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News Article
Why Coffey's NHS plan has left many unimpressed
Patient Safety Learning posted a news article in News
Tinkering around the edges, the King's Fund said. A few short-term fixes, according to the Health Foundation. And a plan that will have minimal impact, the Royal College of GPs added. These were just a handful of the reactions from those involved with the NHS. And they were not even from organisations usually at the front of the queue when it comes to criticising government policies. So why has Therese Coffey's first announcement as Health Secretary for England received such a negative response? The fact is the problems the health and care system are facing are deep-rooted. Much is made of the impact of the pandemic but the health service was already struggling before Covid hit. The pandemic has simply exacerbated the situation. At the heart of it all is a lack of staff. Addressing this is not easy and cannot be done overnight. It takes five years to train a doctor, three a nurse, which is why there is a big push on international recruitment at the moment. To free up GP appointments, pharmacists are being asked to take on some of their workload, while funding rules are being relaxed to allow GPs to use more of their money to recruit senior nurses. But there is nothing in the plan about where these new senior nurses are going to come from, which is why the Royal College of GPs has been so dismissive. It is a similar story for hospitals services, where accident-and-emergency waits, ambulance response times and the backlog in routine treatments such as knee and hip replacements have all worsened in recent years. Coffey is also introducing a £500m fund to get thousands of medically fit patients out of hospital as soon as possible. Local areas will decide how to spend the money and it could allow hospitals to pay for extra help at home for patients who need it. But it amounts to little more than a sticking plaster and is an approach already used to relieve the pressure during the pandemic. The real issue is the care sector is short of staff, with even more vacancies than in the NHS. Read full story Source: BBC News, 22 September 2022 -
News Article
Staffing shortages force NHSE to abandon safety target
Patient Safety Learning posted a news article in News
NHS England has this week told trusts it is abandoning a patient safety target ‘until maternity services in England can demonstrate sufficient staffing levels’ to meet it. The Midwifery Continuity of Care model was designed to ensure expectant mothers would be cared for by the same small team of midwives throughout their pregnancy, labour and postnatal care. It was a key recommendation of 2016’s Better Births review of English midwifery services. NHSE’s chief midwifery officer for England Jacqueline Dunkley-Bent championed the policy and guidance on its implementation was issued in October. However, in her report on the care failures at Shrewsbury and Telford Hospital Trust’s maternity department, Donna Ockenden said the Midwifery Continuity of Care model should be suspended until more evidence was gathered about its effectiveness and there were enough midwives to meet minimum staffing requirements. Ms Ockenden said patient safety had been “compromised by the unprecedented pressures that Continuity of Care models of care place on maternity services already under significant strain”. Read full story (paywalled) Source: HSJ, 23 September 2022 -
Content ArticleThe occupational therapy (OT) workforce is under huge pressure. Increased demand coupled with workforce shortages is challenging OTs’ capacity to provide essential support to people whose lives are impacted by long term health conditions and disability. In November 2022, the Royal College of Occupational Therapists surveyed OT practitioners across the UK about the workplace issues they’re facing now, and how these affect the services they deliver to the public. They also asked how practitioners are impacted personally, including whether they intend to continue working as OTs. The challenges shared by over 2,600 respondents have significant implications for the resilience of the current and future OT workforce, and the people who use OT services.
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Content ArticleIn this BMJ article, consultant in geriatrics and acute medicine David Oliver describes his experience of being an inpatient in the hospital he works in. He talks about how his three-day admission with respiratory syncytial virus and pneumococcus has given him a better understanding of what patients experience in hospital. He describes how lack of privacy, poor quality food and noise affected him during his stay as an inpatient. He also highlights that although all staff were professional and kind, they were clearly overworked and unable to focus on more 'minor' concerns that patients have.
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Content ArticleA shortage of nurses across the world, including in countries that provide nurses for international recruitment, has created a global health emergency, according to the latest report from the International Council of Nurses. The report, Recover to Rebuild: Investing in the Nursing Workforce for Health System Effectiveness, lays out the devastating impact that the Covid-19 pandemic has had on nurses around the world. It urges that investment in a well-supported global nursing workforce is needed if health systems around the world are to recover and be rebuilt effectively. It also warned against reliance on the “quick fix” of international recruitment instead of investing in nursing education, as this was contributing to staff shortages even in countries with a long tradition of educating nurses to work in higher income countries. The report, co-authored by the organisation's chief executive, Howard Catton, and nursing workforce policy expert Professor James Buchan, includes the findings of workforce surveys from more than 25 countries, including the UK, as well as other research.
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Content ArticleThis article by Katherine Virkstis, Managing Director of the US health thinktank Advisory Board, looks at the growing problem of a nursing 'skills gap' in the US. She argues that this area is often overlooked, but needs to be tackled to ensure patients are safe. A recent boom in new nurses graduating means that the balance of the nursing workforce is now less experienced than it has previously been. The growing complexity of patients and care approaches in healthcare systems also means that the demand for highly-trained nurses with specific skills has increased. The author explains this as a widening 'experience-complexity gap' and suggests four strategies to close the gap: Bolster emotional support and show staff your own vulnerability as a leader Dramatically scope the first year of practise Differentiate practice for experienced nurses Reinforce experienced nurses' identity as system citizens
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Content ArticleIn this blog, Carl Heneghan, Urgent Care GP and Professor of Evidence-based Medicine at the University of Oxford, looks at how the shortage of doctors working in urgent care is affecting patient safety. He tells the story of a patient with a blocked catheter, highlighting that with early intervention, this should cause few complications, but if not treated promptly, it can cause bladder damage and chronic kidney failure. This example highlights the need to ensure patients are seen quickly if they have an urgent need in the community. The blog points out that current Government plans to scale up urgent community response teams are inadequate as they only cover 12 hours a day and there is a shortage of GPs willing to work in urgent care.
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Content ArticleIn this report, the Public Accounts Committee, which examines the value for money of UK Government projects, programmes and service delivery, looks in detail at the implementation of NHS England’s three-year recovery programme for tackling the Covid-19 backlog of elective care.
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News Article
Consultant refused to carry out urgent surgery at trust facing criticism from CQC
Patient Safety Learning posted a news article in News
A consultant surgeon refused to attend hospital to carry out urgent surgery at a trust which later had upper gastrointestinal surgery suspended after an unannounced Care Quality Commission visit. The CQC report into upper GI surgery at the Royal Sussex County Hospital in Brighton – based on an inspection in August – said incident reports revealed occasions when upper GI surgeons could not be contacted or refused to come into hospital to treat patients. In one case, a consultant would not come in to carry out urgent surgery, it added. Low numbers of surgeons meant the on-call rota for upper GI was shared with the lower GI surgeons. This meant an upper GI specialist was not always available immediately, despite guidance from a professional body that 24/7 subspecialty cover was needed at centres which carry out major resectional surgery. This surgery was suspended at the RSCH after the August inspection and has yet to be reinstated. Mortality at both 30 and 90 days for patients with oesophago-gastric cancer was twice the national average between 2017 and 2020 – though the trust was not an outlier – and there was an increasing number of emergency readmissions for patients who had undergone upper GI surgery, the report said. Read full story (paywalled) Source: HSJ, 1 December 2022 -
News Article
Nurses across UK to strike for first time on 15 and 20 December
Patient Safety Learning posted a news article in News
Nurses across the UK will go on strike for the first time over two days in the fortnight before Christmas after ministers rejected their pleas for formal talks over NHS pay. The Royal College of Nursing (RCN) said its members would stage national strikes – the first in its 106-year history – on 15 and 20 December. Senior sources said the industrial action was expected to last for 12 hours on both days – most likely between 8am and 8pm. The unprecedented national industrial action will seriously disrupt care and is likely to be the first in a series of strikes over the winter and into the spring by other NHS staff, including junior doctors and ambulance workers. On Friday, RCN general secretary, Pat Cullen, said the UK government had chosen strikes over listening to nursing staff, adding: “If you turn your back on nurses, you turn your back on patients.” The RCN said that despite a pay rise of about £1,400 awarded in the summer, experienced nurses were worse off by 20% in real terms due to successive below-inflation awards since 2010. It said the economic argument for paying nursing staff fairly was clear when billions of pounds were being spent on agency staff to plug workforce gaps. It added that in the last year, 25,000 nursing staff around the UK had left the Nursing and Midwifery Council register, with poor pay contributing to staff shortages across the country, which it warned were affecting patient safety. There are 47,000 unfilled NHS registered nurse posts in England alone. Read full story Source: The Guardian, 25 November 2022 -
News Article
Plea to blur line between doctors and nurses amid NHS staff crisis
Patient Safety Learning posted a news article in News
The NHS staffing crisis will be solved only if doctors and nurses get more flexible about their job descriptions and break down barriers between roles, according to Rishi Sunak’s health adviser. Bill Morgan argues that training times for doctors and nurses may have to be reduced, and suggests developing “sub-consultants” and entirely new medical professions, He wants ministers to create an Office for Budget Responsibility-style body to predict future workforce needs. The Treasury has held down the numbers of doctors and nurses Britain trains to prevent “supply-induced demand”, which encourages people to seek appointments that are not needed, Morgan argues. Chronic shortages of qualified staff are the biggest problem facing the health service, which has more than 130,000 vacancies. Morgan acknowledges that this means “some of the government’s key manifesto commitments will not be met”, citing the promise of 6,000 extra GPs. Sunak said this week that the government was “thinking creatively about what new roles and capabilities we need in the healthcare workforce of the future”. He urged the NHS to shed “conventional wisdom”. Read full story (paywalled) Source: The Times, 24 November 2022 -
News Article
NHS ‘needs thousands more staff to meet cost of living crisis demands’
Patient Safety Learning posted a news article in News
NHS therapy services won’t be able to manage increased demand driven by the cost of a living crisis as they are already thousands of therapists short, The Independent has been told. NHS counselling services in England are not meeting therapy access targets due to a shortfall of 2,000 workers, according to sources. The findings come as a poll by the UK Council for Psychotherapy (UKCP) and YouGov, shared with The Independent, found that almost one in two adults felt the cost of living crisis was affecting their mental health. According to the survey of more than 2,000 adults, 25 to 34 years old were most likely to say the cost of the living crisis was impacting their mental health. Adam Jones, policy and public affairs manager for the UKCP, said “I think what we’re concerned about is the fact that already, there is a record level of demand for mental health services. We also know there are record rates of prescription for antidepressant medication as well. We’re concerned the capacity currently is already falling short. “So with the rising demand going forward, we’re concerned that services are going to be stretched, waiting time is going to go up, average number of therapy sessions received is going to go down He warned that although the NHS is focussed on training new therapists, there was already an existing workforce of psychotherapists and counsellors who don’t work in the NHS. “We’d like to see more targeted recruitment of psychotherapists and counsellors who are already trained, and so that most would only require a short adaptive training to be able to work in an NHS context.” Read full story Source: The Independent, 23 November 2022 -
News Article
GPs in England treat up to three times more patients than safety limit demands
Patient Safety Learning posted a news article in News
GPs are struggling to cope with as many as 90 appointments and consultations a day – more than three times a recommended safety limit. General practices in England are carrying out more appointments than before the pandemic but face severe workforce shortages. More than 1.45 million patients waited at least 28 days to see a GP in September, according to the most recent NHS figures. GPs who spoke to the Observer last week say that almost every day they breach the BM) guideline of “not more than 25 contacts per day” to deliver safe care. One doctor said he had more than 90 consultations on one day. A conference of local medical committee representatives in England this week will highlight the growing pressures faced in general practice. Surgeries are being urged to impose stricter caps on the number of patient appointments for each GP. One of the proposed motions submitted to the conference by Kensington and Chelsea local medical committee says “focusing on patient safety” is more appropriate than meeting high patient demand. It says the NHS should focus on “safe capacity”. Such a move would mean longer waits for GP appointments, but doctors say it would help safeguard patient care and the welfare of staff in general practice. Read full story Source: The Guardian, 20 November 2022 -
News Article
NHS care backlog push at serious risk - National Audit Office
Patient Safety Learning posted a news article in News
The plan to tackle long waits in hospital treatment and cancer care in England by 2025 is at serious risk, the spending watchdog says. The National Audit Office report warned inflation and other pressures on the NHS could undermine the push. These included a lack of staff and hospital beds, which was affecting productivity, the watchdog said. But NHS bosses said they could overcome the challenges and the health service was on track to hit its targets. NHS England and the government have set a series of targets over the next three years. They include: returning performance on the 62-day target for cancer treatment to pre-pandemic levels by March 2023 ending waits of over a year and a half for planned treatment, such as knee and hip operations, by April 2023 ending waits of over a year for planned treatment by March 2025 The NAO report comes as the chancellor prepares to set out his tax and spending plans in his Autumn Statement on Thursday. Cuts to public spending are likely but Health Secretary Steve Barclay has strongly hinted the NHS will receive more money. Read full story Source: BBC News, 17 November 2022 -
News Article
BMA chief warns Scotland's GPs are at 'tipping point'
Patient Safety Learning posted a news article in News
GP surgeries across Scotland are at risk of collapsing because of staff shortages and increased demand, a senior doctor has warned. Dr Andrew Buist, chairman of the British Medical Association's (BMA) Scottish GP committee, told the BBC many practices were at "tipping point". More than a third of surveyed surgeries reported at least one GP vacancy – up from just over a quarter last year. About half of the GP surgeries in Scotland took part in the BMA survey. It showed 81% of practices said demand was exceeding capacity - with 42% saying demand substantially exceeded capacity. Dr Buist told BBC Scotland: "I worry that we're reaching a tipping point for some practices. "They lose one or maybe two doctors out of three, and the remaining doctors cannot continue so they return the contract and the practice may cease to exist. "That is a real concern in some parts of Scotland that that is happening and it's going to happen increasingly as the situation develops over this winter." Read full story Source: BBC News, 15 November 2022 -
News Article
NHS staff ‘petrified’ of how bad winter will be at hospitals in England
Patient Safety Learning posted a news article in News
Doctors and nurses are “absolutely frightened and petrified” about how bad this winter will be for the NHS in England, hospital bosses have revealed. Staff fear services will not be able to cope with a combination of flu, resurgent Covid, winter and the cost of living crisis damaging people’s health, and also the wave of looming strikes over pay. “People are genuinely scared,” said the chief executive of one acute NHS trust in England. “I’m talking to senior clinicians and consultants and nurses who are absolutely frightened and petrified about what’s potentially to come,” added the hospital boss, speaking on condition of anonymity. Staff are anxious because of “the potential for the impact of Covid and flu, the impact of industrial action, the impact of cost of living, the impact on people’s health from that, [and] the massive increases in mental health need, and the breakdown in primary care and social care.” Chiefs of other NHS trusts in England said they shared that gloomy prognosis. They are bracing themselves for having to curtail and cancel services on days when staff stop work over pay, including outpatient clinics and non-urgent surgery. The NHS will face an “onslaught” this winter, one said. Read full story Source: The Guardian, 15 November 2022 -
News Article
State of social care in England ‘never been so bad’, social services boss warns
Patient Safety Learning posted a news article in News
The state of social care in England has “never been so bad”, the country’s leading social services chief has said, with half a million people now waiting for help. Sarah McClinton, president of the Association of Directors of Adult Social Services (ADASS), told a conference of council care bosses in Manchester: “The shocking situation is that we have more people requesting help from councils, more older and disabled with complex needs, yet social care capacity has reduced and we have 50,000 fewer paid carers.” Over 400,000 people rely on care homes in England and more than 800,000 receive care at home. But care services are struggling with 160,000 staff vacancies, rising demand and already tight funding for social care that is being squeezed by soaring food and energy inflation. About a third of care providers report that inability to recruit staff has negatively affected their service and many have stopped admitting new residents as a result. Last month the Care Quality Commission warned of a “tsunami of unmet care” and said England’s health and social care system was “gridlocked”. Problems in social care make it harder to free up beds in hospitals, slowing down the delivery of elective care. “The scale of how many people are either not getting the care and support they need, or are getting the wrong kind of help, at the wrong time and in the wrong place is staggering,” said McClinton, who is also director for health and adult services in Greenwich. “It is also adding to the endless pressures we see with ambulances and hospitals, and adding to the pressures we see in our communities, more people requesting help with mental health and domestic abuse.” Read full story Source: The Guardian, 2 November 2022 -
News Article
Number of NHS doctors off sick 'may be nearly triple the official estimate'
Patient Safety Learning posted a news article in News
The government could be significantly underestimating the number of medics going off work due to the coronavirus, according to a survey by the Royal College of Physicians (RCP). The health secretary, Matt Hancock, said on Sunday that 5.7% of hospital doctors were off sick or absent because of Covid-19, but a doctors’ survey of more than 2,500 medics found the rate was almost three times that – 14.6%. In recent weeks in London, nearly a third of hospital doctors said they were off work for Covid-19 and non-Covid-19 reasons, according to the RCP’s poll of members, conducted on Wednesday and Thursday. Prof Andrew Goddard, the president of the RCP, said the number who had been off work in London “should be a sobering wake-up call” for the rest of the country, with the largest rises in confirmed cases now being outside the capital including in the West Midlands. Read full story Source: The Guardian, 5 April 2020 -
News Article
Nearly 35,000 patients overdue follow-ups at single trust
Patient Safety Learning posted a news article in News
Nearly 35,000 patients are overdue a follow-up appointment at North Lincolnshire and Goole Foundation Trust, HSJ has learned. Almost 20% of the 34,938 follow-up appointments are in ophthalmology. A paper from the trust’s November board meeting said the “backlog of follow-up appointments… clearly remains a risk”. The report also said the service was failing some of the quality guidelines set out by the National Institute for Health and Care Excellence (NICE). The trust told HSJ it had introduced a clinical harm review process last year to address the backlog. It has reviewed “more than 5,000 patients”, out of the 34,938 cases to date, according to Chief Operating Officer Shaun Stacey. He said the trust had initially identified 83 patients who could have come to “potential harm”. Read full story Source: HSJ, 28 January 2020 -
News Article
Safety fears as hospitals redeploy nurses to care for patients in corridors
Patient Safety Learning posted a news article in News
Hospitals are having to redeploy nurses from wards to look after queues of patients in corridors, in a growing trend that has raised concerns about patient safety. Many hospitals have become so overcrowded that they are being forced to tell nurses to spend part of their shift working as “corridor nurses” to look after patients who are waiting for a bed. The disclosure of the rise in corridor nurses comes days after the NHS in England posted its worst-ever performance figures against the four-hour target for A&E care. They showed that last month almost 100,000 patients waited at least four hours and sometimes up to 12 or more on a trolley while hospital staff found them a bed on the ward appropriate for their condition. “Corridor nursing is happening across the NHS in England and certainly in scores of hospitals. It’s very worrying to see this,” said Dave Smith, the Chair of the Royal College of Nursing’s Emergency Care Association, which represents nurses in A&E units across the UK. "Having to provide care to patients in corridors and on trolleys in overcrowded emergency departments is not just undignified for patients, it’s also often unsafe.” A nurse in south-west England told the Guardian newspaper how nurses feared the redeployments were leaving specialist wards too short of staff, and patients without pain relief and other medication. Some wards were “dangerously understaffed” as a result, she claimed. She said: “Many nurses, including myself, dread going into work in case we’re pulled from our own patients to then care for a number of people in the queue, which is clearly unsafe. We’re being asked to choose between the safety of our patients on the wards and those in the queue." Read full story Source: The Guardian, 12 January 2020 -
News Article
Health strike: RCN nurses in second day's strike
Patient Safety Learning posted a news article in News
About 9,000 nurses across Northern Ireland have begun a 12-hour strike today in a second wave of protests over pay and staffing levels. More than 2,000 appointments and procedures have been cancelled, including a number of elective caesarean operations. The Health and Social Care Board said it expects "significant disruption" Royal College of Nursing (RCN) Director Pat Cullen told BBC Radio Ulster's Good Morning Ulster programme that nurses felt "bullied" by health officials. Her comments followed a warning by the heads of Northern Ireland's health trusts on Tuesday that this week's strikes could push the system "beyond tipping point". Valerie Thompson, a deputy ward sister at Londonderry's Altnagelvin Hospital, said concerns over safe staffing levels and pay parity had brought her to the picket line. "We need to have the proper amount of staff to care for our patients, give them the respects, dignity, care they deserve," she said. "We are a loyal workforce; we get on with it, and rally around. But it is difficult. We miss breaks, go home late, staff are just exhausted." Read full story Source: BBC new, 8 January 2020 -
News Article
'Breaking point': fears over lack of intensive care beds for children
Patient Safety Learning posted a news article in News
Critically ill children are being rushed from one part of England to another because NHS hospitals are running short of intensive care beds in which to treat them, the Guardian has revealed. An increase in severe breathing problems in children driven by winter viruses and infections, including flu, means some are having to be transferred sometimes many miles from their home area because there are not enough paediatric intensive care (PICU) beds locally. Specialist doctors who staff the units say the situation is “dangerous and rotten for the families” involved and that staff are firefighting to handle the number of children needing sometimes life-saving care, many of whom are on a ventilator to help them breathe. In the past few weeks, young patients have been sent from the Midlands to Sheffield, from London to Cambridge, and from one side of the Pennines to the other in order to get them a place in a PICU. One doctor at a PICU in the Midlands said: “PICU beds are always in high demand. But since winter hit this year, around six weeks ago, the situation feels like we are simply firefighting. Many days I come on shift to find there are no beds in [our] region and the patients referred to us end up in Southampton, Sheffield, Oxford and other centres far away." “The PICU network is overstretched. There aren’t enough beds, nurses or skilled doctors.” Read full story Source: The Guardian, 29 December 2019 -
News Article
Nurses' strike in Northern Ireland: RCN confirms January strike dates
Patient Safety Learning posted a news article in News
Nurses in Northern Ireland have announced their plans for further strike action in the new year. Earlier this month, more than 15,000 nurses took to the picket lines over pay and staffing levels. It was the first time in the 103-year history of the Royal College of Nursing (RCN) that its members had taken such action. It has announced nurses will strike on 8 January and 10 January 2020, unless a resolution is reached. Read full story Source: BBC News, 24 December 2019 -
Content ArticleMuch research has been done into the causes, extent and impact of health inequalities that affect rural and coastal populations. Health services in these areas currently face serious challenges due to a combination of factors, including social deprivation, ageing populations and workforce staffing issues. In this blog, Patrick Mitchell, Director of Innovation, Digital and Transformation at Health Education England (HEE), describes a new HEE programme that aims to help tackle health inequalities in rural and coastal areas.
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Content Article
HSJ Primer: Breaking point (25 April 2022)
Patient Safety Learning posted an article in Workforce and resources
Recently the Financial Times health and data reports produced an incisive piece showing the world what is all too readily apparent to people in the NHS: bed capacity has been stretched to breaking point. The report said this “calls into question [the NHS’s] ability to meet a commitment to increase non-urgent hospital treatment by 30 per cent above pre-pandemic levels over the next three years”. It also demonstrates the dangerous congestion that is causing ambulances to stack up outside emergency departments and medically fit patients to languish in vital beds past their due time for discharge. This congestion is causing dangerous delays, leading to a rising number of serious incidents in ambulances queuing to get to the front door of the ED. There is doubtless much that can be done inside hospitals to improve efficiency, alleviate bottlenecks and improve patient flow.
