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Found 321 results
  1. News Article
    A chief executive has apologised after a survey of his trust’s staff from minority ethnic backgrounds found many had been subjected to racist behaviour by colleagues. The staff at East of England Ambulance Service Trust said peers had made monkey noises and referred to banana boats in front of them, excluded them from social events, and assumed they could speak Middle Eastern and Asian languages just because of their skin colour, they told researchers. The trust has had substantial cultural problems for several years, and commissioned the survey to “better understand the experience, perceptions and realities of the trust BME staff”, a board paper said. The report on its findings, published this week in trust board papers, warns: “There are risks that a minority of EEAST employees are demonstrating behaviours or using language which could be perceived as racist. Reports of subsequent inaction by managers further risk this behaviour being normalised.” Read full story (paywalled) Source: HSJ, 15 March 2023
  2. Content Article
    A BBC Newsnight investigation hears devastating evidence and testimony of ambulance failings in the north east of England. What does it take to run a safe service that patients can trust? 
  3. Content Article
    In this letter to Steve Barclay MP, Secretary of State for Health and Social Care, the chair and chief executive of the Patients Association, Sir Robert Francis and Rachel Power, raised their concerns about how the Government is dealing with the growing crisis in health and social care. The letter asked him to declare a national incident in the NHS and to publish solutions to the current crisis, developed with patients and carers. The letter also asked the Minister to publish the long-term workforce plan and includes an offer from the Patients Association to work with the Department for Health and Social Care (DHSC).
  4. Content Article
    In this article, Richard Murray, Chief Executive of The King's Fund, reflects on what 2023 has in store for the health and care system in England. Acknowledging the intense pressure all services are currently under, he highlights that patients aren't currently receiving the care they need meaning that coping with operational challenges is going to dominate the early part of the year for the health and care sector. He warns of the futility of the Government adding new performance management measures to the sector, and expresses hope that Integrated Care Boards (ICBs) could make a difference by bringing together stakeholders to tackle longer-term problems such as integration, population health and inequalities.
  5. Content Article
    In this article for The Guardian, an anonymous hospital consultant describes the situation in many NHS emergency departments in January 2023—patients ready for medical admission waiting in ambulances in the hospital car park, patients receiving IV antibiotics in chairs in the corridor and staff completely overwhelmed by the workload. The author highlights that accident and emergency departments are now being used for a purpose for which they were not designed—looking after patients who need to be admitted to hospital wards. They describe the implications of this on patient safety and staff wellbeing and argue that the NHS and Government need to call the situation what it is—a crisis—or we will come to accept poor quality care and low patient safety standards as the norm.
  6. Content Article
    Letter from Sir David Sloman Chief, Operating Officer NHS England, Professor Sir Stephen Powis, National Medical Director NHS England, and Dame Ruth May, Chief Nursing Officer, to ICBs and Trusts regarding the upcoming ambulance industrial action.
  7. Content Article
    This report by The Patient Experience Library looks at patient experience in urgent and emergency care (UEC), reviewing four years' worth of studies from sources including government bodies, policy think tanks, academic institutions and the local Healthwatch network.
  8. News Article
    Harm to patients has become “normalised” as burned-out paramedics are working without breaks, the national care watchdog has warned. Concerns over the pressures on staff at South East Coast Ambulance Service have been raised by the Care Quality Commission (CQC). Senior staff told the CQC that patients were being adversely affected by ambulance delays but it was now being seen as “part of the culture”. The CQC found pressures on staff within the South East Coast Ambulance Service, such as long waits outside of the emergency department, had led to low morale and staff feeling they were not valued. It said: “Staff described feeling frustrated and burnout and that senior leaders did not understand or respond to the challenges or concerns they raised. Some local senior managers described that harm to patients, caused by delays in reaching them, had become normalised as a culture.” “At times there were many outstanding category 3 [urgent] patients awaiting an ambulance or assessment by a paramedic practitioner. At busy times, these patients waited for extended lengths of time for crews and callbacks. Therefore, this group of patients were at risk of deterioration whilst they were waiting for a response.” Read full story Source: The Independent, 26 October 2022
  9. 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
  10. 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
  11. 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
  12. News Article
    An air ambulance service has been praised by inspectors for providing an "outstanding level of care". The Care Quality Commission (CQC) carried out checks on the Essex & Herts Air Ambulance Trust (EHAAT) in August and September. The report said patients felt "truly respected and valued as individuals" and described teamwork as "exemplary". Ben Myer, EHAAT head of clinical delivery, said "everyone worked so hard to make the desired result a reality". The service provides emergency care and transport in Essex and Hertfordshire, and surrounding areas when needed. As well as being rated outstanding overall, the charity was also rated outstanding for being safe, effective, caring, responsive to people's needs - and being well-led. Jane Gurney, EHAAT chief executive, thanked the local community for supporting the service, and issued a personal thank you to "each team member across the charity, whatever their role, all of whom work so hard every day to uphold these high standards". Read full story Source: BBC News, 12 October 2022
  13. News Article
    Several ambulance trusts have moved to the highest level of alert in the wake of severe pressure on emergency services in recent days. Internal data seen by HSJ suggests ambulance response times have deteriorated dramatically, while the average time for call handlers to answer 999 calls has increased to almost two minutes in some areas. Staff across the country have been sounding the alarm over the pressures, with one senior source saying the situation was “really dire” again, after a period in which pressures had eased in August and September. The internal data showed ambulance trusts in the South West, East of England, London and the West Midlands had all declared the highest level of alert, known as REAP 4. More are expected to follow. The average response time for category 2 calls in the South West – including suspected heart attacks and strokes – was 1 hour 24 minutes, with 10% of these calls responded to in more than 3 hours 11 minutes. The target is 18 minutes. Emergency departments have also faced severe pressure. An emergency care consultant in Plymouth tweeted that patients were facing 70-hour waits to be admitted to wards, with some waiting 18 hours to be handed over by ambulance staff. Fionna Lowe added: “I have taken to asking families to feed their relatives. It has never been this bad.” Read full story (paywalled) Source: HSJ, 4 October 2022
  14. News Article
    Hannah Rusby reassures her patient he’s in good hands. He is in his eighties, skeletal, confused and struggling to answer basic questions. His breathing is rapid. After a few minutes of probing questions and basic tests, Rusby knows this is serious — after months of decline while living alone, the man is critically ill and needs to go to hospital urgently. With more than 500,000 people waiting for social care assessments across England, emergency calls such as this are increasingly common. “We are becoming a middleman for all the other services,” said Rusby, who qualified as a paramedic seven years ago and works for the London Ambulance Service (LAS). She said the job increasingly involves responding to people who fall through society’s cracks. Daniel Elkeles, 49, chief executive of the LAS, agrees: “There are lots of patients who, if something else were available, we wouldn’t need to take them to hospital. As the population has got older and frailer, it’s unsurprising that an increasing number of the calls are not traditional emergencies.” He believes paramedics can be the link between GPs, community nursing and social care. From next week, the LAS will pilot having three cars covering six boroughs in southwest London. Each will have a paramedic and a community nurse and will respond to 999 calls from elderly people who have fallen at home. They’re going to see every frail elderly person who has fallen [and] hasn’t broken a bone, and our aim is to keep all of those patients at home. The community nurse will assess the house to make sure it’s safe then refer the patient to their GP and an urgent community response team,” said Elkeles. The service hopes this will mean as many as 1,000 fewer people going to A&E a year. Read full story (paywalled) Source: Sunday Times, 2 September 2022
  15. News Article
    The Care Quality Commission (CQC) has urged system leaders to move away from “quick fixes” to the “enormous gap in resources and capacity” in urgent and emergency care. A report by the CQC and a large group of emergency clinicians and other health and care leaders calls for a ”move away from reactive ‘quick fixes’ such as tents in the car park or corridor care to proactive long-term solutions and to address the enormous gap in resources and capacity”. The use of tents and treating more patients in corridors have been increasingly adopted by hospitals in recent months, sometimes encouraged by NHS England, particularly when they are under pressure to reduce handover delays from ambulances. The report, 'People First: a response from health and care leaders to the urgent and emergency care system crisis', suggests: expanding use of urgent community response teams to attend minor injuries 999/111 calls, giving acute and social care providers direct access to GP and community service booking systems, and providing “rapid access” to support packages to help people avoid hospital admission. Read full story (paywalled) Source: HSJ, 22 September 2022
  16. News Article
    An ambulance trust accused of withholding key evidence from coroners was previously warned its staff needed training to ‘understand the real risk of committing criminal offences’ in relation to inquests into patient deaths. North East Ambulance Service, which has been accused by whistleblowers of withholding details from coroners in more than 90 deaths, was told by its lawyers in 2019 about serious shortcomings in its processes for disclosing information, according to internal documents obtained by a campaigner. According to the documents, the lawyers said trust staff could “pick and choose” documents to release to coroners “regardless of relevance.” The following year, an audit report said the issues had not been addressed. Whistleblowers’ concerns about the trust were first reported by The Sunday Times in the spring, with a review highlighting several cases between 2018 and 2019 where key facts were omitted in disclosures to coroners. But campaigner Minh Alexander has since obtained new details of warnings that were being made to internally, from lawyers and auditors who were advising the trust. Read full story Source: HSJ, 20 September 2022
  17. 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.
  18. 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.
  19. Content Article
    With the NHS often characterised as being trapped in a permacrisis, what can be done to shift the dial? In this NHS Confederation podcast, Daniel Elkeles, chief executive of the London Ambulance Service NHS Trust, talks about improvements in the urgent and emergency care pathway, shifting the narrative on primary care and busting the barriers holding the health and care system back. With industrial action taking a toll, Daniel, who leads the world’s largest ambulance service, sheds light on the untold impact of strikes, the effect on long-term innovation and recovery and why culture change in the ambulance service is top of his mission list.
  20. Content Article
    The Healthcare Safety Investigation Branch (HSIB) have published a third interim report for this investigation which focuses on staff wellbeing across the urgent and emergency care systems and the impact that this has on patient safety.
  21. Content Article
    The National Guardian’s Office has published Listening to Workers – the report following its Speak Up review of NHS ambulance trusts in England. The review found the culture in ambulance trusts did not support workers to speak up and that this was having an impact on worker wellbeing and ultimately patient safety.
  22. News Article
    Ambulance staff across most of England and Wales will go on strike on 21 December in a dispute over pay. The coordinated walkout by the three main ambulance unions - Unison, GMB and Unite - will affect non-life threatening calls only. But it could mean people who have had trips and falls not being responded to. Members of GMB, which represents nearly a third of the 50,000-strong workforce, will then follow that up with another walkout on 28 December. It comes as Royal College of Nursing members are also preparing to go on strike on 15 and 20 December in parts of England, Wales and Northern Ireland. The walkouts will involve paramedics as well as control room staff and support workers, with the military on standby to help out. The only service which will be completely unaffected, however, is the East of England. Under trade union rules, life-preserving care has to be provided so the two highest category calls - covering everything from heart attacks and strokes to major trauma - will still be responded to. But Matthew Taylor, of the NHS Confederation, which represents health managers, said he was worried the action would "undoubtedly" affect patient care and how quickly ambulance services could respond and may even deter people from seeking help. "The prospect of industrial action over Christmas is very concerning," he added. Read full story Source: BBC News, 6 December 2022
  23. 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
  24. News Article
    Ambulance services across England are set to go on strike before Christmas as thousands of paramedics and call handlers voted for action. The announcement by union Unison comes as the Royal College of Nursing (RCN) confirmed 100,000 nurses across England, Wales and Northern Ireland will walk out on 15 and 20 December. The union is calling for action on pay and a big increase in staff numbers, warning that unless these things happen, services will continue to decline. Saffron Cordery, interim chief of NHS Providers, said on BBC radio four: “I think in terms of the ambulance strike, we know the challenges already of not having enough paramedics, call handlers available, because we’ve seen the challenges to ambulance handover times that we have at the moment in terms of not being able to transfer patients from ambulances into A&E departments and the challenges that brings when they can’t get back out on the road. “Additional challenges on top of that, I think, will make response times incredibly stretched.” Sources told The Independent that one option could be for services to maintain levels of staff to be able to respond to the most serious calls - category one and two calls - and deprioritise the less serious category three and four calls. This has previously been negotiated during smaller-scale strikes. However, senior sources suggested that on a larger scale it would be hard to not respond to category three calls, which might include an older person who has fallen. It is also unclear how 999 call centres would operate during strikes as this work would likely count as life-saving emergency care, The Independent understands. Read full story Source: The Independent, 2 December 2022
  25. News Article
    More than 11,000 ambulances a week are caught in queues of at least an hour outside A&E units in England, a BBC News analysis shows. The total - the highest since records began, in 2010 - means one in seven crews faced delays on this scale by late November. Paramedics warned the problems were causing patients severe harm. One family told BBC News an 85-year-old woman with a broken hip had waited 40 hours before a hospital admission. She waited an "agonising" 14 hours for the ambulance to arrive and then 26 in the ambulance outside hospital. When finally admitted, to the Royal Cornwall Hospital, which has apologised for her care, she had surgery. Both ambulance response times and A&E waits have hit their worst levels on record in all parts of the UK in recent months. In Cornwall, patients facing emergencies such as heart attacks and strokes are now waiting more than two hours on average for an ambulance. The target is 18 minutes. They are thought to be among the worst delays in the country but none of England's ambulance services is close to the target, while Wales, Scotland and Northern Ireland are all missing their targets. Read full story Source: BBC News, 1 December 2022
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