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Found 348 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. Content Article
  3. 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
  4. 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
  5. 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
  6. 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
  7. Content Article
    Key findings Bystander Cardiopulmonary Resuscitation (CPR) Ongoing strategies are needed at a population level to ensure that people who sustain an OHCA are treated rapidly with high quality resuscitation, including defibrillation, through a co-ordinated network of accessible and identifiable public access devices. Advance treatment plans When advance treatment plans are in place, they should be documented using a standard process (such as the ReSPECT form) to ensure that people receive treatments based on what matters to them and what is realistic. Effective communication between all parts of the healthcare system, including, primary care, community services, ambulance services and acute hospitals is then needed to ensure that appropriate decisions are made, irrespective of time or location. Prediction of survival No single factor is accurate enough for clinical decision-making at the time of admission to hospital following an OHCA. Time is needed to ensure an accurate assessment of prognosis can be made. Neurological prognosis is particularly difficult to assess, and this should be delayed for at least 72 hours after return of spontaneous circulation. Targeted temperature management Elevated temperature is common following an OHCA and is associated with a worse prognosis, but this can be improved by accurate, active temperature control. The current approach in clinical practice appears to be inconsistent and a more active approach is needed. Rehabilitation Physical, neurological, cardiac and emotional impairment following an OHCA can all affect quality of survival, and patients benefit from targeted rehabilitation and support. In some areas of the UK there is no provision of these services. These gaps should be closed by local clinical teams and commissioners working together.
  8. 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
  9. Content Article
    Safety-II is rapidly capturing the attention of the improvement world. However, there is very little guidance on how to apply it in practice. THIS Institute at the University of Cambridge have funded a study to explore how Safety-II (or Resilient Health Care) is being translated into healthcare policy and practice. Ruth is looking for people to take part in a one-off interview. She wants to speak to people who: work within the NHS to improve patient safety (whatever your role!) have or are applying Safety-II principles to improve safety in either maternity, A&E, ICU or anaesthetics (however successfully you feel you are doing it!) More information is attached. To get involved please contact Ruth R.M.Baxter@leeds.ac.uk and @RuthMBaxter
  10. 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
  11. 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
  12. Content Article
  13. 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
  14. 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)
  15. Content Article
  16. Content Article
    The report proposes twelve actions to help stem the crisis facing the NHS: Focus Leadership 1. Set up a winter-crisis taskforce and settle additional funding early. Minimise Demand 2. Campaign for widespread and early Covid-19 and flu vaccinations across the NHS workforce. 3. Extend public-facing Covid-19 and flu-vaccination strategies to all those aged over 18. 4. Mandate FFP2/3 face-mask wearing for NHS staff in health-care settings. 5. Be prepared to reintroduce the mandating of mask wearing on public transport and in confined spaces. Improve Patient Flow and Efficiency 6. Improve the speed and consistency of access to primary care. 7. Roll out technology to release capacity and manage patient demand. 8. Increase support for social-care services and expedite patient discharges. 9. Identify and enable the flexible use of regional surge capacity. Maximise Capacity 10. Stand up a volunteer and reservist workforce. 11. Expand use of private-sector capacity. 12. Prioritise staff retention.
  17. News Article
    The NHS has been forced to publish hidden trolley waits data, after intervention by the UK Statistics Authority, The Independent has learned. In a letter to NHS Digital and NHS England in July, Ed Humpherson director general for regulation at UKSA asked the organisations to publish monthly data on patients whose total wait in A&E is longer than 12 hours, following an ongoing row with emergency care leaders. NHS England promised to publish this internal data but has yet to comply, and as a result it was referred to UKSA by the Royal College of Emergency Medicine over concerns that the public data is misleading. Dr Katherine Henderson, president of the Royal College of Emergency Medicine, told The Independent: “For some time, we have been calling for NHS England to publish the 12-hour data measured from time of arrival. This data will show the real scale and depth of the crisis that urgent and emergency care is facing. We believe that through transparency around the sheer number of patients facing 12-hour waits, we can drive political and health leaders into action. Read full story Source: The Independent (25 August 2022)
  18. News Article
    Patients may come to harm as a result of NHS 111 chaos, experts claimed on Tuesday as patients were advised to avoid the service this weekend. The helpline for urgent medical advice was targeted by cyberhackers earlier this month, leaving staff working on pen and paper. The Adastra computer software, used by 85 per cent of 111 services, was taken offline after the attack leaving call handlers unable to book out-of-hours urgent appointments and fulfil emergency prescriptions. But almost three weeks on, most staff are still operating without the system, leaving GPs unable to see patients’ medical records during urgent consultations or automatically forward prescriptions to pharmacies. The NHS has told hospitals to prepare public awareness campaigns to “minimise” pressures on urgent and emergency care services this winter. Some hospitals have already issued messaging urging patients not to turn up at accident and emergency (A&E), unless they are facing a “serious emergency.” Helen Hughes, chief executive of the charity Patient Safety Learning, said the continuing chaos raises “serious patient safety concerns” and will “inevitably result in avoidable harm”. Telling patients not to go to A&E “unless it is absolutely necessary” is only possible if GPs and NHS 111 “have the capacity and the resources to meet the demands that this places on them”, Ms Hughes said. “Significant delays in receiving a response are potentially missed opportunities for patients to receive timely medical advice and treatment that may prevent future harm,” she added. “Delays in receiving timely care and treatment will inevitably result in avoidable harm to patients.” Read full story (paywalled) Source: The Telegraph (23 August 2022)
  19. News Article
    Some of the country’s leading acute hospitals are not meeting a key NHS standard for mental health support in emergency departments, HSJ research suggests, with some regions faring better than others. Latest official estimates indicate that more than a third of EDs (36 per cent) are not yet meeting ‘core 24’ standards for psychiatric liaison – which requires a minimum of 1.5 full-time equivalent consultants and 11 mental health practitioners. The long-term plan target is for 70 per cent of acute trust emergency departments to have the optimum ‘core 24’ standard service by 2023-24. The NHS appears to be on track to hit this, with significant progress made, despite the pandemic. Annabel Price, chair of the Royal College of Psychiatrists’ liaison faculty, said tackling the workforce crisis with a fully funded plan would “prove instrumental in boosting recruitment across all acute trusts”. Read full story (paywalled) Source: HSJ, 23 August 2022
  20. News Article
    On Monday, September 20, 2021, Michael Wysockyj felt unwell and did what any gravely sick person would do: he put his life in the hands of the ambulance service. The 66-year-old from Norfolk was whisked by paramedics to the Queen Elizabeth hospital in King’s Lynn at 6.28pm. Nearly four hours later, he was still trapped inside the vehicle. The hospital was too full to take him. He died at 4.42am. So great were the concerns of the coroner, Jacqueline Lake, that she took the unusual step of issuing a “prevention of future death” notice. “The emergency department was busy at the time and unable to offload ambulances,” she said in her report. “An x-ray cannot be carried out in an ambulance and must wait until the patient is in [the emergency department].” This episode should be an anomaly in the failure of emergency services. It is not. The crisis is “heartbreaking”, according to Dr Ian Higginson, vice-president of the Royal College of Emergency Medicine. “If you call for an ambulance and you’re waiting many hours for one and you have a serious condition, that is going to have an impact on your outcome. It would be reasonable to assume the long delays that patients are subjected to waiting for ambulances at the moment will filter through into excess mortality.” Read full story (paywalled) Source: The Times, 21 August 2022
  21. News Article
    The NHS is to launch a campaign urging the public to avoid A&E in an echo of appeals to protect the health service during the Covid pandemic. The head of the NHS has instructed hospitals to prepare a public awareness campaign calling for people to “minimise” pressures on urgent and emergency services. Such an instruction has never been issued so early in the year, and comes amid concerns that hospitals and ambulance services are already facing strains usually seen in the depths of winter. People suffering a genuine emergency will still be encouraged to go to A&E, but on Friday night there were warnings that the campaign risks exacerbating the problems caused by patients staying away from the health service during Covid. Prof Carl Heneghan, an urgent care doctor and professor of evidence-based medicine at the University of Oxford, said the NHS needed to be very careful about trying to dissuade the public from using services. “The NHS seems to be the only business I know that doesn’t know how to deal with demand, and work with the needs of its customers,” he said. “As an urgent care doctor, I need to be in front of the patient to do my job. It’s often too difficult for the new mum to know when it’s appropriate to turn to emergency services. These decisions are difficult – it’s the job of a doctor. “Too often I see elderly patients who apologise for taking my time and I say ‘don’t apologise – you could have been 24 hours away from death’.” Read full story (paywalled) Source: The Telegraph, 19 August 2022
  22. News Article
    A 90-year-old woman waited 40 hours for an ambulance after a serious fall. Stephen Syms said his mother, from Cornwall, fell on Sunday evening and an ambulance arrived on Tuesday afternoon. She was then in the vehicle for 20 hours at the Royal Cornwall Hospital. It comes as an ambulance trust warns lives are at risk because of delays in patient handovers. It was also reported a man, 87, who fell, was left under a makeshift shelter waiting for an ambulance. South Western Ambulance Service said it was "sorry and upset" at the woman's wait for an ambulance. Mr Syms, from St Stephen, told BBC Radio Cornwall: "We are literally heartbroken to see a 90-year-old woman in such distress, waiting and not knowing if she had broken anything. "The system is totally broken." He said it took nine minutes before his 999 call was answered. "If that was a cardiac arrest, nine minutes is much too long, it's the end of somebody's life," he said. Mr Syms said paramedics were "absolutely incredible people". He added: "The system is not deteriorating, it's totally broken and needs to be urgently reviewed." Read full story Source: BBC News, 19 August 2022
  23. News Article
    Senior doctors have raised concerns about the numbers of patients now dying in their A&E department due to extreme operational pressures. HSJ has seen an internal memo sent to staff at Royal Albert Edward Infirmary in Wigan, which warns it is becoming “increasingly common” for patients to die in the accident and emergency department. The memo suggests the department has reported five deaths in the latest weekly audit, when it would normally report one or two fatalities. The memo said: “Of the 72 patients in A&E as I write this, 16 have been there over 24 hours and 34 over 12 hours. The longest stay is almost 48 hours… “It’s becoming increasingly common to die in A&E. We have included A&E deaths [in weekly audits] for the last 4 years. They used to be 1 or 2. This week there were 5. They used to die at or just after arrival, but that’s changing too… “There is every reason to think winter will be worse.” The memo echoes warnings made by numerous NHS leaders in recent months around the intense service pressures and an increased risk of incidents and mistakes. Read full story (paywalled) Source: HSJ, 17 August 2022
  24. News Article
    England’s mental health inpatient system is “running very hot” and operating well above recommended occupancy levels, HSJ has been told, as new funding to address the problem is revealed. The move was announced by NHS England mental health director Claire Murdoch in an exclusive interview with HSJ. It comes amid a steep rise in mental health patients waiting more than 12 hours in accident and emergency. Last month, an HSJ investigation revealed 12-hour waits for people in crisis had ballooned by 150% in 2022 compared to pre-pandemic levels. Problems finding specialist beds have been cited by experts as one of the root causes of A&E breaches. Ms Murdoch told HSJ the funds would not come from ”within the mental health service budget” and that they would be used to “help address any pressures where we think the answer is more of either beds or other urgent and emergency care which has a capital need.” NHSE is now working with the 42 integrated care systems to determine where the money can best be used. Ms Murdoch said the money would be spent ”where there is a particular need” and that there was “no blanket approach” to its allocation. Read full story (paywalled) Source: HSJ, 10 August 2022
  25. News Article
    The chief executive of a trust trialling the new emergency care standards being considered by the government has called for a new six-hour target to either move patients out of accident and emergency, or for them to receive treatment. North Tees and Hartlepool Foundation Trust chief executive Julie Gillon told HSJ a new target should be set as a “body of evidence” indicates patients are at risk of deterioration following A&E waits of six hours or more. The proposal is likely to be broadly welcomed by many clinicians, but could prove controversial in some quarters. NHS England did not include a six-hour target in the bundle of new A&E metrics being piloted, and the proposal could be interpreted by some as a watered-down version of the existing four-hour standard. However, Ms Gillon cited analysis by the Royal College of Emergency Medicine last year which revealed thousands of excess deaths resulting from overcrowding and long stays in A&Es. Read full story (paywalled) Source: HSJ, 4 August 2022
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