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Content ArticleA new report from the Public Policy Projects (PPP) calls on integrated care systems (ICSs) to harness the unique capabilities of the pharmacy sector and implement a pharmacy-led transformation of healthcare delivery. The report, Driving true value from medicines and pharmacy, is chaired by Yousaf Ahmad, ICS Chief Pharmacist and Director of Medicines Optimisation at Frimley Health and Care Integrated Care System, and is the culmination of three roundtable events attended by key stakeholders from across the pharmacy sector and ICS leadership. Insight from these roundtables has also been accepted as evidence in the Health and Care Select Committee’s recent inquiry into the future of the pharmacy sector.
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Content ArticleSolving Together is a partnership that enables people with different ideas and views to put forward solutions and experiences. From Monday 9 October to Friday 3 November 2023, Solving Together is hosting a series of conversations on Children and Young People’s Mental Health that aim to get ideas on how access and waiting times for community services could be improved. The conversation topics are: Reducing inequalities in access, experience and outcomes Prevention and early intervention Experience of services Transfer of care and wider support
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News Article
Community waiting list surges back above 1 million
Patient Safety Learning posted a news article in News
The community services waiting list has risen sharply to more than 1 million, with children suffering the longest waits, new data has revealed. NHS England figures published today show the adult community waiting list increased from 704,000 to 781,000 between October 2022 – the first published data available – and August. The children and young people’s list rose from 207,000 to 221,000. This means the overall community waiting list for England has exceeded 1 million for the first time since figures were first published in October last year. Waits for musculoskeletal services dropped to a low of 255,000 in January. But this progress has since reversed – and, in July, the number of people waiting for care climbed to a high point of 319,000. The waiting for podiatry and podiatric services, meanwhile, has climbed by 7% since October from 117,000 to 126,000, adding an extra 8,000 people to the waiting list. These services also account for 46 per cent – or 5,635 – of the waiting list over 52 weeks. Waiting lists for smaller adult specialties have also significantly worsened. For example, nursing and therapy support for long-term conditions saw large increases in three areas: continence and colostomy, rising by 16%; respiratory and COPD, rising by 27%; and diabetes, rising by 37%. Read full story (paywalled) Source: HSJ, 12 October 2023 -
News ArticleChildren are waiting years for autism and cerebral palsy treatments as NHS leaders accuse the government of ignoring warnings of a crisis in community care. The number of patients waiting for NHS community services hit more than one million in August and a new analysis has revealed one in five of those patients are children. The waits are so bad in some areas of England that a 12-year-old needing treatment might not get it until they are 16, the NHS Community Services Network warned. The analysis, by NHS Confederation and NHS Providers, also found 34,000 children have been waiting more than 18 weeks for diagnosis and care, which is the maximum time anyone should be waiting, with the backlogs growing quickly in spinal and eye care. Matthew Taylor, chief executive for NHS Confederation, which represents hospitals, community service providers and primary care, told The Independent that long waits can impact children more severely than adults because delays in treatment can have a knock-on effect on communication skills, social development and educational as well as mental wellbeing. “We have a real and growing problem with long waits in community services, but despite repeated warnings that neglect of these vital services is having a detrimental impact on patients, these warnings seem to be met with a shoulder shrug from the government. Leaders are working incredibly hard to deliver these important services for patients but are fighting a rising tide and need help,” he said. Read full story Source: The Independent, 20 October 2023
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Content Article
CQC: State of Care 2022/23
Patient Safety Learning posted an article in Care Quality Commission (CQC)
The Care Quality Commission (CQC) State of Care is an annual assessment of health care and social care in England. The report looks at the trends, shares examples of good and outstanding care, and highlights where care needs to improve. -
Content ArticleThe Community Hospitals Association (CHA) has designed a suite of resource packs as a way of sharing some of the learning in an accessible way. This resource pack focuses on the topic of safer staffing in community hospitals. This resource pack has been compiled because of requests from members of the CHA and the Special Interest Group in Q
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Event
Safer case loads and workforce standards (10 November 2023)
Sam posted an event in Community Calendar
untilThis free online event is an exciting opportunity to hear nursing workforce expert, Professor Alison Leary MBE, speak on the subjects of safe caseloads in community nursing. Professor Alison Leary PhD RN FRCN is Chair of Healthcare & Workforce Modelling at London South Bank University and Director of the QNI’s International Community Nursing Observatory. We will also hear from Cathy Woods and representatives of the software company Yarra, on the Use of E-CAT software for Monitoring Caseloads. The E-CAT product for district nursing is an electronic tool which supports caseload analysis and audit. Underpinned by a bespoke dependency tool and based on a methodology validated by the University of Ulster, the tool looks at caseload variables at all levels, from caseload holder to commissioner and facilitates caseload benchmarking and performance management. The tool has been implemented in all five health trusts in Northern Ireland providing a significant regional evidence base. We will be able to hear about the experience of using E-CAT in Northern Ireland from the NI Public Health Agency. Register -
Content ArticleIt is more important than ever that Integrated Care Systems (ICS) invest urgently in community mental health. The introduction of the Community Mental Health Framework in 2019 presented a once-in-a-generation opportunity for mental health systems. With ringfenced transformation funding coming to an end in April 2024 and in a climate of crisis and uncertainty, we need to ensure these changes are embedded. Rethink Mental Illness have launched their new report, 'Building Community into the Integrated Care System; A practical guide to developing robust community mental health', where they: Summarise the significant challenges facing mental healthcare. Provide a toolkit of practical, workable solutions to common barriers to transformation. Explore the role that the VCSE sector can have in pursuing the four core aims and future goals of ICSs.
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Content ArticleStandardising community pharmacy information so it can be shared digitally should reduce the burden on GPs and lead to safer, more personalised care, writes Stephen Goundrey-Smith. The Professional Record Standards Body’s (PRSB) Community Pharmacy Standard enables information to be recorded in the community pharmacy and sent to the person’s GP and all the services covered by the England Community Pharmacy Contractual Framework. Having access to better information will allow the community pharmacy team to take on a greater range of clinical services and reduce the burden on GPs and other parts of the health and care system. It will also raise the profile of the clinical contribution that community pharmacists make to the wider NHS.
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Content ArticleChanging our services so that more care is provided in community settings and people can leave hospital when they are fit for discharge has been an explicit policy aim for decades. Other, similar countries have been on the same mission and have had more success. Why might this be? This new analysis from the Nuffield Trust looks internationally at how our performance compares and how other countries have succeeded in building up community health and care services to understand what England might learn.
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Content Article
Patient-led assessments of the care environment (PLACE)
Patient Safety Learning posted an article in Environmental
PLACE assessments will provide motivation for improvement by providing a clear message, directly from patients, about how the environment or services might be enhanced. The 2023 programme is planned for launch in early September 2023. -
Content ArticleCommunity hospitals play a very important role in supporting patients but, unlike with larger hospitals, little has been known until now about how they struggle with delayed discharges. Following a freedom of information request, the Nuffield Trust reveals the number of patients experiencing delays leaving community hospitals, and highlights the capacity challenges such hospitals face.
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News ArticleHospitals are sending frail, vulnerable patients home before they are better and without vital medical care, leaving them unable to fend for themselves. Over the past fortnight, The Mail on Sunday has received an alarming number of letters from readers who have told of their anger, frustration and sheer desperation at being denied support they were promised. Many have been left bed-bound and unable to wash, dress or use the bathroom for weeks on end. The daughter of an 87-year-old stroke survivor had to put a hospital bed in her living room and provide 24/7 care for her mother after the local health team failed to provide adequate support. Within a year, the woman was dead, having been treated with little more than paracetamol. In another case, a 70-year-old woman had to take her immobile 84-year-old husband to the hospital in a taxi every day for several weeks to have vital injections, because carers refused to come to their home. And the disabled wife of one 74-year-old man, who fell off a roof and broke his pelvis and ribs, told of the heartbreak at not being able to look after her husband due to her own poor health. Campaigners say a Government scheme designed address the ‘problem’ of bed-blockers – the somewhat derogatory term used to describe patients, most of them elderly, who are occupying a hospital bed that they don’t strictly need – is to blame. The protocol, called Discharge To Assess, launched eight years ago, aims to get patients home as quickly as possible amid reports that some elderly patients ended up stuck in wards for months on end – usually because the NHS hasn’t been able to organise the next stage of their care, so it’s not safe discharge them. Read full story Source: Mail Online, 2 September 2023
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EventuntilIn this Patient Partnership Week webinar, the Patients Association will be talking about their work with patients, the Royal College of Physicians and NHS England to explore what the future of outpatient care should look like. The webinar will be chaired by Sarah Tilsed, Head of Patient Partnership. Joining her are: Dr Fiona McKevitt, Clinical Director for Outpatient Recovery and Transformation, NHS England Dr Theresa Barnes, Clinical Lead for Outpatients, Royal College of Physicians Irene Poku, Representative Patient and Public Involvement and Engagement with experience of using outpatient services. Sarah champions the voice of patients in our work and the work of other organisations. As outpatients is such a pivotal part of the NHS and is visited by millions of patients, it really is important that patients feed into the design and delivery of this service, as they know what is and isn’t working for them in terms of their care. The webinar will explore how patients have been involved. Register
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News Article
Leading clinicians ‘horrified’ as NHSE slashes community funding without warning
Patient Safety Learning posted a news article in News
Senior medics have reacted in horror to NHS England’s decision to ‘dramatically’ cut the funding of a key long-term plan commitment designed to improve older people’s community services and deliver more care at home. British Geriatrics Society president Jennifer Burns told HSJ the professional body was “horrified” that the budget for the Ageing Well programme for 2022-23 would be £70m instead of the £204m originally promised in the long-term plan for the NHS. “We are dismayed that the promised funding for the Ageing Well programme as set out in the NHS long-term plan is being so dramatically cut at this time,” Dr Burns said. NHSE said: “The NHS is also investing an additional £200m in funding for virtual wards across the country by March 2023, delivering more care to patients safely in the comfort of their own home which will directly benefit older patients.” But Dr Burns said that although virtual wards would go “some way to helping with hospital admissions”, they were “no substitute” for the original commitments. “Older people suffered a devastating toll during the pandemic. Now is the time for systems to ensure the right services are in place and there is sustainable planning for the healthcare needs of an ageing population.” Read full story (paywalled) Source: HSJ, 7 April 2022 -
News Article
Trust admits staff shortages causing inappropriate discharges
Patient Safety Learning posted a news article in News
A trust has admitted it is having to discharge patients inappropriately into care homes or community hospital beds because of a shortage of home care workers. A report to East Kent Hospitals University Foundation Trust’s board last week revealed that 160 extra beds had been commissioned to maintain flow across the local health economy “due to insufficient domiciliary/care package capacity.” It went on: “The clinical commissioning group have tried via Kent County Council to commission additional domiciliary care without success. It is acknowledged by the local health economy that it is important to withdraw from these additional beds as quickly as possible as they are not a cost-effective resource and more importantly, in many cases, they are not the ideal discharge destination for those patients who could have been discharged home with a care package. “Patients are being transferred into community hospital beds or residential home beds due to a lack of domiciliary care packages. Although this is a national issue, it will not be resolved locally until appropriate pathway capacity is commissioned.” Professor Adam Gordon, president elect of the British Geriatrics Society, said: “If people have been sent to a care home when they don’t want or need to be there that can affect their motivation and result in a form of deconditioning. One of the principles of effective rehabilitation in older people is that if you don’t use it, you lose it.” Read full story (paywalled) Source: HSJ, 17 March 2022 -
News ArticleVulnerable people released from immigration detention in the UK are too often left without crucial continuity of care, leading to quickly deteriorating health, concludes a report. The report comes from Medical Justice, a charity that sends independent volunteer clinicians into immigration removal centres across the UK to offer medical advice and assessments to immigration detainees. The charity said that between 1 October 2020 and 30 September 2021 a total of 21 362 people were detained in UK immigration centres and 17 283 were released into the community, having been granted bail or leave to enter the UK or remain. Of these, 2239 were considered to be “adults at risk.” One woman whose delay in treatment “could potentially have life or limb threatening consequences”, struggled to re-arrange an orthopaedic oncology appointment that she missed because she had been detained. One released Medical Justice client described how he ended up a number of times in Accident & Emergency, having been unable to secure a recommended cardiology appointment. The report found that release from detention is often unplanned, chaotic and medically unsafe. Medical Justice sees repeated cases of vulnerable people released into the community without adequate care plans, with little or no information and support about entitlement and how to access a GP, and rarely with referrals to community support services such as local mental health teams. This has included people who had very recently attempted suicide in detention. Read full story Source: BMJ, 4 March 2022
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News Article
Sussex woman forced to sleep in wheelchair due to lack of care staff
Patient Safety Learning posted a news article in News
A woman has been left to sleep in her wheelchair several nights a week and remain in bed for the rest of it due to a lack of social care in her local area. Mandy Page, 53, who lives alone in Hove, has difficulty getting into and out of bed on her own and previously had carers to provide support in the morning and evenings. However, since before Christmas she has had no care support in the evenings after the MyLife East Sussex agency told her it was no longer covering her care, and that the agency believed her care was now being provided by her local authority. Page receives dialysis three times a week at Royal Sussex county hospital, and on those days arrives home, by hospital transport, after 6pm. This means that without help getting out of her wheelchair and into bed she must sleep in the wheelchair. “It’s very stressful, because at the moment I’m in bed every day. I can’t get up without help, and I can’t get back to bed on a dialysis day,” Page said. “On a dialysis day, I go to dialysis and I’m in my wheelchair. Every other day, I’m in bed all day and all night. That’s no life. Page’s situation exemplifies the crisis in social care. England has faced chronic shortages of care workers, with a survey by Care England finding that 95% of care providers struggle to recruit and retain staff. In 2020/21, there were around 105,000 vacancies at any one time in the social care sector, and more than a third of the sector’s staff left their jobs during the year. Page says the lack of adequate social care has taken a negative toll on her quality of life, and has meant she hasn’t been able to undertake everyday tasks. Rob Persey, the executive director for health and adult social care at Brighton and Hove council, said the council had not been able to source a new provider for Page since her earlier care was withdrawn. “This is a national as well as a local problem as there are insufficient home care staff to meet demands. Various local initiatives, including additional funding, have been taken to increase the home care workforce, but so far they have only had a limited impact." “We recognise Mandy does not want respite care, and acknowledge this is a completely unacceptable situation for her,” he said. Read full story Source: The Guardian, 28 February 2022 -
News Article
Ombudsman’s COVID report highlights ‘tragic individual cases’
Patient Safety Learning posted a news article in News
A Covid report by the Local Government and Social Care Ombudsman has highlighted some ‘tragic individual cases’ over the past months. The report analyses cases over the first 18 months of the pandemic which for the majority reveal that councils and care providers weathered the unprecedented pressures they were under fire. However, the report also reveals the ‘serious impact on people’s lives’ when things go wrong. Cases include a woman who died from COVID-19 at a care home with poor infection control procedures which was then compounded by staff trying to cover up the facts. The Ombudsman’s report focuses on the lessons that can be learned from the complaints it has received about the pandemic and welcomes that, in many cases, councils and care providers are already using their experiences from the pandemic to consider how they can make improvements to services. Michael King, Local Government and Social Care Ombudsman, said: “We have investigated some tragic individual cases over the past months. Each represents poor personal experiences where councils and care providers did not get things right. “Our investigations have shown that, while the system did not collapse under the extreme pressures placed on it, Covid-19 has magnified stresses and weaknesses present before the pandemic affecting some councils and providers. “We have always advocated how crucial good complaint handling is in any setting, so I am particularly saddened that, in some authorities, dealing with public concerns and complaints itself became a casualty of the crisis. At a time when listening to public problems was more important than ever, we saw some overstretched and under-resourced complaints teams struggle to cope. “If evidence was needed, this report proves that managing complaints should be considered a frontline service.” Read full story Source: Care Home Professional, 24 February 2022 -
News Article
Up to 900,000 older people taken to A&E each year due to lack of NHS care at home
Patient Safety Learning posted a news article in News
Almost 900,000 older people are admitted to hospital every year as an emergency because the NHS is failing to keep them healthy at home, Age UK has warned. A major lack of services outside hospitals means elderly people are also suffering avoidable harm, such as falls and urinary tract infections, the charity said. In a new report it urges NHS bosses to push through huge changes to how the “hospital-oriented” service operates and establish “home first” as the principle of where care is provided. Doing so would reduce the strain on overcrowded hospitals and leave the NHS better set up to respond to the increase in the number of over-65s and especially over-85s, Age UK said. Its report, on the state of health and care of older people in England, concluded that “our health and care system is struggling, and too often failing, to meet the needs of our growing older population.” Read full story Source: The Guardian, 11 July 2023 -
News Article
NHS trialling 'smart goggles' so nurses can see more patients
Patient Safety Learning posted a news article in News
NHS nurses will wear “smart goggles" as part of efforts to see more patients under a £400,000 pilot scheme. Health chiefs said the virtual reality headsets would mean details of a consultation could be directly transcribed, reducing the amount of time spent filling in patients’ notes. The technology will also allow live footage to be streamed to hospital specialists for second opinions, so patients do not have to have extra appointments in hospitals. The intention is to give nurses more time for clinical duties such as checking blood pressure, dressing wounds and assessing a patient’s health needs. Dr Tim Ferris, NHS director for transformation, said: “These new smart glasses are the latest pioneering tech and really show us what the future of the NHS could look like. “They are a win-win for staff and patients alike, freeing up time-consuming admin for nurses, meaning more time for patient care.” Read full story (paywalled) Source: The Telegraph, 20 August 2022 -
News Article
Covid redeployment ‘wrong’ and ‘will never be repeated’
Patient Safety Learning posted a news article in News
Redeployment of community staff to other services – meaning visits for babies and parents were missed – was the “wrong decision” and would “never be repeated”, a provider has stated. Nikki Lawrence, the head of public health nursing at Sirona Care and Health, which provides community services for Bristol and the surrounding area, appeared to blame the government for about 70% of its health visiting staff being redeployed to adult services, leaving around 30% to care for new families at the height of the pandemic. Health visitors take over from midwives to monitor the health of children and parents for a period after the baby is born, including to guard against safeguarding threats. Ms Lawrence said: “The national learning about redeployment – we have reflected on it, the government has reflected on it and they have agreed it was the wrong decision to make. “We basically abandoned families at a time of need, and that decision will never, ever be taken again, from what I’ve been told. In hindsight it was the wrong decision to make, and… it did have a detrimental impact on families and we really regret that, but it was out of our hands.” Read full story (paywalled) Source: HSJ, 16 August 2022 -
News Article
NHS leaders warn that social care workforce crisis risks patient safety
Patient Safety Learning posted a news article in News
NHS leaders across England say staffing gaps and a lack of capacity in social care are putting the care and safety of patients in the NHS at risk. Almost 250 NHS leaders responding to an NHS Confederation survey say that patients are being delayed in hospital much longer than they should, with the knock-on impact resulting in higher demand on A&E departments and longer ambulance response times. More than 9 in 10 NHS leaders warn of a social care workforce crisis in their area which they expect will get worse this winter. Nearly all NHS leaders say the lack of capacity in social care is putting the care and safety of patients at risk. More than four in five warn that the absence of care packages for people to be able to return home or be moved into a care home is the main reason why medically fit patients are stuck in hospital longer than they should be. Almost all NHS leaders say that the most impactful solution would be better pay for social care staff and want the Government to increase investment in social care as a priority. An acute trust executive director in the South West accused the Government of presiding over a “national scandal.” “If the social care capacity shortfall was solved then we would not be holding ambulances at all, we would have almost no problems with elective recovery and our emergency departments would not be crowded and unsafe,” they said. Another acute trust chair in the East of England added: “The result of using nearly 20 per cent of our beds for patients who are medically fit but need packages of care to return home is an overcrowded A&E, twelve-hour trolley waits and much delayed ambulance handover times. The connection is very clear to us…Until we find a solution to social care staffing and funding, the situation can only get worse.” Commenting on the survey results Lord Victor Adebowale, chair of the NHS Confederation, said: “Decades of delay and inertia have left social care services chronically underfunded and in desperate need of more support. “NHS leaders stand alongside their sister services in social care in wanting a rescue package for the sector. They are sounding the alarm and sending a clear message to Government that the social care system has not been ‘fixed’." Read full story Source: NHS Confederation, 28 July 2022 -
News Article
Norfolk and Norwich Hospital unable to discharge 180 patients
Patient Safety Learning posted a news article in News
A senior hospital nurse said she could not discharge 180 patients due to a lack of "care and support" at home. Norfolk and Norwich University Hospital said among the people that did not need to be in hospital was a patient who had been there for 145 days. Claire Fare, senior discharge matron, said delays "impact on the whole of the flow" of patients. Norfolk County Council's social care department blamed the "national care crisis" for the problems. In June, the hospital, which has about 1,200 beds, pleaded for family and friends to help look after fit patients to ease demand. Melanie Syson, the hospital's discharge coordinator, said there was a person in the hospital ready for discharge that had been there for more than four months. "She is medically fit to be discharged but we are waiting for support to be ready at home," she said. Ms Syson added: "The length of stay of the patients seems to be getting longer." To help cope with the delays, the hospital opened a "home-first unit" in January for patients who did not need acute care but it was unable to discharge. The unit focuses on rehabilitation to try to prevent the patients coming back into hospital or requiring more care at home. Stephanie Ward, the ward sister, said it aimed to "give patients the time they need to do things themselves as much as they can". Read full story Source: BBC News, 15 July 2022 -
News Article
Rehab services ‘very bizarre’ in some places, says NHSE director
Patient Safety Learning posted a news article in News
NHS England’s director of community health has said a new strategy for rehabilitation care is needed, because present coverage is sometimes ‘bizarre’, with other services ‘masquerading’ as rehab. Matthew Winn, who is also Cambridgeshire Community Services Trust CEO and senior responsible officer of the “ageing well” programme in the NHS long-term plan, made the comments in a webinar for local senior clinicians and managers in the sector. He said there was an intention to roll out a national “intermediate care strategy”, describing it as “the essence” of providing rehabilitation and helping hospital patients to “optimise, to recover, to rehab through a skilled multiprofessional team”. They would leave hospital in a “timely pathway” and not need as much social care support afterwards. It comes amid huge pressure to speed up hospital discharge, which often relies on rehab services. Read full story (paywalled) Source: HSJ, 14 July 2022
