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Found 435 results
  1. News Article
    Hospitals “desperate” to free up beds could be putting patients in danger, The Independent has been told. NHS trusts are being forced into “risky behaviours” in the push to free up hospital beds and A&E departments, experts have warned. It comes as new data reveals that waits for ambulance crews outside hospitals hit 26 hours in September, with more than 4,000 patients likely to have experienced severe harm due to delays. In documents leaked to The Independent, hospital leaders in Cornwall warned staff that current pressures in its emergency care system combined with ambulance delays have “tragically resulted in deaths”. Royal Cornwall Hospitals Trust and the Cornwall Partnership NHS Foundation Trust said in the document that ambulance delays and waits in A&E were causing a “risk to life”, and that as a result they were planning to begin discharging patients into the care of the voluntary sector. The document said: “It is likely that the risk of such support not meeting all the patients’ individual requirements is less than the risk to life currently experienced in the community when there are significant handover delays at the hospital front doors.” It comes as North West Ambulance Service launched an investigation after a patient died waiting in the back of an ambulance outside A&E, the Manchester Evening News reported. Read full story Source: The Independent, 24 October 2022
  2. News Article
    A patient flow model which involves moving A&E patients to wards “irrespective” of whether there are beds available, is under review for wider rollout by NHS England and is being endorsed by senior clinicians, despite safety fears, HSJ has learned. The Royal College of Emergency Medicine has said it would be “unethical” for leaders not to at least consider implementing some form of “continuous flow” model for emergency patients. The approach has been been trialled recently by North Bristol Trust and at several London trusts. HSJ understands NHS England is considering the wider implementation of the continuous flow model, although no final decision has yet been made. The calls come despite patient safety concerns about the model being raised by the Nuffield Trust think tank, who said the evidence for the model is “poor” and could spread risk to other parts of the hospital. Read full story (paywalled) Source: HSJ, 21 October 2022
  3. News Article
    Paramedics in England cannot respond to 117,000 urgent 999 calls every month because they are stuck outside hospitals looking after patients, figures show. The amount of time ambulance crews had to wait outside A&E units meant they were unavailable to attend almost one in six incidents. Long delays in handing patients over to A&E staff meant 38,000 people may have been harmed last month alone – one in seven of the 292,000 who had to wait at least 15 minutes. Of those left at risk of harm, 4,100 suffered potential “severe harm”, according to the bosses of England’s ambulance services. Read full story Source: The Guardian, 21 October 2022
  4. Content Article
    'State of Care' is the Care Quality Commission's annual assessment of health care and social care in England. The report looks at the trends, shares examples of good and outstanding care, and highlights where care needs to improve.
  5. News Article
    The NHS is setting up “war rooms” as it prepares for one of the toughest winters in its history, officials have announced. In a letter to staff, health leaders in England set out “winter resilience plans”, which include new system control centres that are expected to be created in every local area. These centres will be expected to manage demand and capacity across the entire country by constantly tracking beds and attendances. They will be operated by clinicians and experts who can make quick decisions about emerging challenges in the health service, NHS England said. The data-driven centres will be able to spot when hospitals are near capacity and could benefit from mutual aid. Where A&Es are especially busy, ambulances will be diverted to nearby hospitals with more space. Meanwhile, NHS England announced plans to expand falls response services so people are treated in their homes, avoiding unnecessary trips to hospital where possible. NHS England’s chief executive, Amanda Pritchard, said: “Winter comes hot on the heels of an extremely busy summer – and with the combined impact of flu, Covid and record NHS staff vacancies – in many ways, we are facing more than the threat of a ‘twindemic’ this year. “So it is right that we prepare as much as possible – the NHS is going further than it ever has before in anticipation of a busy winter, and today we have set out further plans to step up these preparations – building on our existing plans to boost capacity set out in August this year." Read full story Source: The Guardian, 19 October 2022
  6. News Article
    Angry exchanges between paramedics and A&E staff in Liverpool have broken out after new measures were deployed to hold and treat patients in the back of ambulances. Sources said there have been “Mexican standoff” situations at Aintree Hospital in recent days, after hospital staff insisted patients who had been brought inside should be returned to ambulance vehicles. Staff at North West Ambulance Service told HSJ they were informed of a new protocol last week, which said patients should be kept in the back of ambulances if the corridor of the emergency department is full with patients. There have been repeated orders from NHS England and the Care Quality Commission over the past year for hospitals to ensure patients can be offloaded by ambulance crews, even if they fear they do not have adequate staffing or beds to accept them. One senior source at NWAS said: “To see a new protocol like this is absolutely unprecedented. I very much doubt the execs had approved it. “We’ve had Mexican standoff situations over the weekend with crews who have brought patients into ED being told to take them back out to their vehicles, but they’ve refused to do this as it means they cannot cohort. “We completely accept that taking extra patients means the ED and hospital staff have to deal with additional and unacceptable risk, but holding ambulances is not the solution because the risks to patients out in the community are even greater. Despite repeated instructions from NHS England and the CQC this still doesn’t seem to be understood.” Read full story (paywalled) Source: HSJ, 17 October 2022
  7. News Article
    Staff at accident and emergency departments across Scotland have expressed “deep concern” at the daily “excessively long waiting times” that are forcing a record number of patients to wait more than 12 hours, according to a leading NHS consultant. Dr John-Paul Loughrey, vice-chair of the Royal College of Emergency Medicine Scotland national board, warned that while such long waits were once regarded as “never events,” they are now daily occurrences. Amid fears the delays will spike significantly over the winter months, especially with another wave of Covid-19 expected, Dr Loughrey said staff were already “burned out,” “exhausted,” and “overwhelmed with a system facing increasing strain.” The latest weekly data on A&E treatment shows that in the week ending 2 October, the number of patients waiting more than 12 hours had soared by 45% week-on-week. “There is deep concern among staff around the excessively long waiting times,” Dr Loughrey said. “The weekly data that show significant increases in long waits translates to real patients on the ground or in the community who are seeking urgent and emergency care. “The system is failing them. We know that long waiting times are associated with patient harm and even death. Staff face moral injury daily, but they are working incredibly hard and doing all they can to minimise this harm to patients.” Read full story Source: The Scotsman, 16 October 2022
  8. News Article
    Senior doctors have sent a warning over the “shambles” of heart attack care after pressures on the NHS have left patients waiting eight hours for an ambulance. The caution comes as several hospitals in the past week have declared critical incidents over the level of pressure on their emergency care services. Portsmouth Hospital said on Monday: “Demand for an emergency response is far outstripping the capacity available in Portsmouth and South East Hampshire at this time.” Professor Mama Mamas, a consultant cardiologist in Stoke and Professor of Cardiology at Keele University, told The Independent: “I was on call this weekend and I was seeing delays of eight hours. It was several people, three or four this weekend with heart attacks that waited between four and eight hours … it’s a national disgrace that we’re in this situation. “I think that patient care is being compromised. We know that time is muscle and an eight-hour delay getting an ambulance to a patient with a heart attack is impacting on the survival levels.” Read full story Source: The Independent, 13 October 2022
  9. News Article
    Mental health patients are increasingly having to turn to A&E for help, experts have warned, as new research suggests nearly one in four are being forced to wait more than 12 weeks to start treatment. The Royal College of Psychiatrists said its research found 43% of adults with mental illness say the long waits for treatment have led to their mental health getting worse. Almost a quarter (23%) have to wait more than 12 weeks to start treatment, with many so desperate they turn to A&E or dial 999. The college said many people face a “hidden wait time” for starting treatment, with no publicly available data on how long people wait from their initial referral to actually starting treatment. Those surveyed for the research had a range of mental illnesses, including eating disorders, addiction, bipolar disorder, anxiety and depression. Dr Kate Lovett, the college’s presidential lead for recruitment, said: “We cannot sit idly by and watch the most vulnerable people in our society end up in crisis. Not only do spiralling mental health waiting times wreak havoc on patients’ lives, but they also leave NHS services with the impossible task of tackling rising demand.” One female patient, a 45-year-old from south London, told how she ended up in A&E after having to wait seven months to be referred to a community team. “The only other way to get help was to present to A&E, which was a traumatic experience – having to be reassessed and readmitted again and again. Turning up to A&E was the only way I could be seen regularly. No one should have to go through that.” Read full story Source: The Guardian, 10 October 2022
  10. Content Article
    This article tells the story of two-year-old Chloe, who died after hospital staff failed to recognise that she had meningitis, sending her home after her parents first took her to A&E. The NHS Trust carried out an internal investigation which identified many areas where care should have been better and set out a range of recommendations for improving care of children in A&E in the future. The Trust only apologised to the family after an out-of-court settlement was made.
  11. News Article
    Several ambulance trusts have moved to the highest level of alert in the wake of severe pressure on emergency services in recent days. Internal data seen by HSJ suggests ambulance response times have deteriorated dramatically, while the average time for call handlers to answer 999 calls has increased to almost two minutes in some areas. Staff across the country have been sounding the alarm over the pressures, with one senior source saying the situation was “really dire” again, after a period in which pressures had eased in August and September. The internal data showed ambulance trusts in the South West, East of England, London and the West Midlands had all declared the highest level of alert, known as REAP 4. More are expected to follow. The average response time for category 2 calls in the South West – including suspected heart attacks and strokes – was 1 hour 24 minutes, with 10% of these calls responded to in more than 3 hours 11 minutes. The target is 18 minutes. Emergency departments have also faced severe pressure. An emergency care consultant in Plymouth tweeted that patients were facing 70-hour waits to be admitted to wards, with some waiting 18 hours to be handed over by ambulance staff. Fionna Lowe added: “I have taken to asking families to feed their relatives. It has never been this bad.” Read full story (paywalled) Source: HSJ, 4 October 2022
  12. News Article
    Tina Hughes, 59, died from sepsis after doctors allegedly delayed treating the condition for 12 hours while they argued over which ward to treat her on. Ms Hughes was rushed to A&E after developing symptoms of the life-threatening illness on September 8 last year. Despite paramedics flagging to staff they suspected sepsis, it was not mentioned on her initial assessment at Sandwell General Hospital, in West Bromwich. A second assessment six hours later also failed to mention sepsis while medics disagreed over whether to treat her on a surgical ward or a high dependency unit. The grandmother-of-five was eventually transferred to the acute medical unit at 3am the next morning where sepsis was finally diagnosed, but she continued to deteriorate and was admitted to intensive care four hours later and put on a ventilator. She died the following morning. A serious incident investigation report by Sandwell and West Birmingham Hospitals NHS Trust has since found there was "a delay in explicit recognition of sepsis". Read full story (paywalled) Source: The Telegraph, 4 October 2022
  13. News Article
    Hospital trusts are still treating many patients just before the four-hour A&E target deadline, whose proposed abolition was reversed by government last week, HSJ analysis has revealed. Several of those still treating large proportions of attenders in the 10 minutes before the cut-off are among the top performers on the target. NHS England’s 2019 clinical review of standards had proposed to scrap the four-hour target, claiming it was no longer the most appropriate or effective measure. NHSE had planned to replace it with a new bundle of measures, such as the average time spent in emergency departments. It has been trialling these at 14 trusts for more than two years, with enforcement of the four-hour target by NHSE being substantially wound down. The move to end use of the four-hour target was never officially endorsed by government, but both Matt Hancock and Sajid Javid indicated they backed the idea. However, their successor as health and social care secretary, Therese Coffey, announced that she would not be abolishing it. Royal College of Emergency Medicine president elect Adrian Boyle warned this “target-associated” patient flow could be “diverting clinicians away from more sick cases to people with lower acuity”. He added “the scrutiny and managerial grip that used to go with [the target]” has been “taken away”. Read full story (paywalled) Source: HSJ, 27 September 2022
  14. News Article
    The four-hour emergency care target is “not the right answer” long term, but services have been left “in limbo” by Therese Coffey’s promise that it will no longer be scrapped, the president of the Royal College of Emergency Medicine has said. Katherine Henderson said RCEM was “delighted” there could be more focus on the four-hour target in the short term following the health and social care secretary’s surprise comment last week, as emergency care has been “in a performance policy vacuum since before the pandemic”. But Dr Henderson said that in the long term there should be performance metrics that account for the “journey” of the most acutely unwell patients, and should be a further review of NHS England’s clinical review of standards – which proposed a suite of new measures to replace the totemic four-hour target. She added that more than a dozen A&Es which are involved in trialling the new measures have been “left in limbo”. Dr Henderson, whose term as RCEM president ends in October, said plans to use virtual wards and urgent community response teams to improve patient flow and prevent emergency admissions would have limited impact this winter due to a lack of staff. Read full story (paywalled) Source: HSJ, 26 September 2022
  15. News Article
    Therese Coffey has pledged there will be no changes to the four-hour target for A&E waiting times – despite NHS England’s prolonged bid to axe the controversial measure. The new health and social care secretary told the House of Commons Thursday: “I can absolutely say there will be no changes to the target for four-hour waits in A&E.” Ms Coffey’s comments appear to represent a major blow to NHS England, which has since 2019 been pushing for a new bundle of metrics to replace the target. Fourteen trusts have been trialling these, which include measures such as average time spent in an emergency department and 12-hour waits from time of arrival, as part of the Clinical Review of Standards. NHSE had also, after a protracted battle, secured the support of key stakeholders, including the Royal College of Emergency Medicine, NHS Providers and Heathwatch England, to back its plans to ditch the target, for so long the NHS’s most significant performance metric. The bold position – with Ms Coffey just weeks into the role – also contradicts the stance taken by both recent predecessors Sajid Javid and Matt Hancock, who both signalled they were supportive of scrapping the target. Read full story (paywalled) Source: HSJ, 22 September 2022
  16. News Article
    Performance on waiting times targets at Scotland's hospital A&E units has hit a new low. Figures for the week ending 11 September showed just 63.5% of patients were dealt with within four hours. Health Secretary Humza Yousaf said the figures were "not acceptable" and he was determined to improve performance. Scottish Tory health spokesman Dr Sandesh Gulhane said the figures showed the "crisis in A&E is not merely continuing, but deepening". The Scottish government target is that 95% of patients attending A&E are seen and subsequently admitted or discharged within four hours. Doctors working in emergency medicine have issued stark warnings recently about the impact of long waits in A&E. It is simply not safe, and patients are dying as a result, they say. Read full story Source: BBC News, 20 September 2022
  17. News Article
    Therese Coffey is considering abolishing four-hour A&E waiting time targets as part of her “emergency plan” to tackle the NHS. The new health secretary is understood to be looking at a range of measures to address the growing crisis in the NHS, understood to be announced next Thursday. But a source close to the discussions told The Independent getting rid of the four-hour waits – first suggested in March 2019 – would have to be given the green light by the new prime minister Liz Truss. The announcement will focus on the health secretary’s “ABCD” priorities – standing for “ambulances, backlog, care, dentists and doctors” – with improvements to mental health services as an addition. Policies also being looked at include more call handers for ambulances, more diagnostic community centres, speeding up the hospital building programme, reducing “bureaucratic” burdens on GPs, improving direct access to counselling services for patients and “robust” management of the national dentists’ contract. There is concern among those involved that the move would see the four-hour wait replaced by a new target, which could be as difficult as the current target to achieve. Read full story Source: The Independent, 18 September 2022
  18. Content Article
    Are you applying Safety-II principles to improve safety in maternity, A&E, ICU or anaesthetics? If so, Dr Ruth Baxter would love to interview you!
  19. News Article
    The NHS needs to do more to support care homes and people who have fallen with alternatives to ambulance calls and hospital admissions, the NHS England chief executive has said. Speaking at the Ambulance Leadership Forum, Amanda Pritchard acknowledged this winter would be a difficult one for the health service, saying: “The scale of the current and potential challenge mean that we do need to continue to look further for what else we can do… We need to pull out all the stops to make sure that they [patients] get that treatment as safely as possible and as quickly as possible.” She added one area of focus should be making sure certain patient groups can access other – more appropriate – forms of care, rather than calling an ambulance by default and often resulting in hospital admission. On care homes, she said: “Can we wrap around even more care for these care homes so they get to the point where they don’t need to call for help at all or, if they do, there are alternatives pathways [to the emergency department]?” She suggested another area where responses could be made more consistent was for patients who had fallen but without serious injuries, which she said made up a “really significant part of activity”. These patients took a long time to reach and, if admitted to hospital, risked long admissions, she said. Some areas were working to find other ways of responding to non-injury falls patients and trying to keep them away from hospital, she said. Read full story (paywalled) Source: HSJ, 6 September 2022
  20. News Article
    NHS trusts across London are set to start moving patients from A&E onto wards “irrespective” of whether there are beds available, The Independent has learned. The new model, which involves moving patients every two hours out of A&E and onto wards called acute medical units, has prompted concerns that patients could be “double lodged” on hospital wards. The move follows the trial of a new system by North Bristol NHS Trust last month, which said it would be moving three patients every hour from A&E onto wards in a bid to address severe ambulance handover delays. On Thursday, health secretary Steve Barclay said that the “number one” priority for the NHS currently is tackling ambulance handover delays, with a “small” number of trusts accounting for half of all delays. In a memo seen by The Independent, NHS clinicians in one hospital were told that London trusts would be rolling out the North Bristol model at “pace” ahead of winter. The system involves moving one patient from A&E onto a ward every two hours “irrespective of bed availability”. Speaking to The Independent, one NHS director said the move would lead to “double lodging” patients, which means squeezing more patients into wards, and that this could be “dangerous” for patients. However, A&E doctors told The Independent that the move should be welcomed, as it spreads the crowding and risk for patients across hospital departments rather than confining it to A&E. Read full story Source: The Independent, 4 September 2022
  21. Content Article
    The pandemic has had an enormous impact on health and care services in the UK. In this article, Nuffield Trust fellows Jessica Morris and Sarah Reed take a closer look at access and waiting times before and after the start of the Covid-19 pandemic. They highlight that before the pandemic, pressure on the system was already reducing access to NHS services and making waiting times longer. Covid-19 has made the situation significantly worse due to the need for heightened infection control practices, rising levels of staff sickness and burnout, the cancellation of routine care and redirection of staff. Enabling services to recover will be challenging given these ongoing pressures and real-term budget cuts for the NHS this year. The article examines the impact of the pandemic on waiting times relating to: General practice Elective (planned) care Diagnostic testing Cancer care A&E Ambulance
  22. News Article
    Record NHS waiting lists cannot be attributed to the pandemic as the health service has been “steadily declining” for a decade, a report says. The number of people waiting for routine hospital treatment in England has almost tripled from 2.5 million in April 2012 to 6.78 million, after reaching 4.6 million in February 2020. While Covid accelerated this trend, analysis suggests that even without the pandemic waiting lists for elective care would stand at 5.3 million. The Quality Watch report, by the Nuffield Trust and Health Foundation think tanks, says the NHS was “already stretched beyond its limits” before Covid struck. Analysis of performance figures show waiting times for scans, A&E and cancer care have been increasing for many years amid chronic staff shortages. This deterioration means thousands of cancer patients each month face unacceptably long waits for treatment — damaging their survival chances. The report found waiting times for 15 key diagnostic tests, such as MRI or CT scans, had also rocketed. In April 2012 632,236 patients were on waiting lists for these tests. This backlog increased to one million by February 2020 before hitting 1.6 million this year. Read full story (paywalled) Source: The Times, 5 September 2022
  23. News Article
    Patients waiting for surgery are turning up at A&E because they “can't cope”, the head of the NHS Confederation has warned. Matthew Taylor, chief executive of the body which represents all areas of the health service, said the NHS was in a "terrible situation" where it was facing "more demand than we can deal with". Some 6.7 million people are waiting to start hospital treatment after being referred by their GP, latest official data show. Urgent and emergency care is also under significant pressure, with 12-hour A&E waits increasing by a third in July to reach 29,317 - the worst on record. "We also know that people, many people, who are sick in the community waiting for operations, for example, and that's one of the reasons people end up in the emergency department because they get to the stage where they can't cope,” Mr Taylor said. "So the problem is that pressures in one part of the system drive pressure in others.” Read full story (paywalled) Source: The Telegraph (30 August 2022)
  24. Content Article
    This study in BMJ Open examines the impacts of the four episodes of industrial action by English junior doctors in early 2016. The authors looked at the impact of the strikes on A&E visits, outpatient appointments and cancellations, admitted patients and all in-hospital mortality. The study concluded that industrial action by junior doctors during early 2016 had a significant impact on the healthcare provided by English hospitals. It also found that t here were regional variations in how these strikes affected providers, and that there was not a measurable increase in mortality on strike days.
  25. Content Article
    This report by the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) examines the quality of care provided to patients aged 16 years and over who were admitted to hospital following an out-of-hospital cardiac arrest (OHCA). The report is based on the findings of a study that looked at the clinical care delivered to patients from the time of an OHCA to discharge from hospital or death. The review of the clinical pathway included the community and emergency service response, hospital admission and inpatient care (in particular cardiac and critical care services). Data were also collected to assess organisational aspects of care within acute hospitals.
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