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Found 433 results
  1. News Article
    The number of people dying needlessly in A&E soars on a Monday as hospitals are stretched to the limit and failing to discharge patients at the weekend, new data shows. Figures uncovered by The Independent show an average of 126 patients died every Monday between 2020-2023 – 25% higher than any other day. On a Saturday, the average number of deaths drops as low as 90. Waiting times are also shown to spike massively at the start of the week, with an average of 9,300 patients spending more than 12 hours waiting on a Monday – up to 2,000 more than any other day. Medical experts said the rise in A&E waits can be attributed to people staying away from hospitals during weekends and patients not being discharged from medical care, causing a bottleneck in an already buckling system. The stark statistics also directly contradict repeated government efforts to make the NHS a seven-day service. Multiple coroners have warned the government and health leaders about delays to patients’ treatment and diagnosis due to variations in staffing and access to specialists – particularly over the weekend. Adrian Boyle, president of the Royal College of Emergency Medicine, said the NHS England data clearly signposted an “increased risk” at the start of the week. Another expert said the sharp rise in deaths on Mondays showed an A&E “running constantly in the red zone”. Read full story Source: The Independent, 8 April 2024
  2. News Article
    The headline A&E target was missed in March despite NHS England’s controversial last-ditch attempts to deliver it. Four hours A&E performance was 74.2 per cent in March—1.8 percentage points lower than NHSE’s 76 per cent threshold—but up from 71.5 per cent in the same month last year. NHSE’s attempts to improve four hours performance ahead of a year-end deadline—which included new cash incentives, asking directors to sign personal commitments, and encouraging trusts to focus on less sick patients—saw March performance 3.3 percentage points higher than 70.9 per cent in February. Around a third of acute trusts (38 of 119) met the 76 per cent target in March–more than double the number of trusts above the threshold in February (15). An interim ambulance response time for category 2 incidents, set at 30 minutes, was also missed in 2023-14—despite some improvement, and despite the government providing significant extra funding. The average response time across the year was 36m 23s—better than 2022-23 when it was 50m—but much worse than the pre-covid average of 21m 47s in 2018-19 and 23m 50s in 2019-20. Many ambulance trusts have continued to struggle with delays in handovers to A&E departments and South Western Ambulance Service Foundation Trust – which has seen some of the worst delays over the winter—averaged 45m 54s for category 2 incidents in March. Read full story (paywalled) Source: HSJ, 11 April 2024
  3. News Article
    A woman who feared she was having a heart attack said she spent nine days in a hospital staff room because of a shortage of beds. Zoe Carlin, 23, was admitted to Altnagelvin Hospital in Londonderry in March after experiencing severe chest pain. She said she spent more than a week in a “locker room” where she had to use a hand bell to call staff during what she described as a “dehumanising” ordeal. The Western Health and Social Care Trust (WHSCT) said it faced "extreme pressures" in its hospital emergency departments but could not comment on individual cases due to confidentiality. “For the full nine days I was in this alcove,” she told BBC Radio Foyle’s North West Today programme. “It’s basically the nurses' locker room. You can see the nurses’ lockers with their names on them. They [staff] just said there’s not enough beds,” she added. A privacy screen did not fully cover the room’s doorway and she had no access to a private bathroom. She said she was forgotten about at meal times on three occasions. A spokesperson for WHSCT said, "We are acutely aware of the continuing challenges and extreme pressures not just in our emergency departments but across both of our acute hospital sites with full escalation of beds on all wards and departments. In the Western Trust, when we learn of examples where care falls below the standard we expect, we review the circumstances and explore ways to improve care in the future." Read full story Source: BBC News, 11 April 2024
  4. News Article
    In the next few days, once the data has been collected, the Government will come out and say that, thanks to its policies, the situation in A&E is improving. Despite estimates released recently by the Royal College of Emergency Medicine that soaring waits for A&E beds led to more than 250 needless deaths a week in England alone last year, the Government will point to declining numbers of patients who breached the four-hour target this March. The four-hour target means we're meant to see and either discharge or admit patients within four hours of their arriving in A&E. But it's a sham, writes Professor Rob Galloway in the Daily Mail. Because, for the past month, the four-hour data has been manipulated, the result of two policies introduced earlier in the month by the Government. Read full story Source: Daily Mail, 3 April 2024
  5. Content Article
    NHS England’s response to claims of excess deaths due to long A&E waits leaves a lot to be desired, writes Steve Black for the HSJ. The Royal College of Emergency Medicine (RCEM) claim that more than 250 A&E patients are dying each week because they waited more than 12 hours to be admitted. If long waits in A&E are killing an extra 250-400 people every week, it is the biggest performance problem in the NHS. NHSE should urgently ask their analysts to rework this analysis with current data to test (or refute) the validity of the claim. The first step to solving a huge problem is admitting the scale of the problem, not denying it exists. This analysis features a refinement of the RCEM estimate that includes estimated mortality from waits between four and 12 hours. This increases the estimate to 400 extra deaths per week compared to the RCEM number of 250.
  6. News Article
    More than 150,000 patients had to wait a day in A&E before getting a hospital bed last year, according to new data. Freedom of information data compiled by the Liberal Democrats from 73 hospital trusts – about half the total – found that the number of patients forced to wait more than 24 hours in A&E before a bed could be found for them has increased by tenfold since 2019. The majority of those forced to wait were elderly or frail, with two-thirds of the patients over the age of 65. Read full story Source: Guardian 8 April 2024
  7. News Article
    A gran was left lying outside in the cold facing a seven hour wait for an ambulance following a fall before finally being rescued — by firefighters. Betsy Hulme, 83, was left in agony with a broken hip when she tumbled in her back garden in Leek, Staffordshire. Son Steve, 60, a former ambulance technician, dialled 999 only to be told it would be several hours until paramedics could get to them due to long handover delays. After a further three hours of Betsy waiting on cold concrete slabs while soaked in rain water, desperate Steve decided to drive to a nearby fire station to ask for help. Fire crews then came to rescue to lift gran-of-four Betsy into her son's car who took her to hospital where she remains after undergoing a hip repair operation. Dad-of-two Steve, of Leek, has now branded emergency response times as “absolutely disgusting”. He said: "It’s opened my eyes if I’m honest. It’s absolutely disgusting. I’m so grateful and thankful to the fire service - but it really isn’t their job. I can't remember in my time working as an ambulance technician going to someone and saying, 'I’m sorry it’s taken us twelve hours to get here'." “It was never anywhere near those ridiculous times when I worked there until 2000 and something has gone drastically wrong since. I can't speak highly enough of the boys and girls who work in the NHS, it's the people above them. Its systemic change that's needed." Read full story Source: Wales Online, 4 April 2024
  8. Content Article
    Read the Royal College of Emergency Medicine's general election manifesto. A one page summary is below and the full manifesto can be found at the link at the bottom of the page.
  9. News Article
    Patient safety in the Accident & Emergency unit at the Queen Elizabeth University Hospital in Glasgow will be reviewed by an NHS watchdog. Healthcare Improvement Scotland (HIS) was first contacted by 29 A&E doctors in May 2023 warning that safety was being "seriously compromised". HIS last month apologised for not fully investigating their concerns. The review will consider leadership and operational issues and how they may have impacted on safety and care. In the letter to HIS, the 29 consultants highlighted treatment delays, "inadequate" staffing levels and patients being left unassessed in unsuitable waiting areas. They claimed this resulted in "preventable patient harm and sub-standard levels of basic patient care". The doctors also said critical events had occurred including potentially avoidable deaths. The consultants said repeated efforts to raise the issues with health board bosses "failed to elicit any significant response". Read full story Source: BBC News, 4 April 2024
  10. Content Article
    Prime Minister Rishi Sunak promised speedier care, but specialists believe long waits for hospital beds are costing thousands of lives. The pledge he made in January last year, as one of five priorities on which he said voters should judge him, was that “NHS waiting lists will fall and people will get the care they need more quickly”. New calculations by the Royal College of Emergency Medicine (RCEM) show that, with regard to the broader aim of delivering speedier treatment, his government is falling shockingly short.
  11. News Article
    More than 250 patients a week could be dying unnecessarily, due to long waits in A&E in England, according to analysis of NHS data. The Royal College of Emergency Medicine analysed the 1.5 million who waited 12 hours or more to be admitted in 2023. A previous data study had calculated the level of risk of people dying after long waits to start treatment and found it got worse after five hours. The government says the number seen within a four-hour target is improving. This is despite February seeing the highest number of attendances to A&E on record, it adds. The Royal College of Emergency Medicine (RCEM) carried out a similar analysis in 2022, which at that time resulted in an estimate of 300-500 excess deaths - more deaths than would be expected - each week. The analysis uses a statistical model based on a large study of more than five million NHS patients that was published in 2021. RCEM president Dr Adrian Boyle said long waits were continuing to put patients at risk of serious harm. "In 2023, more than 1.5 million patients waited 12 hours or more in major emergency departments, with 65% of those awaiting admission," he said. "Lack of hospital capacity means that patients are staying in longer than necessary and continue to be cared for by emergency department staff, often in clinically inappropriate areas such as corridors or ambulances. "The direct correlation between delays and mortality rates is clear. Patients are being subjected to avoidable harm." Read full story Source: BBC News, 1 April 2024
  12. Content Article
    The idea of Emergency care services experiencing seasonal spikes in demand – so called ‘Winter Pressures’ are fast becoming a thing of the past. Instead, long waits have become the new norm year-round, and staff are caring for patients in unsafe conditions on a daily basis. It is well established that long waits are associated with patient harm and excess deaths. Last year the UK Government published a Delivery Plan for the Recovery of Urgent and Emergency Care (UEC) services. A year on, far too many patients are still coming to avoidable harm.   New analysis by the Royal College of Emergency Medicine (RCEM) reveals that there were almost 300 deaths a week associated with long A&E waits in 2023.
  13. Content Article
    With a record number of patients stuck in A&E, Healthwatch England’s CEO Louise Ansari wants to see a longer-term plan to improve conditions in which people wait for life-saving care. This should include real-life monitoring and reporting on patient experience.
  14. News Article
    Trusts will be told to hit the four-hour A&E target in 78% of cases by next year after NHS England finally made an agreement with government, HSJ understands. The new target is just two percentage points higher than the target set for the current year of 76% – and must be hit in March 2025, according to NHS planning guidance. NHS England will also aim to maintain “core” general and acute beds at 99,000 on average across 2024-25 after funding was agreed with the government. This would maintain the beds at levels seen over recent months, but it would be a significant increase in the permanent “sustainable” beds available in the health service compared with previous years. Most trusts have fallen well short of the 76% target through much of 2023-24, and NHSE has pressed for them to make last-ditch attempts in recent weeks to try and get closer to the target ahead of the March 2024 deadline. This has included offering new capital funding rewards for improvement and telling trusts to focus on non-admitted patients. Elective recovery targets are expected to slip, and government has conceded making significant progress on these is almost impossible, with ongoing doctors strikes on top of other capacity problems. Read full story (paywalled) Source: HSJ, 27 March 2024
  15. News Article
    An ambulance trust is having to protect its staff from the effects of fumes – including potential cancer risk – as they are spending so long in their vehicles outside hospitals. South Western Ambulance Service Foundation Trust (SWASFT) has carried out a risk assessment of the impact of diesel engine emissions after following concerns from staff, many of whom are spending hours waiting to handover on each shift. The region has faced the worst handover delays to emergency departments in recent years. Ambulance engines normally have to be kept on while waiting, to keep essential equipment running, and sometimes for warmth. But with queues of a dozen or more ambulances at times, staff and patients can be exposed to substantial emissions for long periods. The trust’s risk assessment – which has been seen by HSJ – warns exposure to diesel emissions is associated with eye and upper respiratory tract irritation, while prolonged exposure can lead to coughing, increased sputum production and breathlessness. There is also “epidemiological evidence which indicates that sustained occupational exposure to diesel engine exhaust emissions may result in an increase in the risk of lung cancer”. It gives a risk rating of 20 – one of the highest possible – which, under the trust’s policies, indicates “activities must not proceed” until mitigations are in place. Read full story (paywalled) Source: HSJ, 27 March 2024
  16. News Article
    A&E staff are unable to properly look after the most vulnerable mental health patients or treat them with compassion because emergency departments are so overwhelmed, top medics have warned. An exclusive report shared with The Independent shows more than 40% of patients who needed emergency care due to self-harm or suicide attempts received no compassionate care while in A&E, according to their medical records. The data, collated by the Royal College of Emergency Medicine (RCEM), prompted a warning from top doctor Dr Adrian Boyle that mental health patients are spending far too long in A&E – where they are cared for by staff who are not specifically trained for their needs – before being moved to an appropriate ward. Dr Boyle, who is president of the RCEM, said there had been some progress in improving care for a “historically disadvantaged” group, but added: “Patients with mental health problems are still spending too long in our emergency departments, with an average length of stay of nearly 10 hours and this has not really improved. “An emergency department is frequently noisy and agitating, the lights never go off and cannot be described as an environment that promotes recovery.” When a patient goes to A&E after a self-harm attempt, they should receive an assessment by a clinician into the type of self-harm, reasons for it, future plans or further suicidal thoughts. The college said it indicates a “significant gap” in the NHS’ ability to provide holistic care for mental health patients with complex needs and warned “urgent” improvements are needed. Read full story Source: The Independent, 25 March 2024
  17. News Article
    An NHS watchdog has apologised to 29 doctors at Scotland's biggest hospital for not fully investigating their concerns about patient safety. A&E consultants at Glasgow's Queen Elizabeth University Hospital wrote to Healthcare Improvement Scotland (HIS) to warn patient safety was being "seriously compromised". They offered 18 months' worth of evidence of overcrowding and staff shortages to back their claims. But HIS did not ask for this evidence. The watchdog also did not meet any of the 29 doctors - which is almost every consultant in the hospital's emergency department - to discuss the concerns after it received the letter last year. Instead, it carried out an investigation where it only spoke to senior executives at NHS Greater Glasgow and Clyde before then closing down the probe. HIS has now issued a "sincere and unreserved apology" to the consultants and upheld two complaints about the way it handled their whistleblowing letter about patient safety. One consultant who signed the letter told BBC Scotland: "We'd exhausted all our options and thought HIS was a credible organisation. "We offered to share evidence of patient harm. We were shocked that they ignored this and didn't engage with us as the consultant group raising concerns." Another consultant added they were "shocked at their negligence." Read full story Source: BBC News, 25 March 2024
  18. Content Article
    The total value of clinical claims associated with emergency medicine was nearly £700m in 2022/23, making them the second highest total value of claims by speciality. This podcast focuses on clinical negligence claims from the emergency department, and how insights from claims data can be used by emergency medicine teams to help improve safety. Hosted by Justine Sharpe from NHS Resolution's Safety and Learning team, the episode features guests from NHS England’s Getting It Right First Time team and the Royal College of Emergency Medicine. Topics covered include: The key themes and recommendations from NHS Resolution's 2022 ED reports, including discussion of cauda equina and aortic dissection How to use local claims data from NHSR and operational performance data from GIRFT to inform safer patient care Insights into specialty reviews and handover, communication and the importance of multidisciplinary ED teams.
  19. News Article
    NHS England has confirmed new financial incentives for trusts to deliver strong performance against the four-hour emergency target this month. National leaders are desperate for the NHS to hit the four-hour target in 76% of cases in March, telling trusts earlier this month that it was necessary to restore confidence in the health service. They took the unusual step at the start of the month of asking local leaders to sign a commitment to deliver the necessary performance. The recent pressure has come under criticism for encouraging hospitals to prioritise four-hour performance over caring for the sickest patients. It was also indicated there would be new financial incentives for those delivering the best performance. In a letter, NHSE confirmed a significant expansion to the criteria for trusts to claim a share of a £150m incentive fund, by improving their headline accident and emergency performance. Read full story (paywalled) Source: HSJ, 12 March 2024
  20. News Article
    More than 7,300 people waited longer than 24 hours for emergency treatment in Scottish hospitals last year, with the longest wait more than 122 hours. Public Health Scotland statistics obtained by Scottish Labour through freedom of information (FoI) revealed that 7,367 patients were in an emergency department for more than 24 hours before being discharged, admitted or transferred in 2023. The longest wait in A&E last year occurred at NHS Ayrshire and Arran’s University Hospital Crosshouse, where a patient waited more than 122 hours, or the equivalent of five days. Waits of more than 88 hours were recorded in NHS Borders, and 72 hours in NHS Lanarkshire. Dame Jackie Baillie, Scottish Labour’s health spokeswoman, has demanded action from Neil Gray, the health secretary. “Scotland’s A&E departments are in the grip of a deadly crisis, with lives being put on the line day in and day out,” she said. “That some people have waited days — even a working week — to be seen is dangerous and disgraceful. “Hard-pressed A&E staff are working tirelessly to look after patients, but SNP mismanagement has created a perfect storm in our hospitals. Neil Gray has inherited an NHS in deadly disarray from his colleagues. “It’s time for action to be taken now to bolster A&E departments by tackling delayed discharges and investing in primary care to avoid putting further pressure on hospital services.” Read full story (paywalled) Source: The Times, 11 March 2024
  21. News Article
    Distressed elderly patients are being “treated like animals” and left begging for care as NHS staff struggle to cope with overwhelmed wards and an ever-increasing ageing population, an investigation by The Independent has revealed. Scores of families have come forward to share harrowing allegations of neglect as one top doctor warns that elderly people are receiving care “well below the standards they should expect” – including long waits in waiting rooms and “degrading” corridor care. In one shocking case, a 96-year-old patient admitted to the hospital with a urinary tract infection (UTI) was allegedly left semi-naked and delirious in his hospital bed – before choking on vomit after being sedated without his family’s permission, his daughter told The Independent. Another patient, 99, was traumatised after being left in a bed next to the body of a dead woman. The investigation was sparked by the horrific story of 73 year old Martin Wild who was left so desperate for pain medication he was forced to call 999 from his hospital bed. It comes as analysis by the Independent shows the government was warned three times last year by coroners over the increasing risk to elderly patients’ lives amid fears they are not being “effectively safeguarded”. Read full story Source: The Independent, 11 March 2024
  22. News Article
    Long A&E waits have got worse at more than one in five acute trusts, despite an improving trend nationally. Around 30 acute trusts have reported an increase in long accident and emergency waits, bucking the national trend. According to data covering the nine months to December, the proportion of waits more than 12 hours from time of arrival has improved to 6.3%, down from 8% during the same period in 2022. However, 28 out of 119 acute trusts reported a rise of up to 3 percentage points. HSJ’s analysis, which used published and unpublished data, showed 11 of these trusts had worsened despite improving their headline performance against the four-hour target. Adrian Boyle, of the Royal College of Emergency Medicine, said the emphasis on the four-hour target “incentivises focus on the people who are being sent home, and takes effort and attention away from the people who are being admitted to hospital”. He added: “The harms of long waits are greatest for people being admitted to hospital. We are disappointed by the current lack of focus in the planning guidance to help our most vulnerable patients.” Read full story (paywalled) Source: HSJ, 27 February 2024
  23. News Article
    A newly installed electronic patient record contributed to the “preventable” death of a 31-year-old woman in an emergency department, a trust has been warned. Emily Harkleroad died at University Hospital of North Durham in December 2022 following “failures to provide [her] with appropriate and timely treatment” for a pulmonary embolism, a coroner has said. The inquest into her death heard emergency clinicians had raised concerns about a newly installed electronic patient record, provided by Oracle Cerner, which they said did not have an escalation function which could clearly and quickly identify the most critical patients. The inquest heard the new EPR, installed in October 2022, did not have a “RAG rating” system in which information on patient acuity “was easily identifiable by looking at a single page on a display screen” – as was the case with the previous IT system. The software instead relied on symbols next to patients’ names which indicate their level of acuity when clicked on, but did “not [provide] a clear indication at first glance” of their level of acuity. Rebecca Sutton, assistant coroner for County Durham and Darlington, said that “errors and delays” meant Ms Harkleroad did not receive the anticoagulant treatment that she needed and “which would, on a balance of probabilities, have prevented her death”. “It is my view that, especially in times of extreme pressure on the emergency department, a quick and clear way of identifying the most critically ill patients is an important tool that could prevent future deaths.” Read full story (paywalled) Source: HSJ, 23 February 2024
  24. Content Article
    On 18 December 2022, Emily Harkleroad collapsed when out with a friend. She was taken by ambulance to the University Hospital of North Durham Emergency Department. Despite staff recognising that pulmonary embolism was the likely diagnosis, there were failures to provide Emily with appropriate and timely treatment for pulmonary embolism. Errors and delays in the Emily’s medical treatment resulted in her not receiving the anticoagulant treatment that she needed, and which would, on a balance of probabilities, have prevented her death. She died as a result of pulmonary embolism in the early hours of 19 December 2022 at the University Hospital of North Durham.
  25. Content Article
    Corridor nursing is increasingly being used in the NHS as demand for emergency care grows and A&E departments struggle with patient numbers. In this anonymous account, a nurse shares their experience of corridor nursing, highlighting that corridor settings lack essential infrastructure and pose many safety risks for patients. They also outline the practical difficulties providing corridor care causes for staff, as well as the potential for moral injury.  Using the System Engineering Initiative for Patient Safety (SEIPS) framework, they describe the work system, the processes and how that influences the outcomes.
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