it is entirely predictable and almost inevitable that some level of harm will arise.
“This may take the form of a deteriorating medical or physical condition, or distress and anxiety, potentially affecting the outcome for patients and definitely creating a poor patient experience.”
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Source: The Guardian, 14 November 2021
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Loophole in the law leaves patients at risk of abuse and sexual assault

A loophole in the law is leaving vulnerable patients at risk of abuse and sexual assault by unregulated private ambulance staff, The Independent has revealed.
While many private ambulance providers are regulated, a small number, such as those providing services at events, those providing first aid, and those who are subcontracted, fall outside the reach of the Care Quality Commission (CQC).
This is due to a loophole in the legislation, which means that organisations providing healthcare at events are not required to be CQC registered.
The Independent has learned that around 10,000 patients a day are seen by ambulance workers who are unregulated and not part of any registered professional body.
Alan Howson, chief executive of the Independent Ambulance Association, said he was concerned about healthcare providers that “operate outside of the scope” of the care watchdog and in “plain sight and unchecked”, leaving patients at risk from staff who might “seek to misuse their power”.
His concerns were in response to an internal report by the CQC, completed last year, which identified specific risks around sexual harm in relation to private providers, as well as “inconsistency” in providers’ recording of incidents.
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Source: The Independent, 14 November 2021
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Landmark sickle cell disease inquiry finds evidence of racism in patient care

A groundbreaking inquiry into sickle cell disease has found “serious care failings” in acute services and evidence of attitudes underpinned by racism.
The report by the all-party parliamentary group (APPG) on Sickle Cell and Thalassaemia, led by Pat McFadden MP, found evidence of sub-standard care for sickle cell patients admitted to general wards or attending A&E departments.
The inquiry also found widespread lack of adherence to national care standards, low awareness of sickle cell among healthcare professionals and clear examples of inadequate training and insufficient investment in sickle cell care.
The report notes frequent disclosures of negative attitudes towards sickle cell patients, who are more likely to be people with an African or Caribbean background, and evidence to suggest that such attitudes are often underpinned by racism.
The inquiry also found that these concerns have led to a fear and avoidance of hospitals for many people living with sickle cell.
Care failings have led to patient deaths and “near misses” are not uncommon, leading to a cross-party call for urgent changes into care for sickle cell patients.
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Source: The Independent, 15 November 2021
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Staffing agencies triple rates as care homes and NHS fight over nurses

Nursing shortages are allowing “profiteering” staffing agencies to triple their rates, care leaders have warned, raising the risk of vulnerable patients being forced to move care homes and increasing the burden on the NHS.
The crisis is forcing some nursing homes to become standard residential care homes without support for people with chronic diseases.
The shortage also makes it harder for NHS hospitals to discharge patients. Some hospitals have redeployed their own staff into nursing homes to free beds in hospitals. In other places, NHS trusts are competing for staff with care providers.
Geoff Butcher, director of Blackadder Corporation, which runs six homes in the West Midlands, said that he paid nurses about £19.50 an hour, slightly higher than the NHS rate of £16.52. “Two of our nurses resigned recently and they’ve gone to an agency for £35 an hour,” he said. “And that agency then came to us and said we can have these staff back at £52 an hour. They want £95 an hour for those nurses on a bank holiday nightshift. It’s utterly unaffordable.
“Because the NHS can’t recruit they are having to use these agencies as well. So the NHS is bidding against us, therefore they’re pushing the rates up, and the whole thing has gone into a completely crazy spiral. The agencies are just grossly profiteering out of it."
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Source: The Guardian, 14 November 2021
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