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Found 364 results
  1. News Article
    One in five cases in which patients attend A&E needing mental healthcare are spending more than 12 hours in the department – at least double the rate of patients with physical health problems. Unpublished internal NHS data seen by HSJ also suggests the proportion of mental health patients suffering long waits in accident and emergency has almost tripled when compared to the situation before the pandemic. According to the data, the proportion of attendances by patients with a mental health problem who waited more than 12 hours in A&E before being admitted or discharged increased from 7% (34,945 breaches) in 2019-20 to 20% (88,250 breaches) in 2022-23. The situation has become so difficult, that some acute trusts are spot purchasing private sector mental health in order to discharge patients. Read full story (paywalled) Source: HSJ, 5 June 2023
  2. News Article
    About 23,000 people died in accident and emergency departments last year, according to an estimate by Labour based on Freedom of Information requests to every NHS trust in England. Half of the trusts responded to the party’s requests and, based on that information, it calculated that just over 23,000 people had died – an increase of more than 20% on 2021, and nearly 40% on 2020. The increase in deaths corresponds with a sharp rise in NHS waiting times, as hospitals struggle with high demand and a lack of resources after the Covid-19 pandemic. Wes Streeting, the shadow health secretary, said: “People turning to the NHS in an emergency should know they will be seen and treated before it’s too late. The Conservatives’ failure over 13 years to properly staff or reform the NHS has a cost in lives.” Maria Caulfield, the health minister, defended the government’s record, however, saying: “We are delivering a record number of tests, speeding up discharge from hospitals, and cutting waiting lists as we also work to halve inflation, grow the economy, reduce debt, and stop the boats.” Read full story Source: The Guardian, 19 May 2023
  3. News Article
    Patients spent up to 25 hours on trolleys in corridors waiting for treatment and in some cases were left lying on "urine-soaked sheets" and in another on a "blood-stained pillow for several hours" at the Royal Infirmary of Edinburgh. Healthcare Improvement Scotland (HIS) inspectors also raised concerns over fire safety in the overcrowded A&E after two visits to the hospital - the first of which was carried out between February 20 to 22 and a further unannounced follow-up in March. The watchdog found "multiple systemic failures" in a report published on Thursday but NHS Lothian said a major improvement drive was already underway. The health board added that the hospital was had just endured its busiest winter on record ahead of the inspections. At the time of the inspection, the emergency department was on some days operating at over three times its capacity. The report described this as unsafe and a "fire safety risk" with the evacuation plan in place at the time not reflecting the "significant" impact of overcrowding. Read full story Source: The Herald, 18 May 2023
  4. News Article
    An acute trust chair has said its emergency department is effectively operating as a primary care service. Hattie Llewelyn-Davies, who has chaired The Princess Alexandra Hospital Trust since late 2021, told HSJ: “We’ve done an awful lot of changes in the way we run out A&E and same day emergency care service to try and get the flow through working better… “We have particular problems with the Princess Alexandra because we are right in the middle of Harlow. And we have a GP service and primary care service which is under massive pressure. We have very high levels of deprivation in Harlow. “When somebody is sick in Harlow and can’t get a doctor’s appointment on the spot, they walk into us. We have a very high level of people coming in, so a very high level of footfall but a very low level of admissions. “We are therefore running effectively a primary care service through our A&E.” Read full story (paywalled) Source: HSJ, 15 May 2023
  5. Content Article
    Key findings The pandemic exacerbated socioeconomic inequalities in service use. People from the most deprived areas who died at home used less of almost all services than people from the least deprived areas, and were prescribed fewer medications for symptom management. For general practice interactions the difference grew during the pandemic, with people from the most deprived areas having almost one whole interaction less than people from the least deprived areas. People from Asian ethnic backgrounds were more likely to use hospital beds in an emergency and to use general practice services before the pandemic. While general practice interactions increased for all ethnic groups during the pandemic, the increase was largest for people from white ethnic backgrounds. People who died at home were less likely to have planned hospital admissions during the pandemic, with 4.8% having at least one admission during the pandemic compared with 5.3% pre-pandemic. People who died from circulatory diseases also had fewer outpatient appointments during the pandemic. These differences reflect reductions in planned care across the board, as the NHS focused on responding to Covid-19, but for people approaching the end of life, the reductions were not just a matter of delaying care. Conversely, there was an increase in the use of Accident & Emergency (A&E) during the pandemic for people who died at home, particularly for people who died from dementia and Alzheimer’s disease. For this group, the proportion of people who had at least one A&E visit in the last month of life increased from 12% to 15% and there was also an increase in how often people went. Use of general practice increased during the pandemic among people who died at home. The proportion of people with at least one general practice interaction in the last month of life rose from 64% pre-pandemic to 75% during the pandemic and the number of interactions per person also increased, from 2.5 to 3.8. People who died at home during the pandemic were more likely to be prescribed at least one medication for symptom management than people who died at home before the pandemic (38% vs 34%) and the number of medications prescribed per person increased from 1.3 to 1.5 between the pre-pandemic and pandemic periods. However, our patient and public involvement group highlighted that patients and families were not always clear what different medications were for, and wanted more support surrounding the use of medications, particularly when a syringe driver was needed.
  6. Content Article
    1. Eradicate overcrowding and corridor care for patients 2. Provide the UK with the Emergency Medicine workforce it needs to deliver safe care 3. Ensure our NHS can provide equitable care to emergency patients 4. Focus on evidence based interventions to tackle overcrowding 5. Introduce meaningful and transparent metrics to facilitate performance and better outcomes for patients
  7. News Article
    A major acute trust has warned ahead of next week’s nursing strike that it will face ‘very severe staffing shortages’ in children’s A&E, with ‘as few as one nurse per ward’, much less critical care capacity, and fewer operating theatres open than on Christmas Day. Cambridge University Hospitals Foundation Trust’s medical director said in a note, seen by HSJ, that the hospital would only have 60 to 70% of its critical care beds open and that “it is not possible to guarantee patient safety on our wards over the forthcoming weekend” with severe staffing shortages in “almost all areas”. The Royal College of Nursing is planning no derogations (exceptions) to its planned 48-hour walkout, from 8pm on Sunday until 8pm on Tuesday, whereas its previous action has exempted emergency care. There have been national warnings about the significant safety threat posed, but the CUH message, sent to all staff by medical director Ashley Shaw, sets out a more stark picture of critical services scaled back. It says: ”Our current information indicates there will be a severe shortage of nurses in almost all ward areas, with as few as 1 nurse per ward per shift." Read full story (paywalled) Source: HSJ, 26 April 2023
  8. News Article
    Around 10 per cent of the 1.2 million accident and emergency attendees in February waited 12 hours or more, newly published NHS England data has revealed, laying bare the true extent of the NHS’s emergency care crisis. The data – which NHSE has collected for years but has only now started to publish – shows 125,505 patients waited 12 hours or more from their arrival at A&E to be admitted, transferred or discharged. This is more than double the highest figure under the existing metric of around 55,000, which only starts the clock from when the patient has received a decision to admit. NHSE’s decision to publish the data for 12-hour breaches from time of arrival follows a concerted campaign by the Royal College of Emergency Medicine, which has long raised concerns the measure from decision to admit has significantly masked the true extent of long waits in A&E. Read full story (paywalled) Source: HSJ, 13 April 2023
  9. News Article
    Staff in hospital emergency departments in England are struggling to spot when infants are being physically abused by their parents, raising the risk of further harm, an investigation has found. Clinicians often do not know what to do if they are concerned that a child’s injuries are not accidental because there is no guidance, according to a report from the Healthcare Safety Investigation Branch (HSIB) that identifies several barriers to child safeguarding in emergency departments. Matt Mansbridge, a national investigator, said the report drew on case studies of three children who were abused by their parents, which he said were a “hard read” and a “stark reminder” of the importance of diagnosing non-accidental injuries quickly, since these are the warning sign in nearly a third of child protection cases for infants under the age of one. “For staff, these situations are fraught with complexity and exacerbated by the extreme pressure currently felt in emergency departments across the country,” Mansbridge said. He said the clinicians interviewed wanted to “see improvement and feel empowered” to ask difficult questions. “The evidence from our investigation echoes what staff and national leads told us – that emergency department staff should have access to all the relevant information about the child, their history and their level of risk, and that safeguarding support needs to be consistent and timely/ Gaps in information and long waits for advice will only create further barriers to care,” he said. Read full story Source: The Guardian, 13 April 2023
  10. Content Article
    Findings There is no specific guidance for ED clinicians on the identification of suspected non-accidental injuries and what to do if they suspect an infant has a non-accidental injury. There may be barriers to routinely escalating cases of children with a potential non-accidental injury to paediatric (child specialist) and safeguarding teams. Delays in the availability of information about potential safeguarding concerns add to the pressures on ED staff when making decisions about infants with potential non-accidental injuries. There remain concerns about, and an inconsistent approach to, sharing safeguarding information between organisations. The Emergency Care Data Set (ECDS) gathers information about ED attendances and includes a field for when such attendances are related to safeguarding. The ECDS safeguarding information collected is not currently utilised within the NHS and there is minimal quality assurance in place to ensure that it is reliable. Risk factors for non-accidental injuries which do not meet the criteria to be included on the Child Protection – Information Sharing system (the electronic system designed for information sharing between the NHS and social services) are not included in a patient’s summary care record and may therefore remain unknown to clinicians. The investigation identified mechanisms which could enable safeguarding information that is not currently available to ED clinicians, to be made available through existing national and regional digital systems. Safeguarding teams are often located physically distant from EDs. This can create a barrier to communication and liaison with the team. Safety recommendations HSIB recommends that the Royal College of Emergency Medicine, working with relevant stakeholders, develops guidance to support clinicians in the diagnosis and management of non-accidental injuries. HSIB recommends that NHS England, working with relevant stakeholders, reviews the utility of the safeguarding data in the Emergency Care Data Set and agrees a process for assuring the quality of any data to be captured. Safety observations HSIB makes the following safety recommendations: It may be beneficial if there was an electronic system available for clinicians to view any safeguarding information to assist in decision making. It would be beneficial if the safeguarding operating model, to be tested through pathfinders, included a response time for advice when sought by professionals such as emergency department clinicians It may be beneficial if safeguarding teams are either physically located near to, or make efforts to promote their visibility in, emergency departments.
  11. News Article
    Whistleblowers have described the accident and emergency (A&E) department at Hull Royal Infirmary as "incredibly dangerous" and a "death trap". The Care Quality Commission (CSC) found Hull University Teaching Hospitals required improvement overall and its A&E department was rated inadequate. Two clinical staff members, who wished to remain anonymous, described it as a "toxic" place to work. Speaking to the BBC, the two staff members who have worked in Hull's A&E department said they had raised concerns with senior managers and the CQC. They said there were frequently fewer staff than needed and warned inexperienced staff, one whom had never seen a cardiac arrest, were working in areas like resuscitation, which was "incredibly dangerous". "Nurses who aren't even signed off to give oral medication are being put in resuscitation," one said. "It's a death trap, it is terrifying." Despite these concerns, CQC inspectors in December and November did find the service "had enough nursing and support staff to keep patients safe". Read full story Source: BBC News, 28 March 2023
  12. News Article
    Trust executives and senior managers have been criticised by a former national director for their lack of support for an under-pressure A&E. An independent review described York Hospital as “reluctant” to trigger internal escalation processes, and suggested it should be quicker to admit extra patients to inpatient wards during busy periods. Professor Matthew Cooke, a former national clinical director for emergency care who conducted the review, said that during his two-day visit to the department he witnessed a 60-hour delay for a patient to be admitted: “I was surprised not to see any senior managers or executives in the ED, despite such long delays. ED staff reported they rarely saw the executive team.” Professor Cooke also warned of uncertainty over escalation processes, including for reducing pressure in the emergency department by “boarding” patients on wards beyond normal capacity. He said: “On the second morning, there were multiple patients on oxygen in ordinary seats in majors waiting room, cared for by a single nurse. I find it difficult to understand how this is safer than boarding one extra patient on several wards.” “Staff perceived that the organisation was reluctant to move to higher escalation levels and I sensed this meant staff no longer pushed for such actions.” Read full story (paywalled) Source: HSJ, 23 March 2023
  13. News Article
    Self-harm hospital admissions for children aged eight to 17 in the UK jumped 22% in one year. The age group is now the largest for self-harm admissions, with all others seeing a drop, according to NHS data. Charities say early access to support is vital, but high thresholds and long waiting lists mean more young people are ending up in hospital. Emily Nuttal, 29, first struggled with self-harm when she was 12. At 13, she was first admitted to A&E. At that time, she was struggling with changes at school, bullying and troubles at home. Over the years, she said she had had varied experiences in accident and emergency departments. "It's been times where it's been really empathetic and passionate people, understanding, supportive. And there's been times where there's been that stigma and judgement." She said being labelled as "attention-seeking" was really difficult and made it harder to reach out for help again. "I would then only go if I was forced upon by the crisis service, or if somebody else noticed, and they got people involved," she said. Read full story Source: BBC News, 23 March 2023
  14. News Article
    The NHS’s efforts to prop up emergency departments with thousands of additional medical staff has been the wrong approach to solving the crisis in these services, experts have argued. Analysis of NHS staffing data by HSJ shows the emergency care medical workforce has grown by almost two-thirds since 2016, far outstripping the growth in other specialties. Despite this, waiting times in accident and emergency have deteriorated significantly over the same period. John Appleby, chief economist at the Nuffield Trust think tank, said: “Cramming the A&E department with more doctors doesn’t look like it’s having the intended effect over the last four to five years. Waiting times have got worse and we have more staff. “Increasing staffing has helped with waiting times in the past, but maybe we have reached a point where it’s not staffing in A&E which is the issue. The issue is the front door and the backdoor of the A&E.” Read full story (paywalled) Source: HSJ, 17 March 2023
  15. Content Article
    Key insights In 2022, 1.65 million people waited 12 hours or more from their time of arrival (TOA) in an ED. This figure is 4.8 times the number of 12-hour Decision to Admit (DTA) waits reported, demonstrating the metric is misleading. From April 2023, NHS England will routinely publish 12-hour TOA data, a vital first step toward reducing long and unnecessary waiting times in EDs. We must have an accurate picture of these long waiting times, as they can have catastrophic consequences for patient safety and mortality. Using the Standard Mortality Ratio (SMR) and the 12-hour TOA figure, we estimate 23,003 excess patient deaths in 2022 in England were associated with long stays in EDs. While we welcome the Government publishing the data, we seek assurance that this data will be published on a monthly basis at ED level, so that hospitals can use this information to improve quality of care and ensure patient safety.
  16. News Article
    One patient is dying every 23 minutes in England after they endured a long delay in an A&E unit, according to analysis of NHS figures by emergency care doctors. In all, 23,003 people died during 2022 after spending at least 12 hours in an A&E waiting for care or to be admitted to a bed, according to the Royal College of Emergency Medicine (RCEM). That equates to roughly 1 every 23 minutes, 63 every day, 442 a week or 1,917 each month. The college said its findings, while “shocking”, were also “unsurprising” and reflected the fact that emergency departments are often overwhelmed and unable to find patients a bed in the hospital. Rosie Cooper, the Liberal Democrats’ health spokesperson, said “patients are now dying in their droves” due to successive Conservative governments neglecting the NHS, and added that the lives lost due to A&E snarl-ups constituted a “national disaster”. “Long waiting times are associated with serious patient harm and patient deaths,” said Dr Adrian Boyle, RCEM’s president. “The scale shown here is deeply distressing.” Read full story Source: The Guardian, 28 February 2023
  17. News Article
    Hundreds of thousands of older people in England are having to endure chronic pain, anxiety and unmet support needs owing to the worsening shortage of social care staff and care home beds. Age UK has said older people with chronic conditions such as diabetes, high blood pressure and heart failure are increasingly struggling with living in their own homes because of a lack of help with everyday tasks such as getting out of bed, dressing and eating. The decline in the amount of support and care provided to older people is piling pressure on families and carers and leaving the NHS in constant crisis mode, contributing heavily to ambulance queues outside A&E departments, the charity said in a new report It warned that there would be a repeat of the NHS crisis this winter – in which rising numbers of elderly people have been unnecessarily stuck in hospital because of an acute lack of social care – without a shift to preventing unnecessary admissions. Read full story Source: The Guardian, 17 February 2023
  18. Content Article
    Key findings Half (49%) of all the people arriving in A&E by ambulance are over 65. A third (36%) of all the people arriving in A&E by ambulance are over 75. Unplanned hospital admissions have been rising and have become more frequent, particularly for the oldest old. The proportion of older people feeling supported to manage their condition has been falling consistently, almost 20% in relative terms since 2016/17. 2.6 million people over 50 have unmet social care needs increasing to 15% of people in their 70s, and 21% of people in their 80s. In 2022, there were 165,000 vacant posts in social care- an increase of 50% and the highest rate on record. Call for action Integrated Care Systems (ICS) to develop comprehensive strategies for meeting the health and social care needs of older people at home, and in care homes, living in their areas. This must include major efforts to embed prevention in their work so older people can avoid the need for crisis care and maintain their independence. Social care reform and a major and sustained increase in funding. The NHS cannot deliver these improvements alone. The lack of adequate social care for basic daily needs simply stores up problems, leaving older people less able to care for themselves and arriving in hospital with serious health problems that could have been avoided. Multidisciplinary working to become the default method of delivering health and care services to older people. Older people are too often left to fall between the cracks of disjointed services and professionals who don’t communicate well with each other. For ICSs, this means making sure that social care services – and by extension the local authorities that are responsible for them - are central to their leadership and decision-making. A better paid health and social care workforce, with the skills and competencies to properly support older people would make a huge difference to the quality and availability of care. A step change in the recognition of and financial and practical support on offer to unpaid carers, who are holding up many parts of the health and care system.
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