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

NHS Wales consultant explains why healthcare system is on verge of collapse

The NHS is on the verge of collapse due to demand for healthcare rising significantly faster than funding levels, a consultant has warned. Peter Neville, a consultant for NHS Wales, took to social media to explain why, in his view, the system is failing.
The consultant physician, who has been working in the NHS in Yorkshire and Wales for 32 years, set out the challenges facing the health service in a Twitter thread. He said he had experienced the NHS at its best, in 2008, and its worst, in 2022.
He wrote: "Over at least the past 15 years, we have seen a relentless increase in demand, both in primary care and in hospital care. This has been absolutely predictable by social statisticians for decades and is based on the fact that our elderly are surviving much longer.
"Our elderly use a very large percentage of NHS of resources, unsurprisingly because they are more prone to disease, frailty, and dementia. They need more social care and hospital care as they get older. And they are living longer. (Immigrants, by the way, use much less care).
"Over this period NHS funding has, broadly speaking, risen about 1-2% over inflation. If NHS funding increases with inflation yet demand increases, then clearly spend per person will drop. Demand has increased considerably above 2%, which is why the NHS is failing to manage it."
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Source: Wales Online, 3 January 2023
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Ministers could help the patients dying in NHS hospital corridors right now – they just choose not to

With NHS staff being forced to witness our patients dying in corridors, in cupboards, on floors and in stranded ambulances, we can only thank our lucky stars that the country’s second most powerful politician is the man who last year published Zero: Eliminating Unnecessary Deaths in a Post-Pandemic NHS.
Because the chancellor, Jeremy Hunt, cannot possibly stand back and permit these crisis conditions to continue, can he? He knows better than anyone – having written 320 pages on precisely this fact – that avoidable deaths are the very worst kinds of death, the ones that sicken families and clinicians to their core.
Let’s remind ourselves of how strongly Hunt feels about this subject. The blurb of his book, published only last May, rings out with moral righteousness. “How many avoidable deaths are there in the NHS every week?” he asks. “150. What figure should we aim for? Zero. Mistakes happen. But nobody deserves to become a statistic in an NHS hospital. That’s why we need to aim for zero.”
He even offers a road map towards achieving that end that, unusually for a politician, centres on radical candour. Don’t lie. Don’t deflect. Don’t spin. Don’t cover up. Be honest and open about mistakes and failures because this is the first, essential step to fixing them.
To the collective despair of frontline staff, the government’s actual, as opposed to rhetorical, response to the humanitarian crisis gripping the NHS is a perverse inversion of everything the chancellor purports to hold dear.
Read full story
Source: The Guardian, 6 January 2023
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NHS recruiting from ‘red list’ countries after Brexit loss of EU staff, says report

NHS trusts in England have increased recruitment from low-income “red list” countries to make up for the post-Brexit loss of EU staff, despite a code of practice to safeguard health services in those developing countries.
A report by the Nuffield Trust thinktank also identified shortages in vital specialist areas since Brexit, including dentistry, cardiothoracic surgery and anaesthesiology.
It found that Brexit is still causing issues with the supply of medicines in Northern Ireland despite a change in the arrangements put in place by the EU last April.
The report says that since 2021, the Northern Ireland protocol obliging EU trade rules to be followed in the region has led to a different set of medicines being available compared with the rest of the UK.
Of the 597 products specifically approved by the Medicines and Healthcare products Regulatory Agency since Brexit, “only eight were also approved for Northern Ireland under the same name and company”.
It also found that since 2021, 52 products had been granted marketing authorisation for Northern Ireland but not in Great Britain under the EU approvals system, including a painkiller from the Slovenian company Sandoz Farmacevtska Druzba designed to stop people dying from opiate overdoses.
The Democratic Unionist Party (DUP) described the report as “deeply alarming”.
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Source: The Guardian, 7 January 2023
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Rishi Sunak holds emergency talks with NHS leaders over winter crisis

Rishi Sunak has held emergency talks over the weekend with NHS and care leaders in an attempt to tackle the winter healthcare crisis in England.
The NHS Recovery Forum at No 10 on Saturday focused on four key issues: social care and delayed discharge, urgent and emergency care, elective care and primary care.
A Downing Street spokesperson said the aim was “to help share knowledge and practical solutions so that we can tackle the most crucial challenges such as delayed discharge and emergency care”.
But Sunak has been warned that the meeting is unlikely to reverse the NHS’s fortunes. Labour said patients deserved more than a “talking shop” and the Liberal Democrats said it was “too little, too late”.
Senior doctors say the NHS is on a knife-edge, with many A&E units struggling to keep up with demand and trusts and ambulance services declaring critical incidents.
Matthew Taylor, the chief executive of the NHS Confederation, said there were “no silver bullets” to solving the crisis at hospitals and other care centres.
“This crisis has been a decade or more in the making and we are now paying the high price for years of inaction and managed decline,” he said. “Patients are experiencing delays that we haven’t seen for years".
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Source: The Guardian, 7 January 2023
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Care providers ask for doubled fees to care for people discharged from hospitals

Care providers are demanding double the usual fees to look after thousands of people who need to be discharged from hospitals to ease the crisis in the NHS.
Care England, which represents the largest private care home providers, said on Sunday it wanted the government to pay them £1,500 a week per person, citing the need to pay care workers more and hire rehabilitation specialists so people languishing in hospital can eventually be sent home.
The rate is about double what most local authorities currently pay for care home beds, an amount Martin Green, the chief executive of Care England, described as “inadequate”.
The demand comes as the health secretary, Steve Barclay promised “urgent action” with up to £250m in new funding for the NHS to buy care beds to clear wards of medically fit patients. The money will be used to buy beds in care homes, hospices and hotels where people are looked after by homecare providers, as well as pay for hospital upgrades. Stays will be no longer than four weeks until the end of March.
The use of hotels as care homes began during the pandemic and has been controversial, with reports of problems with hygiene and supplies of specialist equipment. The charity Age UK last week criticised their renewed use as “not an appropriate place to provide high-quality care for older people in need of support to recuperate after a spell in hospital”.
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Source: The Guardian, 9 January 2023
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Pandemic care home death: Family to sue over mother's end-of-life consent

A man plans to sue a nursing home because, he says, during the pandemic his mother was put on end-of-life care without her family being told.
Antonia Stowell, 87, did not have the mental capacity to consent because she had dementia, say the family's lawyers. Her son, Tony Stowell, said if end-of-life care had been discussed, he would not have agreed to it.
Rose Villa nursing home in Hull says all proper process in Mrs Stowell's care was followed with precision.
As a prelude to legal action, Mr Stowell's lawyers have obtained his mother's hospital records which, they say, show she was diagnosed with suspected pneumonia while living in the home. End-of-life drugs were then prescribed and ordered by medical professionals.
In a statement, Rose Villa said: "We believe that our dedicated and professional team provided Antonia with the very best care under the direction of her GP and medical team, and all proper process in the delivery of this care was followed with precision."
Mr Stowell's lawyers, Gulbenkian Andonian solicitors, said his mother's hospital records reveal the decision to put her on end-of-life care was made two days before the family was told.
In their letter to the home announcing the planned legal action, they said Mrs Stowell could have had "48 additional hours on a ventilator with treatment… with the necessary implication that Antonia Stowell could still be with us today or at least survived".
The lawyer dealing with the case, Fadi Farhat, told the BBC: "As a matter of law, there is a presumption in favour of treatment which would preserve life and prolong life, irrespective of one's age or condition.
"Therefore to deviate from that presumption means a patient, or family members, should be consulted as soon as that decision is made or contemplated."
He adds: "What is particularly concerning for me is this case occurred at the height of the pandemic. That should worry everybody because it demonstrates that rights can be suspended in times of crisis, when the very purpose of legal rights is to protect us during times of crisis."
Read full story
Source: BBC News, 9 January 2023
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NHS Scotland crisis: Patients 'are not safe in Scotland's A&Es' as health secretary defends winter planning

Patient safety is at risk “every single day”, with patients in desperate need of intensive care waiting hours in Accident and Emergency departments across Scotland, the deputy chair of British Medical Association Scotland has said.
The harrowing description of the scenes in hospitals came as health secretary Humza Yousaf admitted patients were receiving care he would not want to receive himself as the NHS continues to battle intense winter pressures.
Dr Lailah Peel, deputy chair of the Scottish arm of the British Medical Association (BMA), told the BBC’s Sunday Show the crisis was “years in the making”. She blamed a creaking social care system and increased delayed discharges.
The comments come after details of a January 2021 briefing from the Royal College of Emergency Medicine (RCEM) and the College of Paramedics to the health secretary warned of an unacceptable situation in Scotland’s hospitals.
Reported in the Sunday Times, the briefing also specified the actions needed to avoid a similar situation during the current winter crisis, warning an increase of at least 1,000 new beds was needed as well as more doctors and nurses.
Dr Peel said it was the case patients were “absolutely” dying in hospitals in Scotland due to the ongoing crisis in the health service. "There’s no shadow of a doubt that that is happening,” she told the BBC.
Read full story
Source: The Scotsman, 8 January 2023
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NHS to buy care beds to make space in hospitals

Thousands of NHS patients in England will be moved into care homes as part of the government's plan to ease unprecedented pressure on hospitals.
The NHS is being given £250m to buy thousands of beds in care homes and upgrade hospitals amid a winter crisis. The move aims to free up hospital beds so patients can be admitted more quickly from A&E to hospital wards.
The plans will be included in an emergency package to be unveiled by Health Secretary Steve Barclay.
Helen Whately, minister for care, said, "Getting people out of hospital on time is more important than ever. It's good for patients and it helps hospitals make space for those who need urgent care."
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Source: BBC News
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USA: Alzheimer’s drug lecanemab receives accelerated approval amid safety concerns

The US Food and Drug Administration (FDA) has granted accelerated approval for the Alzheimer’s disease drug lecanemab, one of the first experimental dementia drugs to appear to slow the progression of cognitive decline.
Lecanemab will be marketed as Leqembi, the FDA statement said. It has shown “potential” as an Alzheimer’s disease treatment by appearing to slow progression, according to Phase 3 trial results, but it has raised safety concerns due to its association with certain serious adverse events, including brain swelling and bleeding.
In July, the FDA accepted Eisai’s Biologics License Application for lecanemab under the accelerated approval pathway and granted the drug priority review, according to the company. The accelerated approval programme allows for earlier approval of medications that treat serious conditions and “fill an unmet medical need” while the drugs continue to be studied in larger and longer trials.
If those trials confirm that the drug provides a clinical benefit, the FDA could grant traditional approval. But if the confirmatory trial does not show benefit, the FDA has the regulatory procedures that could lead to taking the drug off the market.
Read full story
Source: CNN Health, 7 January 2023
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Doctors and pharmacists call for basic healthcare lessons so pupils don’t bother the NHS

Pupils should learn what health problems they must not bother the NHS with, doctors and pharmacists have said.
In a new strategy paper they call for a “wholesale cultural shift” towards more self-care, insisting this could both empower patients and reduce demand.
Conditions like lower back pain, the common cold and acute sinusitis can generally be treated without the need for GPs or hospital visits, experts said.
They called for the national curriculum to include requirements for both primary and secondary pupils to be taught to treat and manage common health problems at home. Medical students or pharmacists could go into school to offer lessons on “self-care techniques and signposting to appropriate use of NHS services”, they said.
The paper is from the Self-Care Strategy Group, a coalition of pharmacy bodies and GP and patient groups.
Read full story (paywalled)
Source: The Times, 9 January 2023
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Sick man of Europe: why the crisis-ridden NHS is falling apart

Other countries are looking on appalled as the UK’s failure to reform social care has left its health service struggling to survive.
There are blockages on the way in to the hospital, blockages inside them, and perhaps most frustrating for healthcare staff and patients, blockages getting those who have been treated and have recovered out of the front door and home, or into the community.
It is this last problem that is proving hardest to crack. Despite promises from successive UK prime ministers to mend the broken social care system, it remains completely dysfunctional.
This country is by no means unique in its health and social care struggles. Even in nations often held up as having model healthcare systems – such as France and Germany – the combined pressures caused by ageing populations, financial constraints, recruitment problems, Covid-19 and flu have taken their toll.
On the issue of social care, French doctors and experts admit to shortcomings, though not on the scale of those in the UK. “It’s not that we don’t have problems, but things are organised differently,” said Blanche Le Bihan, a professor at the French School of Public Health and researcher at the Arènes scientific research centre in Rennes specialising in social care.
“The system is far too fragmented, that’s the main issue with social care in France – communication, coordination are always complicated,” Le Bihan says. “But while it’s far from perfect, it’s not a major factor in hospitals’ current problems.”
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Source: The Guardian, 8 January 2023
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Doctors union plans 72-hour strike

Junior doctors across England will walk out for 72 hours in March if a ballot for industrial action is successful, the British Medical Association has told ministers.
The BMA confirmed the move ahead of the opening of its ballot on Monday (9 January). The union is calling for real terms pay cuts over the past decade to be reversed, claiming the last 15 years have led to a 26 per cent decline in the value of junior doctors’ pay. 
Robert Laurenson and Vivek Trivedi, co-chairs of the BMA’s junior doctors committee, said: “Pay erosion, exhaustion and despair are forcing junior doctors out of the NHS, pushing waiting lists even higher as patients suffer needlessly.”
Read full story (paywalled)
Source: HSJ, 8 January 2023
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New discharge fund risks being ‘political theatre’, warn NHS leaders

The government has ‘a week to 10 days’ to distribute the £200m it is committing to speed up hospital discharge if the initiative is to have a meaningful impact on reducing the 13,000 patients who are medically fit to leave hospital, national healthcare leaders have told HSJ.
Health and social care secretary Steve Barclay announced this morning that the government was effectively reintroducing the national discharge scheme used to fund “short-term care placements” earlier in the covid pandemic, which was scrapped in April last year.
NHS Confederation chief executive Matthew Taylor said: “We await the full details of the proposed hospital discharge fund with interest. Given the ongoing delay in distributing the delayed discharge fund announced last autumn any funds will need to be rapidly deployed.”
Read full story (paywalled)
Source: HSJ, 9 January 2023
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NHS in England to offer artificial pancreas to help manage type 1 diabetes

More than 100,000 people with type 1 diabetes in England are to be offered an artificial pancreas, which experts believe could become the “holy grail” for managing the disease.
The groundbreaking device uses an algorithm to determine the amount of insulin that should be administered and reads blood sugar levels to keep them steady.
A world-first trial on the NHS found it was more effective at managing diabetes than current devices and required far less input from patients. The device is now set to be rolled out across the NHS in England after it won approval from the National Institute for Health and Care Excellence (NICE).
Prof Partha Kar, national specialty adviser for diabetes at NHS England, said: “This technology has been proven to give the best control for managing type 1 diabetes and should make things like amputations, blindness, and kidney problems possibly a thing of the past.”
Read full story
Source: The Guardian, 10 January 2023
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TV doctor Hilary Jones blasts Government over ‘at risk of collapse’ NHS

TV presenter Dr Hilary Jones has blasted the Prime Minister over his handling of the NHS, warning it is at risk of collapse.
Speaking on ITV’s Good Morning Britain, the GP shared the experiences of “heartbroken” frontline doctors and said if the situation “doesn’t change very quickly, the NHS is finished”.
Dr Jones referred to a group chat between 13,000 doctors who work on the front line and in primary care, where members are sharing stories that show patients experiencing very long delays in receiving treatment. He described how staff are in tears at the end of their shift “and when they return to the next shift, the same patient is still waiting to be seen after 24 hours”.
He added: “For Rishi Sunak and the Government to pretend that this is not a crisis when more than a dozen trusts have announced critical incidents is not only delusional, as the BMA say, I would say at the very best it’s ill-informed misjudgment, at the very worst it’s total irresponsibility and incompetence. I have never known anything like this.”
Read full story
Source: Independent, 5 January 2023
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