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Found 432 results
  1. News Article
    NHS England has revealed a new intervention regime, as it seeks to deliver on its new urgent and emergency care recovery plan. Systems will be placed in three “tiers of intervention”, with those systems deemed “off-target on delivery” being given “tier three intensive support” from NHSE, which will include on-the-ground planning, analytical and delivery capacity, “buddying” with leading systems and “targeted executive leadership”. The approach follows that which has been taken over the past year for elective and cancer care recovery. The urgent care plan, published by NHSE and the Department of Health and Social Care today, says: “NHS England will identify and share good practice so that all can learn from the best. For those systems that are struggling, we will offer support to ensure that they have the best opportunities to drive improvement locally.” Read full story (paywalled) Source: HSJ, 30 January 2023
  2. News Article
    Charging for GP appointments will worsen patient safety and drive more people to A&E, the head of a national safety watchdog has warned. Dr Rosie Benneyworth, the chief investigator for the Healthcare Safety Investigation Branch (HSIB), was responding to a suggestion by former health secretary Sajid Javid who said the present model of the NHS was “unsustainable”. He said “extending the contributory principle” should be part of radical reforms to tackle growing waiting times. But Dr Benneyworth said it would only drive more people to seek help from already overstretched services. She said: “I don’t want to be drawn into the politics around this but I believe in free at the point of delivery NHS and my concern would be [if] we charge people that people would not come forward early for their care and that would leave people needing more urgent and emergency care, because of delayed presentations.” Dr Benneyworth said there needed to be a bigger focus on patient safety in services outside of A&E, such as NHS 111 and out-of-hours services. Read full story Source: The Independent, 26 January 2023
  3. News Article
    NHS 111 sends too many people to accident and emergency departments because its computer algorithm is “too risk averse”, the country’s top emergency doctor has warned. Dr Adrian Boyle, president of the Royal College of Emergency Medicine (RCEM), said that December was the “worst ever” in A&E with 9 in 10 emergency care leaders reporting to the RCEM that patients were waiting more than 24 hours in their departments. Asked what measures could help improve pressures in emergency care, Dr Boyle said more clinical input was needed in NHS 111 calls. “In terms of how we manage people who could be looked after elsewhere, the key thing to do is to improve NHS 111,” Dr Boyle told MPs. “There is a lack of clinical validation and a lack of clinical access within NHS 111 - 50 per cent of calls have some form of clinical input, there’s an awful lot which are just people following an algorithm.” Dr Boyle added where clinical input is lacking “it necessarily becomes risk averse and sends too many people to their GP, ambulance or emergency department”. Read full story (paywalled) Source: The Telegraph, 24 January 2023
  4. News Article
    The new national target to see 76% of A&E patients within four hours by March 2024 has been described as ‘extremely unambitious’ by senior emergency clinicians. Adrian Boyle, president of the Royal College of Emergency Medicine, also told the Commons Health and Social Care Committee that the objective – included in NHS England planning guidance for 2023-24 and agreed with government – could also drive “perverse incentives” for some emergency department managers. The new target to admit, transfer or discharge 76% of patients by the end of 2023-24 is the first time a specific bar has been set against the four-hour standard for several years. In December, just three acute trusts were hitting the new 76% objective. But Dr Boyle told MPs: “The aspiration from NHS England is that we return to a four-hour target performance of 76%. We think that is too unambitious, and we think that is going to create all sorts of perverse incentives, because it’s going to encourage managers and senior clinicians just to focus on people who can be discharged from hospital, without dealing with our problem, which is exit block [people who cannot be admitted as wards are full]. “We think the 76 per cent is an extremely unambitious target. It was 95% – I know that’s going to be a long way to go back to and we haven’t achieved it since 2015, but we would say we need to have a trajectory to a higher target.” Read full story (paywalled) Source: HSJ, 24 January 2023
  5. News Article
    Manchester city council is setting up two special children’s homes to house the increasing number of vulnerable young people who end up stuck in hospital because no residential providers will take them. The homes, believed to be the first of their kind, aim to undercut private operators which sometimes demand tens of thousands of pounds each week to look after children with the most complex needs. Five Manchester children with complex emotional needs spent many weeks in hospital in 2022 because no children’s homes would take them because of their challenging behaviour, according to the city council’s director of children’s services. Manchester council has developed what it calls the Take a Breath model. Two houses are being renovated to house up to four children in total, with the first hopefully moving in by March. The idea is that when children first turn up at hospital – often at accident and emergency after a suicide attempt or self-harming incidents – once their injuries have been treated they can be discharged straight into the new homes rather than occupying a paediatric bed they do not need. Jointly commissioned by the council and the NHS, the two homes will cost £1.4m a year. Of that, MCC expects to spend £5,500 a week for each child. It represents a huge cost saving compared with some external placements. Last year the council was charged £16,550 a week by one private provider to look after a young profoundly autistic person with learning difficulties deemed a danger to themselves and to others. Read full story Source: The Guardian, 22 January 2023
  6. News Article
    Being placed on immunotherapy to treat Stage 4 cancer was a life-saver for Imogen Llewellyn. Three years on, the 34-year-old is currently cancer-free, but said if it was not for specialist doctors, the side effects could have killed her. The Royal College of Physicians (RCP) claims Wales needs more oncology experts in A&E to recognise and treat emergencies. The Welsh government said all acute hospitals were expected to have an acute oncology service. The RCP report wants investment in emergency cancer care because of the sheer volume of patients who need urgent care during their treatment. With about a fifth of acute hospital beds occupied by people who have a cancer-related problems, they add that about a third of admissions could be avoided if same-day care were more widely available in Wales - which in turn would relieve pressure on hospitals. Dr Hilary Williams, consultant oncologist and Wales Cancer Network lead for acute oncology, said: "Wherever a patient lives in Wales, they should be able to access excellent acute oncology services. "When people think about cancer treatment, they might think about undergoing surgery or receiving chemotherapy, radiotherapy or immunotherapy in an organised way, perhaps during weekday hours in a specialist centre. But what happens when an emergency arises?" Read full story Source: BBC News, 24 January 2023
  7. News Article
    A record 350,000 patients waited more than 12 hours to be admitted to hospital from A&E last year, according to figures that raise fears about unsafe care as the NHS faces further waves of strike action. The figures, uncovered in an analysis by the Liberal Democrats, show a steep rise in delays since 2015, when just 1,306 patients waited 12 hours. Senior doctors described the situation as “unbearable” for patients and staff, ahead of a strike in which thousands of ambulance workers will walk out across England and Wales on Monday. The Liberal Democrat leader, Ed Davey, warned that frequent and lengthy delays in emergency medicine are “needlessly costing lives of patients” and said that the government is in “total denial” about the scale of the problem facing hospitals, social care and GP services. “The failure of the Conservative government to grip this crisis is simply unforgivable,” he said. “Instead they have shamefully allowed the situation to go from bad to worse through years of neglect and failure.” Read full story Source: The Guardian, 23 January 2023
  8. News Article
    A growing number of patients deemed to require a hospital admission are waiting so long in A&E that they end up being discharged before being admitted to a ward, HSJ has been told. A senior emergency clinician, who has delivered improvement support to multiple emergency departments across the NHS, said such cases have become a regular occurrence – describing it as a “terrible experience” for some patients. The clinician, who asked not to be named, said: “I suspect every ED in the country are having patients who are spending 24 to 48 hours in ED under the care of a specialist, that in a better time they would have gone onto a ward. That’s happening every day in every department. “If you have been seen by the ED crew and referred to the medics who say ‘you need to be admitted to hospital’, the chances are that they are sick enough that they really do need that bed. “It’s a terrible experience [for the patients]. EDs are busy, noisy and crowded. This is not the place where, if you were feeling ill, to get better in a calm, relaxing area. This idea that somehow it’s OK because these people are not that sick, it’s pretty poor. “It feels very much like battlefield medicine – slap a patch on and try and get them back into battle as quickly as possible. It shouldn’t be the way with civilian healthcare.” Read full story (paywalled) Source: HSJ, 23 January 2023
  9. News Article
    Ask any MP or local Healthwatch what health issue sits at the top of their inbox, and there is a good chance it will be the public’s access to NHS dentists. The launch of a Health and Social Care Committee inquiry into dentistry is therefore welcome news. The inquiry is well timed, coming after a recent BBC investigation showing that 90% of practices across England were not accepting new adult NHS patients. The severe access problems stem from several factors. Longstanding issues relating to the dental contract not offering high enough rates for dentists to provide NHS care, for example, have contributed to a decline in the availability of NHS dentistry. This has led to thousands of people across the country going private or, very concerningly, turning to self-care. Accident and emergency departments are over-flowing with people in severe dental distress, with tooth decay being the most common reason for hospital admission among children aged five to nine in recent years. Read full story (paywalled) Source: HSJ, 19 January 2023
  10. News Article
    Pressures on emergency health services are so bad that the UK government should declare a “national emergency” and call a meeting of the Civil Contingencies Committee (COBRA)—the body summoned periodically to deal with matters of major disruption—peers have said. The cross party House of Lords Public Services Committee said in a report that the government needed to respond with an emergency approach and steps to remedy the situation in the longer term. A recurring theme of the report is the substantial delays highlighted by the media in recent months, which peers said were caused by a “broken” model of primary and community care. This was driving unmet need in directing patients to hospitals where many remained longer than clinically necessary because of inadequate social care. The report recommended that the Department of Health and Social Care should mandate a greater presence of clinical staff in NHS 111 control centres to help boost numbers of clinicians in the 999 and 111 services. This would mean that patients were directed to the right services more quickly thanks to better triaging of calls, which could mean fewer patients being passed to emergency or urgent care services. Another suggestion was for the government to introduce more incentives for faster safe discharges from hospitals, with more capacity in hospitals and social care to help people move through the health system more quickly. Read full story Source: BMJ, 19 January 2023 Further reading on the hub: Patient safety impact of hospital bed shortages – A Patient Safety Learning blog
  11. News Article
    The fact that the NHS is under enormous pressure is undisputed. Almost everything else is debated, including the question of how many patients are dying as a result of the chaos in hospitals. The proportion of patients who wait more than 12 hours in A&E departments to be admitted to a ward has risen from 2% to 7% over the past year. The Royal College of Emergency Medicine has estimated that delays in A&E are leading to 300-500 additional deaths per week. However, officials at NHS England do not accept this figure. The data suggest that something is very awry. Read full story (paywalled) Source: The Economist, 11 January 2023
  12. News Article
    Young people in the midst of a mental health crisis need to have attempted suicide several times before they get a bed in an inpatient unit in England, a report has revealed. Admission criteria for beds in child and adolescent mental health units are now so tight that even very vulnerable under-18s who pose a clear risk to themselves cannot get one. The practice – caused by the NHS’s lack of mental health beds – leaves young people at risk of further harm, their parents confused, exhausted and worried, and the police and ambulance services potentially having to step in. The high thresholds for admission to a child and adolescent mental health services (Camhs) unit are detailed in a report on NHS mental health care for under-18s in England based on interviews with patients, their parents and specialist staff who look after them. The report says a young person has to “have attempted suicide multiple times to be offered inpatient support”. Olly Parker, the head of external affairs at the charity Young Minds, said: “It is shameful that children and young people are reaching crisis point before they get any support for their mental health. We know from our own research that thousands have waited so long for mental health support or treatment that they have attempted to take their own life. “Those who end up in A&E are often there because they don’t know where else to turn. But A&E can be a crowded and stressful environment, and is usually not the best place to get appropriate help.” Read full story Source: The Guardian, 18 January 2023
  13. News Article
    An acute trust chief executive has criticised the lack of communication during last month’s nursing strike, warning that he and other accountable officers could face manslaughter charges if patients are put in danger by decisions made by senior colleagues elsewhere in the system. Matthew Hopkins told a board meeting that Worcestershire Royal Hospital’s emergency department was “pushed to the extreme” on 20 December, with 176 people squeezed into a facility originally built for 50. He said that without warning from regional colleagues, an additional 18 people were brought in to the hospital by the ambulance service and ended up in corridors, at which point the trust declared a critical incident. The chief executive officer said he wanted to put on record an apology to staff for the incident, adding that he was “not aware” of the situation until it unfolded. Read full story (paywalled) Source: HSJ, 17 January 2023
  14. News Article
    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." Read full story Source: The Guardian, 12 January 2023
  15. News Article
    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.” Read full story (paywalled) Source: The Times, 12 January 2023
  16. News Article
    An investigation by The Independent has revealed that the number of patients waiting more than 12 hours in A&E for treatment has exceeded 50,000 a week for the first time. Leaked NHS data shows that last month as many as one in eight patients faced a “trolley wait”—the time between attending A&E and being admitted—longer than 12 hours, as the health service comes under ever greater strain. Sources across the country told The Independent that hospitals are having to “squeeze” patients into spaces other than normal wards or A&E, with no direct oxygen lines. Meanwhile patients wait for hours in ambulances outside emergency departments. Read full story Source: The Independent, 11 January 2023
  17. News Article
    Patients have suffered cardiac and respiratory arrests because of errors using oxygen cylinders, NHS England has warned, citing more people being cared for in “areas without access to medical gas pipeline systems” such as corridors and ambulances queuing outside A&E. A patient safety alert issued by NHS England today identifies 120 incidents in the past year related to oxygen cylinder use, including cylinders either being empty at point of use, not switched on, inappropriately transported, or inappropriately secured. Some of the incidents involved “compromised oxygen delivery to the patient, leading to serious deterioration and cardiac or respiratory arrest” the alert said, and at least 43 caused harm. Read full story (paywalled) Source: HSJ, 10 January 2023
  18. News Article
    Nigel Edwards is the Chief Executive of the think tank the Nuffield Trust. In this interview, he outlines the discharge problems currently faced by NHS hospitals, highlighting lack of staff and resources in the social care sector as major causes of hospital capacity issues. Source: Channel 4 News
  19. News Article
    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
  20. News Article
    The extent of the gridlock in hospitals over Christmas has been revealed, with data in England showing record numbers of ambulances delayed dropping off patients at A&E. More than 40% of crews were forced to wait at least half an hour to hand over patients in the week up to 1 January. That is the highest level since records began a decade ago. But there is hope pressures could soon start easing, with flu and Covid admissions dropping last week. But the UK Health Security Agency is warning it is too early to say whether the flu season - the worst in a decade - has peaked, because reporting lags over the festive period may have affected the data. And Matthew Taylor, of the NHS Confederation, which represents hospitals, said wards were still incredibly full, which was creating delays in A&E and for ambulances. He said hospitals were facing "crisis conditions" that were presenting a risk to patients. Read full story Source: BBC News, 5 January 2023
  21. News Article
    Junior doctors have threatened to stage a “full walkout” for three consecutive days in March in which they would not treat A&E patients. The British Medical Association told the government this morning that junior doctors would strike for 72 hours if it is supported in a ballot that opens next week. The association said that “doctors will not provide emergency care during the strike”, which is likely to worsen deadly accident and emergency delays. Hospital bosses said they were “deeply worried” by the BMA’s announcement, urging the government to start negotiating rather than “sitting back and letting more strikes happen”. NHS bosses fear that the BMA will co-ordinate strike action with the nursing and ambulance unions if the dispute is allowed to rumble on. Nurses will strike on January 18 and 19, and ambulance workers are due to walk out on January 11 and 23. Read full story (paywalled) Source: The Times, 6 January 2023
  22. News Article
    A man turned up to an accident and emergency department in the Midlands complaining about ear wax on the day a hospital declared a critical incident, a nurse who works there has said. Lesley Meaney, a sister at University Hospitals of North Midlands (UNHM), said the patient presented to A&E with “no pain, no discomfort, just eat war wax!” Earlier on 30 December officials at the trust declared a critical incident, citing “extremely high demand for all of our services.” The disclosure by Ms Meaney underlines the scale of the challenge facing the NHS and staff working in hospitals across the country. Writing on Twitter, Ms Meaney added: “Seriously what is up with the general population? A major incident declared, ambulances queuing, and you decide to come to the emergency department on New Year’s Eve with ear wax.” Dr Matthew Lewis, medical director at UNHM, said: “The accident & emergency departments at UHNM are some of the busiest in the country so we would urge the public to only come to our Emergency Departments if it’s for serious, life-threatening conditions that need immediate medical attention, such as persistent severe chest pain, loss of consciousness, acute confusion, severe blood loss, serious burns, broken bones, suspected stroke. Read full story Source: The Independent, 4 January 2023
  23. News Article
    The crisis engulfing the NHS will continue until Easter, health leaders have warned, as senior doctors accused ministers of letting patients die needlessly through inaction. More than a dozen trusts and ambulance services have declared critical incidents in recent days, with soaring demand, rising flu and Covid cases and an overstretched workforce piling pressure on the health service. But amid warnings that up to 500 people a week may be dying due to delays in emergency care alone, and of oxygen for seriously ill patients running out in parts of England, NHS leaders warned more chaos was expected until April. “It seems likely that the next three months will be defined by further critical incidents needing to be declared and the quality of care being compromised,” said Matthew Taylor, chief executive of the NHS Confederation, which represents the whole healthcare system in England, Wales and Northern Ireland. Ministers face growing pressure to grip the crisis. The British Medical Association (BMA) said the government’s “deafening” silence and failure to act was a “political choice” that was leading to patients “dying unnecessarily”. The Liberal Democrats urged the government to recall parliament, while Labour blamed government “mismanagement” for creating a sense of “jeopardy” around the NHS. Read full story Source: The Guardian, 2 January 2022
  24. News Article
    Patients should “make their own way to hospital” if they can do so during Wednesday’s strike by ambulance workers, a cabinet minister said yesterday, as the government warned that the industrial action would put lives at risk. Senior government figures said that ambulance unions had still not agreed national criteria for what conditions would be considered life threatening and responded to during the strike. Steve Barclay, the health secretary, is understood to be writing to all striking unions, including nurses, seeking discussions on patient safety. Yesterday Oliver Dowden, the Cabinet Office minister, said people should still call 999 in an emergency but might in less serious cases have to make their own way to hospital. “We are working to ensure that if you have a serious injury, in particular a life-threatening injury, you can continue to rely on the ambulance service, and we would urge people in those circumstances to dial 999,” he told Sunday with Laura Kuenssberg on BBC1. “If it is the case that you have less serious injuries, you should be in touch with 111, and you should seek to make your way to hospital on your own if you are able to do so.” Read full story (paywalled) Source: The Times, 19 December 2022
  25. News Article
    Patients are not safe from harm in three out of seven emergency departments, a damning new Hiqa inspection report has revealed. The report was released on the same day as an Oireachtas committee was warned of a growing crisis in primary care, with patients in some parts of the country unable to access basic GP services. Emergency Departments in Cork University Hospital (CUH) and University Hospital Limerick (UHL) were among seven EDs assessed by the health watchdog. In three EDs, including Cork and Limerick, inspectors found failures to ensure “service providers protect service users from the risk of harm.” Inspectors also found patients’ “dignity, privacy and autonomy” was not respected in UHL, while CUH was only partially compliant in this area. The report also highlighted lengthy waiting times, including one patient who spent 116 hours on a trolley at UHL. Read full story Source: The Irish Examiner, 15 December 2022
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