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Found 434 results
  1. 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
  2. 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
  3. 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
  4. 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
  5. 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
  6. 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
  7. Content Article
    There has been a steady increase in the numbers of people dying at home in recent years. These trends became entrenched during the pandemic, which could reflect people fearful of Covid-19 in hospitals and care homes just as much as broader patient preferences for dying at home. So did those dying at home receive the care they needed, at a good standard? This new research from the Nuffield Trust sheds light on the services used by people who died at home in England, before and during the first year of the pandemic.
  8. Content Article
    The Royal College of Emergency Medicine (RCEM) commissioned Ipsos to conduct an online poll of UK adults aged 16-75 to better understand their views on emergency care. The poll revealed that confidence in the UK Government’s approach to tackling long waits for patients in A&E is low, with 59% of respondents expressing a lack of confidence that the UK Government has the right policies to tackle long patient waiting times in A&E departments in hospitals. RCEM’s five priorities below for UK Governments will #ResuscitateEmergencyCare to ensure the emergency care system is there for us all in our time of need.
  9. Content Article
    In this article, published on Richard Smith's non-medical blogs, Richard describes the events surrounding his elderly mothers trip to A&E from her care home. Richard highlights a number of safety issues in his account and improvements that could be made to the system and processes. "The nurses have much more confidence in the benefits of the hospital than I do. Hospitals, I know, are dangerous and miserable places for everybody but particularly for the demented; and the danger is increased in the pandemic. There has to be considerable benefit to outweigh the inbuilt risk."
  10. Content Article
    Clinicians in emergency departments (EDs) will see babies and young children with injuries that may be non-accidental. If the cause of such injuries is missed, there is a risk of further harm to the child. However, making a judgement about whether an injury might be accidental or not is complex and difficult. This Healthcare Safety Investigation Branch (HSIB) investigation explores the issues that influence the diagnosis of non-accidental injuries in infants (children under 1 year of age) who visit an ED. Specifically, it explores the information and support available to ED clinicians to help them to make such a diagnosis. Due to the nature of the subject matter no specific incident was used to explore this area of care. Instead, the investigation analysed 10 serious incident reports (reports written by NHS trusts when a serious patient safety incident occurs) to identify the factors that contribute to non-accidental injuries not being diagnosed. These factors were grouped into themes, which informed the terms of reference for the investigation.
  11. 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.
  12. 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.
  13. 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
  14. 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
  15. 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
  16. 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
  17. 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
  18. 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
  19. 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
  20. 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
  21. 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
  22. 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
  23. 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
  24. 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
  25. 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
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