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Found 421 results
  1. Content Article
    In this Channel 4 Dispatches programme, secret footage filmed over the winter reveals ambulance workers battling the odds and A&E departments overwhelmed as patients suffer needless harm and death The footage comes from Daniel Waterhouse, an emergency medical technician who wore a body-mounted camera during his shifts in north-west London for three months this winter, filming every crumbling layer of a system that is close to total destruction.
  2. Content Article
    Emergency care services in the UK face an unparalleled crisis, with more patients than ever before experiencing extremely long waiting times in Emergency Departments (EDs), associated with patient harm and excess deaths. This explainer from the Royal College of Emergency Medicine (RCEM) outlines the latest data on ED waiting times and the impact this is having on patient safety.
  3. News Article
    As the pressures of winter and the Covid treatment backlog grow, the NHS is struggling. In Manchester, one organisation is pioneering a new way to care for people that tries to reduce the burden on the health service. It's the first call-out of the day for nurse Manju and pharmacist Kara in north Manchester. They are on their way to see Steven, who has been diagnosed with Parkinson's disease and had a fall the previous night. This might have led to a call-out for an ambulance crew and a visit to A&E. But instead the Manchester Local Care Organisation (LCO) stepped in. Once at Steven's house, Manju makes sure he hasn't been harmed by his fall, while Kara checks his medication. Manju notes that Steven's tablets could have contributed to his fall. Manju asks Steven how he copes going up and down the stairs. "I'm OK, just about," he says. But when he has a go at coming down the stairs, Manju spots he could use an extra grab rail and says she will sort one out. This intervention by the team has not only avoided Steven ending up in A&E, but also ensures he can continue to live independently in his own home. That's a key part of the LCO mission, according to Lana McEwan, one of the team leaders in north Manchester. "We would consider ourselves to be an admission-avoidance service, so we're trying to prevent ambulances being called in the first instance. "When an ambulance has been called, we're taking referrals directly from the ambulance service and responding within a one or two-hour response depending on need, and that's an alternative to A&E." Local neighbourhood teams are made up of nurses, social workers, pharmacists and doctors, all working together to keep people out of hospital. Read full story Source: BBC News, 9 December 2022
  4. News Article
    Lying on a trolley in a hospital corridor in pain from a broken hip, Anne Whitfield-Ray could not believe she was in the care of the NHS. "It was absolute chaos - like something out of a third world country," said the 77-year-old from Worcestershire. "The staff were rushed off their feet, paint was peeling off the walls and patients were being squeezed in everywhere they could - in makeshift bays, in corridors and side rooms. It was horrific." Anne spent 15 hours in that position until a bed could be found for her. Such delays used to be the exception, something that happened on the odd occasion in the depths of winter. Now they are commonplace. Latest figures show nearly 40% of A&E patients who need admitting face what is called a trolley wait - a delay of four hours or more waiting for a bed to be found. These are the sickest and frailest patients - the ones who cannot be sent home immediately after treatment. Research has linked delays like this with longer hospital stays and even a higher risk of death. By the time patients get to this point, they may have already faced hours of waiting in A&E or, increasingly, stuck outside A&E in the back of an ambulance, as was the case for Anne. She is now back home recovering after surgery, a few days after her fall in October. She said that despite her experience she cannot fault the staff: "They are doing the best they can. But this is not what should be happening in the NHS". Read full story Source: BBC News, 8 December 2022
  5. News Article
    NHS managers will be held accountable for failings at an overcrowded hospital where patients were put at risk of “serious harm” and some were left waiting up to 25 hours for a bed, ministers have warned. Forth Valley Royal Infirmary’s A&E was operating at two and a half times capacity during a visit by Healthcare Improvement Scotland (HIS) in September. Inspectors said that patients were at risk because of poor handling of medicines and unsafe working conditions at the hospital, which was placed in special measures by the Scottish government last month. The Times reported last month that the hospital had been declared “unsafe” by staff after five consultants resigned following severe criticism of the hospital’s leadership. They described it as a “war zone” and told of fire-fighting to cope with patient numbers while working in a “toxic” environment. Read full story (paywalled) Source: The Times, 6 December 2022
  6. News Article
    ‘Rubbish’ communications on Group A Strep from government agencies made A&Es more ‘risky’ over the weekend, after services were flooded with the ‘worried well’, several senior provider sources have told HSJ. On Friday the UK Health Security Agency, successor to Public Health England, issued a warning on a higher than usual number of cases after the deaths of five children under 10 in a week. Several senior sources in hospital, 111/ambulance, urgent care and primary care providers, told HSJ they were not warned UKHSA were making an announcement that would also see services flooded by the worried well. NHS England’s clinical lead for integrated urgent care issued a letter, seen by HSJ, saying a “considerable increase” in 111 demand over the weekend was “in part due to Group A Strep concerns”. Sources in the sector said the increase in demand was “heavily” Strep-related. One senior accident and emergency leader told HSJ that when parents could not get through on 111 they brought their children to emergency departments. “The media messaging has been handled terribly”, they added. They added: “Huge numbers of ‘worried well’ makes the A&E a much more dangerous place. We are just not equipped to deal with the volume of patients. [There is a] much greater chance we would miss one seriously unwell child when we are wading through a six-hour queue of viral, but otherwise well, kids.” Read full story (paywalled) Source: HSJ, 6 December 2022
  7. News Article
    When 85-year-old Koulla fell at home, her family immediately rang for an ambulance. She was in agonising pain - she had broken her hip. It was around 8pm. It took another 14 hours for an ambulance to get to her, leaving her pregnant granddaughter to care for her through the night. When they arrived the crews were able to give her pain relief and quickly transported her to the Royal Cornwall Hospital. But there the wait continued - there were around 30 ambulances queuing to handover patients to A&E staff. It was another 26 hours before she was taken inside to A&E. She then faced many hours in A&E before being taken for surgery. Koulla's daughter, Marianna Flint, 53, said: "It was awful. You feel helpless because you're giving your trust over to them to look after a family member who's in agony and who needs surgery." She has since received a written apology from the Royal Cornwall for the care provided to her mother in August. Ms Flint said: "I almost feel sorry for those looking after her. It's not down to them. There was no room inside to accept her in." Read full story Source: BBC News, 1 December 2022
  8. News Article
    Plans have been drawn up to avoid the NHS being overwhelmed this winter by encouraging patients to “behave in ways they’ve not experienced before” and cut down on in-person GP visits, the Guardian can reveal. An advertising campaign devised by M&C Saatchi, awarded a contract by NHS England worth up to £28.6m, suggested ways people could be encouraged to settle for a virtual appointment or visit a pharmacist instead. To help reduce the mounting pressures facing medics, documents show the agency also advised patients should be told that seeking help via alternative routes instead of rushing to A&E would help the NHS “work better for everyone”. The three-year contract is for the ad campaign “Help Us Help You”, which seeks to change people’s behaviour when accessing healthcare to reduce pressures on the NHS and maintain capacity. Wes Streeting, Labour’s shadow health secretary, said patients were already cutting back on in-person GP appointments – “not because they don’t need them but they’re finding it impossible to get one”. He told the Guardian: “Among those millions of patients who can’t get an appointment when they need it, there will be problems which go undiagnosed until it’s too late". Read full story Source: The Guardian, 30 November 2022
  9. News Article
    Some of the country’s GP are advising patients requiring urgent hospital care to “get an Uber” or use a relative’s car because of the worst ever delays in the ambulance service in England. Patients with breathing difficulties and other potentially serious conditions are being told in some cases that they are likely to be transferred more quickly from a general practice to accident and emergency if they travel by cab or private vehicle. NHS England data shows that October’s average ambulance response times for category 1 to 3 emergencies, which cover all urgent conditions, appear to be the highest since the categories were introduced nationally in 2017. Some patients who require emergency treatment may have to wait several hours for an ambulance to arrive. Dr Selvaseelan Selvarajah, a GP partner in east London, said: “If somebody is not having a heart attack or a stroke, my default advice is ‘have you got someone who can drive you or do you want to get an Uber?’ “These are patients who may have breathing difficulty or are suffering severe abdominal pain, but their life is not in immediate danger.” He said such patients would have previously been transferred by ambulance. Read full story Source: The Guardian, 27 November 2022
  10. News Article
    People suffering from mental illness are increasingly struggling to access help at every level of the NHS – from record numbers facing “unacceptable” delays in referrals to patients waiting up to eight days in A&E for a hospital bed. Figures seen by The Independent show almost four times as many people are waiting more than 12 hours in emergency departments as two years ago. In the community, more than 16,000 adults and 20,000 children who should receive NHS care are unable to access vital services each month. Nearly 80% of those eligible for counselling on the health service are left waiting more than three months for a second appointment, which is when treatment usually begins. Health leaders say they are “deeply concerned” by the lack of resources available to handle the rise in demand – and warned that the cost of living crisis would exacerbate the issue further. Monica Smith went to A&E at Lewisham last month after her mental health deteriorated when her medication ran out and she was unable to get more. The 32-year-old said: “I was told, ‘We can’t find any beds – there’s no bed in the whole country or the whole region, so we’re going to have a bed on A&E and hopefully you’ll get a bed in the morning.’” Monica started hallucinating and was given medication to calm her down, but in the morning there was still no bed. Doctors tried to send her home, she said, but crisis services assessed her three times over the following days and each time decided she was too unwell. Instead, Monica stayed in an annex off A&E with other mental health patients. She said: “I was on this, like, mattress, like a mental health mattress on the floor.” Read full story Source: The Independent, 27 November 2022
  11. News Article
    Ministers have effectively ditched NHS England’s planned new bundle of A&E targets and want trusts to be firmly regulated on the existing four-hour standard and 12-hour breaches, HSJ understands. Multiple senior figures familiar with the process, from inside the NHS and government, said the performance focus for the next two years will be on the two existing accident and emergency waiting time measures, as well as ambulance handover delays. For the last three years, NHS England has been lobbying government to scrap the headline four-hour target, and replace it with a bundle of measures which have been trialled at around a dozen providers. This work has been led by medical director Steve Powis. HSJ understands the decision to continue using the existing four-hour target was driven by concerns among ministers and senior NHS figures that the bundle of measures was too confusing, both for patients and as a means for government to hold the service to account. Read full story (paywalled) Source: HSJ, 23 November 2022
  12. News Article
    Ambulance waiting times for stroke and suspected heart attacks have quadrupled in four parts of England since before Covid-19 – whereas others have only grown by half – underlining the severe impact of long accident and emergency handovers. Response times have leapt across England over the past two years, particularly for category 2 and 3 incidents, but the data makes clear that the steepest increases are in areas where hospitals have the biggest handover delay problems. Of the 10 patches with the largest increases in average category 2 performance between 2018-19 and 2021-22, four are served by major hospitals which make up NHS England’s “cohort one” of trusts selected for the worst handover problems; and four more are on government’s list of 15 which accounted for the most long handover delays last winter. The increase in handover delays – in turn linked to delayed discharge, staffing, lack of community services and social care’s collapse – are the stand-out reason for areas with a steep rise in response times. Read full story (paywalled) Source: HSJ, 18 November 2022
  13. News Article
    Directors of a major hospital have ordered their accident and emergency staff to continue receiving ambulance patients into their department “in all instances”, following angry exchanges with paramedics. Hospital staff and ambulance crews have clashed at the new Royal Liverpool Hospital since its opening last month, after ambulance crews were prevented from bringing patients inside accident and emergency department when it was deemed to be full to capacity. The problems were escalated to hospital directors and North West Ambulance Service Trust earlier this month, resulting in new instructions being issued to the emergency department. In a letter to managers in A&E and the other divisions, seen by HSJ, the three most senior directors at the Royal Liverpool, wrote: “As you are aware we are currently experiencing long delays in accepting handover of patients from ambulance crews. “This phenomenon is not unique to us at the Royal Liverpool, nor is it particularly new, but our recent challenges have undoubtedly been exacerbated due to teams still familiarising themselves with working in a new environment and the patient flow challenges we have been experiencing on site. “However, what has changed has been the extent to which we have managed these pressures by continuing to hold patients in the back of ambulances, which we collectively agree is an unacceptable situation. Whilst providing corridor care is not what any of us would aspire to, we have to recognise and respond to the risk of patients awaiting response in the community. “We have therefore today met with NWAS colleagues and agreed that, with immediate effect, we will, in all instances, continue to receive crews from NWAS into the hospital building.” Read full story (paywalled) Source: HSJ, 16 November 2022
  14. News Article
    Mental health patients are being held “unlawfully” in A&Es across the country as long waits for care and beds force staff into “fudging” the law, The Independent has been told. The University Hospital of North Midland Trust has been sanctioned by the Care Quality Commission (CQC) for holding mental health patients without any legal authority. However, experts have told The Independent the problem is widespread and occurs across every emergency department in the country with some patients waiting “days” and even “weeks” in A&E. Leaders at Barking, Havering and Redbridge NHS Trust have raised repeated concerns in recent months over patients waiting days in their A&E for mental health care. The CQC raised concerns about the assessment of mental health patients at UHNM following an inspection in October and served the trust with a warning notice. In a letter seen by The Independent, the CQC said two patients were “restricted within hospital unlawfully”. It said although staff were working in the patient’s best interests in both cases it was clear that legal procedures “were not being followed”. “Therefore, this can be seen as a significant infringement of any personal or welfare,” it said. Read full story Source: The Independent. 8 November 2022
  15. News Article
    Visiting A&E or relatives is considered much riskier than attending hospital for other reasons, according to the first in-depth piece of research into the subject. The research, authored by the University of Leicester and NIHR Leicester Biomedical Research Centre Bioinformatics Hub, asked 400 participants how they felt about attending hospital across a range of scenarios during the pandemic. It also revealed that consistent staff use of PPE is seen as a top priority by patients, with staff testing receiving significant but much less support. Participants in the Leicester research were asked to rank how ”safe and confident” they felt coming into hospital for a number of reasons on a scale 1-100. The median score given to “visiting a friend or family member” was 49. The score for attending accident and emergency was 50. Attendance at A&E’s fell sharply during the pandemic peak. It is now rising, but has not reached pre-covid levels. The research suggests that fear could still be playing a significant part in the drop off. Attending hospital for elective care received a median score of 61. Participants were most confident in visiting hospital for essential surgery (median score 78), and clinical scans or x-ray (77). Read full story (paywalled) Source: HSJ, 3 September 2020
  16. News Article
    Pilots for a new urgent care model requiring walk-in patients to book slots in emergency departments are expected to be rolled out in at least one site in every health system in the coming weeks, HSJ has learned. The move comes amid concerns from trust managers who warned some 111 providers’ systems were too “risk averse” and were sending too many patients who could have been treated in other care settings to hospitals. Local managers believe NHS 111 not directing enough people to alternative services was a cause of a major incident at Gloucestershire Hospitals Foundation Trust’s emergency services earlier this month, HSJ understands. And trust leaders in other parts of the country are understood to have similar concerns. Trials of 111 First have already been publicly confirmed at Portsmouth Hospitals Trust, Royal Cornwall Trust, Newcastle Hospitals FT and Blackpool Hospitals FT. HSJ also understands five London sites, one for each integrated care system in the capital, are also running trials. These “early adopter” trusts have been given autonomy to trial different models for “111 First”. Most EDs at these sites still treat “walk-in patients” as normal. But in Portsmouth, patients with minor injuries who turn up at ED without calling ahead have, on three different days, been instead told to call 111 following assessments. NHS England said further trials will take place in the Midlands and East of England, but the specific trusts undertaking these trials have not been decided yet. Read full story (paywalled) Source: HSJ, 2 September 2020
  17. News Article
    The development of separate emergency units to help acute trusts manage demand during the covid pandemic may risk increasing “discrimination” against mental health patients, a royal college has warned. In a report shared with HSJ, the Royal College of Psychiatrists said separate emergency assessment units being set up by mental health trusts offered a calmer environment for mental health patients and reduced pressure on emergency departments. But the report, based on 54 survey responses from liaison psychiatry teams, also warned there was a “potential to increase the stigmatisation of mental illness by emergency department staff”. It added: “Within a general hospital there is a risk that prejudicial attitudes amongst staff translate into discriminatory behaviour towards patients. The provision of a separate mental health emergency assessment facility on another site may reinforce the erroneous view that the assessment and management of mental health problems is not a role for an emergency department.” Read full story (paywalled) Source: HSJ, 11 August 2020
  18. News Article
    Boris Johnson has said the government will allocate £300m to NHS trusts to upgrade A&E facilities ahead of a potential spike in coronavirus cases this winter. The funding, which will be split between 117 trusts, comes alongside attempts to reassure members of the public that it is safe to visit A&E departments during the COVID-19 pandemic. “Thanks to the hard work and tireless efforts of NHS staff throughout the pandemic, our A&Es have remained open for the public,” the prime minister said in a statement. “It is vital that those who need emergency treatment this winter access it, and for those who remain concerned about visiting hospitals, let me assure you that the NHS has measures in place to keep people safe.” Hospitals will be able to use the funding to expand waiting areas and increase the number of treatment cubicles to boost A&E capacity, while social distancing rules and hygiene measures are in place to protect patients from COVID-19. Read full story Source: The Independent, 10 August 2020
  19. News Article
    Trials of new systems to prevent overcrowding in emergency departments ahead of a potential second wave of COVID-19 in the winter are taking place at hospitals in Portsmouth and Cornwall and are due to shortly be expanded to other areas, with Dorset and Newcastle likely sites, HSJ can reveal. London is also experimenting with introducing the system, having pulled back from an earlier proposal to roll it out it rapidly, shortly after the COVID-19 peak. In the trials, NHS 111 has acted as a “triage point” enabling patients not facing medical emergencies but needing urgent treatment to book access to primary care, urgent treatment centres or same-day emergency “hot clinics” staffed by specialists. Patients are discouraged from attending without an appointment, but they are able to do so; and sources said performance targets would continue to apply to them, although these were already subject to review pre-covid. Both the Royal College of Emergency Medicine and NHSE are now hopeful a new triage system for emergency care can be in place by the winter. Read full story (paywalled) Source: 15 July 2020
  20. News Article
    People with non-life threatening illnesses will be told to call before going to Wales' biggest A&E department. Patients will be assessed remotely and given a time slot for the University Hospital of Wales in Cardiff if needed. Hospital bosses feel returning to over-crowded waiting rooms would provide an "unacceptable" risk to patients due to coronavirus. The system is set to start at the end of July, but will not apply to people with serious illnesses or injuries. Details are still being discussed by Cardiff and Vale health board, but patients with less serious illnesses or injuries will be told to phone ahead, most likely on the 24-hour number used to contact the local GP out-of-hours service. They will be assessed by a doctor or a nurse and, depending on the severity of the condition, will either be given a time window to go to A&E or be directed to other services. This system was introduced in Denmark several years ago. "This is all about being safe and ensuring that emergency medicine and emergency care is safe and not about putting barriers in place to those more vulnerable people," says the department's lead-doctor Dr Katja Empson. "What we really think is that by using this system, we'll be able to focus our attention on those vulnerable groups when they do present." If successful, the system could become a long-term answer to reducing pressures on emergency medicine, she added. Read full story Source: BBC News, 14 July 2020
  21. News Article
    Far fewer people are having surgery or cancer treatment because COVID-19 has disrupted NHS services so dramatically, and those who do are facing the longest waits on record. NHS figures reveal huge falls in the number of patients who have been going into hospital for a range of vital care in England since the pandemic began in March, prompting fears that their health will have worsened because diseases and conditions went untreated. Patients have been unable to access a wide range of normal care since non-COVID-19 services were suspended in hospitals in March so the NHS could focus on treating the disease. Many patients were also afraid to go into hospital in case they became infected, which contributed to a fall in treatment volumes. Tim Gardner, a senior policy fellow at the Health Foundation thinktank, said: “The dramatic falls in people visiting A&E, urgent referrals for suspected cancer and routine hospital procedures during lockdown are all growing evidence that more people are going without the care they need for serious health conditions." “Early diagnosis and prompt treatment of cancer is crucial to saving lives, and delays in referrals and treatment during the pandemic are likely to mean more people are diagnosed later when their illness is further advanced and harder to treat.” Read full story Source: Guardian, 9 July 2020
  22. News Article
    Delays in going to the emergency department because of the coronavirus pandemic lockdown may have been a contributory factor in the deaths of nine children, a snapshot survey of consultant paediatricians in the UK and Ireland has shown. Three of the reported deaths associated with delayed presentation were due to sepsis, three were due to a new diagnosis of malignancy, in two the cause was not reported, and one was a new diagnosis of metabolic disease. Read full story (paywalled) Source: BMJ, 30 June 2020
  23. News Article
    Appointments to be seen in A&E could be introduced permanently in response to coronavirus, the president of the Royal College of Emergency Medicine has said. Dr Katherine Henderson said it would cause "enormous harm" to patients if Britain returned to crowded casualty units with "elastic walls". Instead, she said patients should be given a "contact point" such as the NHS 111 line to book a slot in an emergency department, or to be seen directly by a specialist or diverted to the care they need. "The old way of doing things involved emergency departments having elastic walls," Dr Henderson told MPs. "We were able to have an infinite number of patients. We were never able to say: 'We're full, we're at capacity.' We now need to recognise that we can't do that." Read full story (paywalled) Source: The Telegraph, 16 June 2020
  24. News Article
    The chief inspector of hospitals has warned that patient safety is at risk if the NHS winter crisis is worsened by coronavirus – and ministers must act now in emergency departments to prevent a catastrophe. Professor Ted Baker, speaking to The Independent in his first interview since the COVID-19 outbreak hit Britain, warned that the NHS could not carry on as before as hospitals across the country struggle to return to normal care while the crisis continues. “If we are going to do something about it, we need to act now, not at the beginning of winter,” he warned, adding the Care Quality Commission (CQC) was also worried about patients being “forgotten” as NHS waiting lists surge to an expected 10 million later this year. "We will be going into winter and all the difficulties of the winter viruses that we normally face, together with Covid. I think next winter is going to be very difficult, unless emergency departments and the whole system supporting emergency departments do things very differently.” He warned providing care in the NHS under the shadow of coronavirus was “a formidable challenge … probably bigger than the challenge we faced at the height of the pandemic”. Prof Baker also told The Independent that the CQC was investigating a number of reports that some hospital patients were discharged unsafely to care homes following a staggering 55% rise in whistleblowing complaints, particularly in care homes, with 2,612 calls between March and May. Read full story Source: The Independent, 17 June 2020
  25. News Article
    Emergency attendances for several conditions are still well below their normal levels, despite a steady increase in overall activity since the peak of the coronavirus outbreak. Weekly data from Public Health England suggests overall A&E attendances increased to around 105,000 in the last week of May, which was an increase from 98,813 over the previous seven days. Data from the 77 A&E departments included in the research suggests that overall attendances are up to an average of 15,000 day, compared to around 10,000 at the peak of the pandemic and the long-term trend of just under 20,000. However, attendances for bronchitis, acute respiratory infections, respiratory, pneumonia, asthma, gastroenteritis are still far below their normal levels. It did not offer an explanation for why attendances for these conditions have remained low, while those for cardiac, influenza, myocardial Ischaemia, and gastrointestinal problems have returned to normal levels or above. Read full story Source: HSJ, 5 June 2020
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