Trusts have been told today by NHS England that they must book appointments by the end of this month for all patients who have been waiting longer than 78 weeks. A letter from NHS England sent to trust leaders set out the new orders and represents system leaders’ attempt to ramp up progress on this cohort of patients, which the NHS and government elective recovery plan commits to eliminating by March.
The appointments must be issued this month, and be dated before the end of March, for these pathways, of which about 48,000 are recorded nationally. The letter also warns trusts that, while NHSE will accept some inpatient cancellations are unavoidable, cancelling outpatient appointments — even during strike action — is viewed as less acceptable.
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Source: HSJ, 12 January 2023
Some hospitals in Scotland have been told to postpone surgeries to ‘decongest’ the system as the crisis in the health service deepens.
A group of NHS hospitals has stopped routine surgery for three weeks in an unprecedented step, as pressures mount on the health service. Health bosses at the NHS Ayrshire & Arran trust warned of “extremely high demand” across the system, as they also asked GPs to see only urgent cases.
Rishi Sunak has repeatedly urged trusts to avoid cancelling elective surgery, urging hospitals not to repeat the errors made in the pandemic, which resulted in record backlogs.
Clare Burden, the chief executive of NHS Ayrshire & Arran, said the cancellations were necessary "due to a combination of staff absence across the system, high bed occupancy levels in our acute and community hospitals, high levels of flu and Covid in our community, some delayed transfers of care, and high volumes of frail patients whose recovery includes complex care.”
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Source: The Telegraph, 11 January 2023
A senior doctor has told Scottish ministers to drop “patient-blaming language” over “unnecessary attendances” at emergency departments.
Lailah Peel, the deputy chairwoman of the British Medical Association in Scotland, said the phrase suggested that patients were responsible for the problems and showed a misunderstanding of the issues.
Patients have waited 30 hours for beds in overcrowded A&E units while ambulances have queued outside hospitals waiting to hand over patients to overstretched staff.
Sturgeon, announcing measures to ease the strain, said: “To reduce the pressures in hospital and the knock-on impacts at the front door we need to do more firstly to avoid unnecessary attendances at hospital and second to speed up the discharge of patients from hospital.”
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Source: The Times, 12 January 2023
Prostate cancer patients across the UK face a “postcode lottery” of care, a charity has warned, with men in Scotland almost three times more likely to be diagnosed at a late stage compared with men in London.
Prostate Cancer UK said the proportion diagnosed when the disease may be too advanced to treat varied hugely depending on where patients lived. Health leaders called the findings “shocking”. In Scotland, more than a third (35%) of men are only diagnosed when the disease is classed as stage 4, meaning the cancer has spread to another part of the body – known as metastatic cancer. In London, the figure is 12.5%.
Chiara De Biase, director of support and influencing at Prostate Cancer UK, said, "We can’t say for sure what’s behind this gap in diagnosis, but it’s clear that men are more likely to be diagnosed at an earlier stage in areas with higher rates of PSA blood testing. That means the key way to tackle this is by raising awareness – especially in places like Scotland which are worst-affected."
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Source: The Guardian, 12 January 2023
John Watkinson was one of the country's top ear, nose and throat surgeons.
But Mr Watkinson's life and career were turned upside down when he was accused of shortening the lives of three patients, suspended and investigated.
General Medical Council investigators would eventually close his case, taking no further action, and Mr Watkinson would receive an apology for what he had experienced from his employer University Hospitals Birmingham (UHB) NHS Trust.
But that was six years after he was first suspended - six years that would see him pushed to the brink.
"As doctors, we're trained in communication skills, we have appraisals, mandatory training," he says. "But the one thing we're not trained to cope with is when somebody declares war on you."
The hospital trust stands by its decision to suspend Mr Watkinson and says its referral to the General Medical Council was "appropriately made following a clinical colleague raising significant concerns" about patient care.
UHB has been in the spotlight in recent weeks, with reviews launched into its culture, leadership, and allegations of poor patient care aired in a Newsnight investigation late last year. It says a review into patient care is now well under way.
Mr Watkinson says he was at the sharp end of this culture when he was suspended and suddenly went "from hero to zero".
He accepts mistakes were made, but not just by him and not ones that would have affected the patients' outcomes.
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Source: BBC News, 13 January 2023
About 15 million more people in England could be prescribed daily cholesterol-lowering statin pills to cut their risk of heart attacks and stroke, new advice for the NHS says.
Given the very cheap price of the tablets and the possible health gains, they should be considered more often, the draft guidance says.
There can be side effects though and there is debate about how widely this long-term treatment should be given and what associated risks are acceptable.
The National Institute for Health and Care Excellence (NICE), which advises the NHS, says people should be thoroughly assessed before statins are prescribed, warning the pills are not a quick fix or substitute for a healthy diet and exercise.
The previous advice was for anyone with a one in 10 chance of having a cardiovascular event, such as a heart attack or stroke, within the next 10 years - based on factors such as age, blood pressure and cholesterol levels - to be offered a statin.
But NICE now says including adults with a one in 20 chance could save 2% of them from having a heart attack or stroke during that period.
Spokesman Paul Chrisp said patients should discuss the benefits and risks with their doctor, adding: "The evidence is clear, in our view, that for people with a risk of 10% or less over 10 years, statins are an appropriate choice."
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Source: BBC News, 12 January 2023
Eight trusts have been awarded roles trialling a new accreditation scheme for surgical hubs as part of an NHS England pilot that will run until March.
The creation of up to 140 surgical hubs, sites which are ring-fenced for surgical work only, is a key plank of the NHS England and government elective recovery plan for addressing the backlog.
The full benefits are still being finalised but accredited trusts will likely get better access to additional recovery funding and central support from the Getting It Right First Time team.
The hubs will focus mainly on providing high volume, low complexity surgery, as previously recommended by the Royal College of Surgeons of England, with particular emphasis on ophthalmology, general surgery, trauma and orthopaedics (including spinal surgery), gynaecology, ear nose and throat, and urology.
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Source: HSJ, 12 January 2023
The chair of an inquiry into hundreds of deaths at a mental health trust has revealed she may not be able to deliver it in its current form following a ‘hugely disappointing’ lack of staff coming forward to give evidence.
Former national clinical director for mental health, Geraldine Strathdee, chair of the non-statutory inquiry into deaths at Essex Partnership University Trust, has penned an open letter warning just 11 of 14,000 staff contacted said they will attend evidence sessions.
It was meant to report in spring 2023. However, after raising concerns with ministers, Dr Strathdee said she believes the inquiry will not be able to meet its terms of reference with a non-statutory status.
The inquiry was announced in 2021 and last year chiefs revealed they were probing 1,500 deaths of people in contact with Essex mental health services between 1 January 2000 and 31 December 2020.
However, without statutory powers, staff are not compelled to give evidence under oath. Many bereaved families, of which just one in four has engaged with the current probe, are campaigning for a statutory inquiry into deaths.
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Source: HSJ, 13 January 2023
Death rates from cancer in the US have fallen by 32% over the three decades from 1991 to 2019, according to the American Cancer Society.
The decline is thanks to prevention, screening, early diagnosis and treatment of common cancers, including lung and breast cancer.
The drop has meant 3.5m fewer deaths. However, cancers are still the second leading cause of death in the US, after heart disease.
In 1991, the cancer death rate was 215 per 100,000 people and in 2019 it dropped to 146 per 100,000 people.
Lung cancer, of which there are 230,000more cases each year, kills the most patients, 350 per day.
But people are being diagnosed sooner, and technological advancements have increased the survival rate by three years.
The report also examined racial and economic disparities in cancer outcomes.
The Covid-19 pandemic added to already existing difficulties for marginalised groups to get cancer screenings and treatment.
For nearly every type of cancer, white people have a higher survival rate than black people. Black women with breast cancer face a 41% higher death rate than white women.
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Source: BBC News, 12 January 2023
ADHD awareness hassoared among women in the UK in the past year, but waiting times and the dearth of clinical awareness are leaving people awaiting diagnosis in a perilous position, leading experts have warned.
Dr Max Davie, a consultant paediatrician and co-founder of ADHD UK, said that people talking openly about their diagnoses – including a number of high-profile celebreties – had led to more people seeking referrals for the condition.
However, while awareness is increasing many trusts and private providers have shut waiting lists because of demand.
“I think it’s probably as big a year as we’ve ever had. We are seeing a lot more people from all walks of life seeking a diagnosis later in life, particularly women,” Dr Davie said. “At the same time waiting lists have gone through the roof. NHS services have been swamped for a while and private providers are also closing their lists – there are wildly inadequate services for ADHD diagnosis, particularly for adults.”
Dr Tony Lloyd, the chief executive of the ADHD foundation, said its own figures suggested a 400% increase in the number of adults seeking a diagnosis since 2020, adding that prescription volumes did not take account of those who do not use medication.
“ADHD remains significantly under-diagnosed and under-treated in the UK – at great cost to public services and to the individual and the workforce,” he said. "Stigma around the condition, which the charity says affects one in 20 people in the UK, resulted in negative outcomes for individuals and high costs to the economy. Dismissing ADHD as a cultural construct and undeserving drain on finite NHS resources only adds to the enduring stigma and stereotyping of those with ADHD,”
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Source: The Guardian, 13 January 2023
Health secretary Steve Barclay has privately conceded that he will have to offer a higher pay rise to NHS staff.
Mr Barclay has admitted that more than one million NHS staff members deserve more money despite previously insisting that existing pay increases were all the government could afford.
But, he also made clear that any new pay rises would come from the current health budget meaning potential cuts to key services, according to The Guardian.
His U-turn comes in advance of nurses in England staging two more strikes next week, which is likely to force hospitals to again work at a reduced capacity following previous industrial action.
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Source: The Independent, 13 January 2023
Patients with emergencies such as heart attacks and strokes in England had to wait more than 90 minutes on average for an ambulance at the end of 2022.
It came after a sharp deterioration in 999 response times in December - they were nearly twice as bad as November.
Record worst waits were also recorded for life-threatening cardiac arrests, while A&E waits of over four-hours reached their highest level ever.
Patient groups warned the delays would be leading to real harm.
Combined, the data - released by NHS England - represents the worst-ever set of emergency care figures since modern records began in 2004.
The figures show:
Average waits of more than 90 minutes to reach emergency calls such as heart attacks - five times longer than the target time - with waits of over 150 minutes in some regions.
Response times for the highest priority calls, such as cardiac arrests, taking close to 11 minutes - 4 minutes longer than they should.
More than a third of patients in A&E waiting longer than 4 hours.
One in seven patients waiting more than 12 hours for a bed on a ward when they need to be admitted.
But there has been some progress with the waiting list for routine treatment falling slightly, to 7.19 million by the end of November.
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Source: BBC News, 12 January 2023
The intense pressure on the NHS in recent weeks has left hospitals unable to cope, patients at risk and staff in despair, writes an A&E doctor in this Guardian article.
"I’ve worked in the NHS for over 10 years and I’ve never known it as bad as it is now. A&Es are swamped and primary care is swamped too. It’s a very sorry of state for all concerned. The last few weeks have been beyond dreadful and it was all predicted by those on the ground months ago".
We’re now in a position in our A&E where we are looking after a ward and a half of admitted patients, who take up the bedded spaces, while simultaneously running an emergency department out of the corridor and waiting room. Having to manage the very sick in inappropriate areas is now becoming the norm.
An emergency department (ED) is not a safe place. It’s filled with some of the sickest people in a hospital, in a chaotic environment. There are lots of comings and goings, with patients being moved frequently and staff looking after multiple patients. It’s a recipe for things getting missed.
If you add in the fact that ED personnel work a shift rota, so new staff come on duty every few hours and they don’t necessarily know the patients, there is more scope for potentially vital information being lost.
"As ED doctors, we have always tried to give the dying a place of privacy, where loved ones can be with them in some relative peace. I would hope that same degree of compassion was present in all A&Es, but it’s becoming more challenging to provide."
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Source: The Guardian, 12 January 2023
Fewer women who gave birth in NHS maternity services last year had a positive experience of care compared to 5 years ago, according to a major new survey. The Care Quality Commission’s (CQC) latest national maternity survey report reveals what almost 21,000 women who gave birth in February 2022 felt about the care they received while pregnant, during labour and delivery, and once at home in the weeks following the arrival of their baby.
The findings show that while experiences of maternity care at a national level were positive overall for the majority of women, they have deteriorated in the last 5 years. In particular, there was a notable decline in the number of women able to get help from staff when they needed it.
Many of the key findings from the survey include a drop in positive interactions with staff and lack of choices about the birth. Just over two-thirds of those surveyed (69%) reported 'definitely' having confidence and trust in the staff delivering their antenatal care. Results were higher for staff involved in labour and birth (78%). In addition, while the majority of women (86%) surveyed in 2022 said they were 'always' spoken to in a way they could understand during labour and birth, this was a decline from 90% who said this in 2019. The proportion of respondents who felt that they were 'always' treated with kindness and understanding while in hospital after the birth of their baby remained relatively high at 71%, however had fallen from 74% in 2017.
Just under a fifth of women who responded to the survey (19%) said they were not offered any choices about where to have their baby. Also, less than half (41%) of those surveyed said their partner or someone else close to them was able to stay with them as much as they wanted during their stay in hospital.
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Source: Medscape, 13 January 2023
Staff at a maternity unit were exposed to almost 30 times the legal workplace exposure limit for nitrous oxide, documents have shown.
Testing at Basildon Hospital revealed the levels more than 16 months before colleagues were informed.
The Royal College of Midwives said its members there were considering legal action.
Routine testing of the maternity suite in June 2021 revealed nine staff members had been exposed to excess nitrous oxide levels during the course of their shifts.
Three had readings of more than 1,000 parts per million (ppm) of the gas, while a fourth recorded almost 3,000. The Workplace Exposure Limit is set at 100ppm.
Trust management apologised after failing to notify staff at the unit until October 2022.
A briefing seen by the BBC stated the issue was logged on the risk register, but "there has not been proper oversight of the problem and staff have not been informed".
One person familiar with the situation, who did not want to be identified, said: "We had an email sent out that said 'emergency maternity staff briefing' and there was a Teams meeting.
"The Teams meeting was very, very difficult to listen to. It was very emotive. People were angry understandably, but I feel like the executive who were on the call didn't handle it very well."
The health secretary said "voluntary arrangements" for emergency cover during recent ambulance strikes could not "ensure patient and public safety".
In a letter to the GMB, Steve Barclay acknowledged unions that walked out had agreed to answer the most serious category one 999 calls.
But he said the lack of cover for category two calls, including strokes, in some areas put lives at risk.
The GMB has accused the government of "demonising" its striking workers.
In response, Mr Barclay wrote on Sunday that he recognised the right to strike and accepted "that a certain amount of disruption is inherent to any strike".
He said he "greatly" valued the "vital work ambulance workers do" but criticised the "volatile" assurances given to him about cover by trade unions during December's industrial action.
The government's anti-strike bill is due to be considered by MPs again on Monday.
The legislation would set minimum service levels for fire, ambulance and rail services during industrial action and could leave unions at risk of legal action if they fail to comply.
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Source: BBC News, 15 January 2023
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