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Found 350 results
  1. Content Article
  2. 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
  3. 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
  4. 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
  5. 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
  6. 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
  7. 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
  8. Content Article
    My mother, 87 years, was admitted to hospital with a suspected heart attack. At the time, she was on a strong dose of a GP-prescribed opioid (fentanyl) to manage her growing lung cancer. The Duty doctor in the hospital seemed panicked as she was so unwell and used a drug to totally reverse her morphine as they thought she had overdosed. This caused excruciating pain for most of the last 60 hours of her life. They hadn’t properly assessed the history of her prescription or asked me, her documented health advocate, about the drug or my mother’s end of life wishes. After a 2-year long traumatic journey for the family, the Inquest issued a Prevention of Future Deaths report, agreeing her prior medication should have been properly assessed. After another year and a convoluted journey through the health system, NHS England’s Patient safety team issued a National Safety Alert to all English hospitals around more careful use of pain relief reversing. Five years later, my good friend was on an unusual cocktail of GP-prescribed drugs for her very painful arthritis. She was admitted to hospital after a fall that dislocated her severely arthritic shoulder. For three days in hospital she went through different medical teams, but no one looked at her pain control needs or her unusual medication, and the only pain relief medication that had worked for her for years was removed totally from very early on in the admission. She suffered on those hard hospital beds, unable to move to a comfortable position due to her painful arthritis, lack of adequate pain control and her shoulder that remained painfully dislocated. She could not move on those beds without help. She was in agony for three days. Sadly she died of a pulmonary embolism in hospital in the midst of that traumatic experience. What both these people have in common is the neglect of their medically prescribed, carefully designed pain control to meet their unique needs, their understandable wishes and personal rights. As a result their essential pain control was totally removed while other necessary medical interventions occurred. These patient and service user’s rights were not respected. Huge suffering resulted. This I believe needs addressing and learning from. Pain control needs of patients with chronic conditions needs to be carefully assessed and addressed on all hospital admissions from the very start of admission. The current complaint and Inquest systems do not have as their agenda these types of safety learning. There are two routes whereby these incidents can be recorded, with one route that may lead to an investigation and system learning nationally. One is the NHS patient portal, which is just for reporting (no one will get back to you, but the information you share could be used to improve safety for future patients), and the other is the Healthcare Safety Investigation Branch (HSIB) who do national investigations almost always on recently occurring events. I would add there are developments in patient safety learning, including patient safety partners rolling out across some health facilities, but this is relatively early on in a national process: https://www.england.nhs.uk/patient-safety/framework-for-involving-patients-in-patient-safety/ The new NICE guidance on Shared Decision Making also adds to the pressure to learn and change from cases like this. Perhaps special guidance is needed for those admitted for emergency care with complex palliative medication needs? I hope a Body will take this up soon. The patient, service user, family and carer voice must be heard and acted on to improve patient safety at these difficult times. If you or anyone you know has had an experience like this, particularly in the last few months, do let me know by emailing me or commenting on this post below, as the routes above could lead to long lasting learning. It is sorely needed.
  9. Content Article
  10. Content Article
    The analysis suggests three ways to improve ambulance service performance: Reduce handover delays by increasing hospital capacity and flow through hospital with more beds, more staff and investment in out-of-hospital care, including social care. Increase ambulance service capacity by further increasing staff numbers and reducing sickness absence by addressing the causes of poor mental health. Reduce demand for ambulances through greater investment in community services, such as mental health services, which can prevent health conditions becoming crises.
  11. 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
  12. Content Article
    Safety recommendations HSIB has made three safety recommendations so far as a result of this ongoing investigation: HSIB recommends that the Department of Health and Social Care leads an immediate strategic national response to address patient safety issues across health and social care arising from flow through and out of hospitals to the right place of care. HSIB recommends that the Department of Health and Social Care conduct an integrated review of the health and social care system to identify risks to patient safety spanning the system arising from challenges in constraints, demand, capacity and flow of patients in and out of hospital and implement any changes as necessary. HSIB recommends that NHS England includes staff health and wellbeing as a critical component of patient safety in the NHS Patient Safety Strategy. Safety observations It may be beneficial for there to be a whole-system patient safety accountability and responsibility framework that spans health and social care. It may be beneficial for NHS organisations to provide time and safe spaces for staff to engage in reflective practice and talk about the emotional impact of their work, with support from people with expertise in staff wellbeing.
  13. News Article
    Further funding cuts to the NHS will unavoidably endanger patient safety, an NHS leader warned last week after the chancellor’s promise of spending cuts of “eye-watering difficulty”. Matthew Taylor, the chief executive of the NHS Confederation, said his members were issuing the “starkest warning” about “the huge and growing gulf between what the NHS is being asked to deliver and the funding and capacity it has available”. The warning came as figures showed that paramedics in England had been unavailable to attend almost one in six incidents in September due to being stuck outside hospitals with patients. Service leaders say wait times for A&E and other care are being exacerbated by an acute lack of nurses, with a record 46,828 nursing roles – more than one in 10 – unfilled across the NHS. "Patients are presenting more unwell," says a GP from South Wales, "Wait times in A&E have become unmanageable, so we’re seeing patients who have waited so long to be seen they’re bouncing back to us. Things we can’t deal with, like injuries and chest pain. We tell them they have to go back to A&E. "Abuse of surgery reception and admin staff began last year and it’s just scaled up from there. We’ve had staff members who have been verbally and physically threatened and we’re struggling to recruit and retain staff – people are hired and quit in a couple days. A lot of people are going off sick with stress." Five healthcare workers describe the pressures they are facing, including ambulance stacking, rising A&E wait times and difficulties discharging patients. Read full story Source: The Guardian, 1 November 2022
  14. News Article
    Scotland's NHS is in "a perilous situation" amid a staffing and funding crisis, according to the chairman of the doctors' union. Dr Iain Kennedy said urgent action was needed to tackle workload pressures ahead of a potentially "terrifying" winter period. It comes after Scotland's health secretary Humza Yousaf admitted NHS Scotland was not performing well. Mr Yousaf told BBC Scotland it would take at least five years to fix. Dr Kennedy, who is chairman of the industry body BMA Scotland, said it was good to hear Mr Yousaf being honest about the scale of the problems, but added that "frankly we cannot wait five years" for things to improve. He told BBC Radio's Good Morning Scotland programme: "The NHS in Scotland is in a perilous situation and we have a particular crisis around the workforce - we simply do not have enough doctors in general practice and in hospitals. "We need more urgent action because the pressures and the workload have really shot up." Dr Kennedy has called on the government to publish a "heat map" showing where NHS vacancies are unfilled across Scotland. He said: "The public need to see transparency on where the vacancies are. We think that there are probably 15% vacancies across hospital consultant posts across Scotland. "Even the government admits to 7% and that we are at least 800 GPs short in Scotland - and I, and others, suspect we are probably well over that figure now." Read full story Source: BBC News, 31 October 2022
  15. News Article
    Steve Barclay is back as England's health secretary, just as the NHS prepares for what its chief executive Amanda Pritchard says could be a "very, very challenging winter". The government has said "intensive work" is under way in the 15 most under-pressure hospital trusts in England, to speed up ambulance delays, free up beds and reduce waiting times in A&E. Emergency departments across the UK are struggling to quickly treat patients. Only 57% of people who turned up at major A&E departments in England last month were seen, admitted or discharged within four hours, well below the 95% national target. The latest figures from Gloucestershire Royal show it performs slightly worse than average, with 55% dealt with in four hours. One medic, speaking anonymously to the BBC, said: "I wouldn't bring a member of my family to this hospital. And winter is going to be worse unless something changes fast." Read full story Source: BBC News, 28 October 2022
  16. News Article
    Senior staff have questioned why a major hospital did not seek support from neighbours when emergency patients were left waiting more than 60 hours to be admitted to a bed. Cambridge University Hospitals Foundation Trust’s emergency department came under severe pressure last week, with patients being bedded down in corridors and facing very long waits to be admitted to a ward. Senior sources told HSJ there were two cases where patients were waiting more than 60 hours last Monday, and the trust declared an internal incident. But the sources felt the trust should have escalated its alert level to “Opel 4”, which prompts calls for external support when trusts are under the most severe levels of operational pressure. This can include diverting ambulances to other hospitals. The trust apologised to patients who had been kept “waiting for a long time” but that the required threshold for Opel 4 had not been reached. Read full story (paywalled) Source: HSJ, 25 October 2022
  17. 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
  18. 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
  19. 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
  20. Content Article
    Key points The health and social care system is gridlocked. People are struggling to access care. Inequalities pervade and persist. The quality of maternity care is not good enough. The care for people with a learning disability and autistic people is still not good enough. Mental health services are struggling to meet the needs of children and young people. Ongoing problems with the Deprivation of Liberty Safeguards process. Depleted workforce. Challenges and opportunities in local systems.
  21. 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
  22. 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
  23. 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
  24. 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
  25. Content Article
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