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Found 167 results
  1. News Article
    Hospitals 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
  2. News Article
    A trust has had to re-examine the cases of more than 31,000 patients after they were automatically and wrongly discharged from its care because they did not have another appointment within the next six months. Dartford and Gravesham Trust in Kent has revealed that soaring waiting times post-covid meant patients who needed follow-up appointments were not offered them within six months, which before covid was a very unusual occurrence. When they passed six months, they were dropped off waiting lists altogether, due to a feature in the trust’s patient administration system designed to ensure outdated pathways are closed. It is a common feature in many such systems, HSJ was told. The trust has now “validated” more than 31,000 patients who have been in contact with it since 1 September 2021. So far, it said, it had not found evidence of harm, although some people have been recalled for clinical review or investigation, and a small number are still to be seen. Read full story (paywalled) Source: HSJ, 22 August 2023
  3. Content Article
    Delayed discharges, where a patient is medically fit to leave hospital but is not discharged, were a particular problem in England in the winter of 2022/23. In this article, Camille Oung from the Nuffield Trust highlights some possible solutions to help better prepare health and care services for discharge pressures next winter.
  4. Content Article
    The eDischarge Information Record Standard was first published in 2015. Despite significant investment in programme initiatives, the widespread implementation of the standards has been slow.  In this report from the Professional Record Standard Body, authors identify the challenges that have inhibited the adoption of the standard, make recommendations for improvements and set out the anticipated benefits that this will bring. The aims of this discovery and user-design phase were: To review the current state of adoption of transfer of care messages between secondary care senders and primary care receivers of transfers of care and identify reasons for the low uptake to date. To understand GP’s needs and priorities for computer readable data that can be shared with primary care systems without loss of meaning. To make recommendations for what needs to happen to enable widespread adoption that supports the needs of GPs to deliver safer patient care.
  5. Content Article
    Successful day surgery requires a day surgery team with the correct knowledge and skills to enable safe, early recovery and discharge but there is an absence of national guidance on supporting competencies. Applying in-patient competency criteria is inappropriate as this pathway is not aimed at promoting early discharge. This joint publication between AfPP and BADS (the British Association Of Day Surgery) provides recommendations for core competencies for adult day surgery through (1) admission, (2) anaesthetic room, (3) theatres, (4) first-stage recovery and (5) second-stage recovery and discharge. They are relevant for staff new to or after a long absence from day surgery and acknowledge some members of the day surgery team may include non-registered practitioners. All can be used as a reference for workbook competency documents in place or in development.
  6. Content Article
    A key piece of guidance aiming to support hospital teams in their work to improve care of older people living with frailty is now available, in a collaboration between Getting It Right First Time (GIRFT) and the British Geriatrics Society (BGS). The guidance is designed to accompany the new GIRFT Hospital Acute Care Frailty Pathway, and offers detailed measures teams should take to improve care and reduce hospital-acquired dependency for those living with frailty, as well as stressing that interventions should be monitored and linked more widely to community-based services.
  7. News Article
    A struggling trust has been warned by regulators that it could see its junior doctors removed, after concerns about clinical supervision and safety at a hospital whose A&E closes at night. NHS England inspectors who visited Cheltenham General Hospital found emergency patients – including potential surgical patients – became the responsibility of the overnight medical team when its accident and emergency closed in the evening. One night, 26 patients had been handed across, the inspectors were told, and some patients were felt to be inappropriate for medical referral. A surgical registrar could be telephoned at Gloucester Royal Hospital about surgical patients. They were told that although there were no incidents of serious harm, there had been many “near misses” and juniors felt “unsafe and unsupported in terms of consultant clinical supervision, overall clinical/nursing staffing support or logistically in managing patients in this setting or arranging transfers”. Read full story (paywalled) Source: HSJ, 7 July 2023
  8. News Article
    More than half of all serious incidents where patients came to harm involving West Midlands Ambulance Service were due to clinical errors. A trust audit found choking management, cardiac arrests and inappropriate patient discharges as themes. It also noted a decision to close all community ambulance stations was taken without first doing a full risk assessment of the impact on safety. After the number of serious incidents increased from 138 in 2021-22 to 327 in 2022-23, an audit by WMAS found 53% were due to mistakes with their treatment. A situation where a person comes to significant harm in care is identified as a serious clinical incident. Sources say the trust also delayed looking into 5,000 serious patient incidents. Read full story Source: BBC News, 29 June 2023
  9. News Article
    An independent review has raised concerns about a mental health trust’s reporting systems and has highlighted a significant number of patient deaths shortly after leaving the trust’s care, including almost 300 who died on the same day they were discharged. However, the review into how Norfolk and Suffolk Foundation Trust collects, processes and reports mortality data made no conclusions on the number of avoidable deaths – the issue which had originally prompted the probe. Local NHS leaders argued the review’s purpose was focused on auditing the trust’s processes, and this had been delivered. But a local MP, Clive Lewis, accused it of “explicitly dodg[ing] the big questions”. The report, which looked at data from between April 2019 and October 2022, has however raised concerns about the number of patients dying soon after being discharged. Read full story (paywalled) Source: HSJ, 28 June 2023
  10. Content Article
    This report examines the reporting of patient deaths at the Norfolk and Suffolk Foundation NHS Trust (NSFT) between April 2019 and October 2022. It was undertaken by Grant Thornton on behalf of the NHS Suffolk and North East Essex and NHS Norfolk and Waveney integrated care boards at NSFT’s request.
  11. Content Article
    Over the two decades before the pandemic, the number of NHS patients admitted to hospital increased year-on-year, despite a reduction in the number of hospital beds. Since the Covid-19 pandemic, fewer patients have been admitted to NHS hospitals and length of stay has risen, raising questions about NHS productivity, quality of care and the prospects of meeting ambitions to recover services. This report by the Health Foundation analyses data around hospital admissions and suggests reasons for these trends.
  12. News Article
    Health ministers are to recruit a new volunteer army for social care to ferry medical equipment and drugs to people’s homes in a bid to free up congested hospital wards. Under the plan, members of the public will be able to sign up on the GoodSam app for roles such as “check in and chat”, which involves support over the phone for people struggling with loneliness. There will also be the chance to “pick up and deliver”, helping to transport medicines or small items of medical equipment to people’s homes from NHS sites so they can be discharged from hospital, and “community response” roles will involve collecting and delivering shopping and prescriptions. The joint NHS and social care volunteers responders programme for England is being launched on Wednesday amid a social care staffing crisis with 165,000 vacancies and millions of hours of care needs not being met. At the end of April, 49,000 people every day had to stay in NHS hospitals in England despite no longer meeting the criteria to be there. News of the planned announcement from the care minister, Helen Whately, has sparked concern among workers in the sector, who warned that volunteering could not solve the social care recruitment and retention crisis. Helen Wildbore, director of Care Rights UK, which represents relatives and residents, said it “feels like a desperate measure to try and save a system that is crumbling”. Read full story Source: The Guardian, 6 June 2023
  13. News Article
    One in five cases in which patients attend A&E needing mental healthcare are spending more than 12 hours in the department – at least double the rate of patients with physical health problems. Unpublished internal NHS data seen by HSJ also suggests the proportion of mental health patients suffering long waits in accident and emergency has almost tripled when compared to the situation before the pandemic. According to the data, the proportion of attendances by patients with a mental health problem who waited more than 12 hours in A&E before being admitted or discharged increased from 7% (34,945 breaches) in 2019-20 to 20% (88,250 breaches) in 2022-23. The situation has become so difficult, that some acute trusts are spot purchasing private sector mental health in order to discharge patients. Read full story (paywalled) Source: HSJ, 5 June 2023
  14. Content Article
    Hospitals can significantly elevate patient satisfaction and enhance the delivery of healthcare services by incorporating best practices from adjacent and non-adjacent sectors. Chetan Trivedi explores several solutions, from multiple sectors, that can serve as a blueprint for hospitals across every key step of the patient journey, spanning from admission to discharge.
  15. Content Article
    This white paper from CEMBooks aims to unpick some of the deeper issues surrounding bed block and emergency department crowding from the perspective of a frontline medic with two decades of emergency and flow management experience. It aims to provide a greater understanding of the factors influencing the current situation and the measures used to define it followed by some practical implementable solutions.
  16. News Article
    Britain is hamstrung by red tape in the NHS and workers are blighted by regulation, Boris Johnson’s former cabinet secretary has said. Lord Sedwill, who was head of the civil service for two years, said that the UK was “failing to fulfil its great potential” because of excessive regulation. He made the comments in a foreword to a report by the Policy Exchange think-tank which also highlights examples of regulation “passing on significant costs” to customers. Examples in the report include NHS rules instructing hospital staff to go through 50 separate steps to discharge patients, “leading to severe delays”. Read full story (paywalled) Source: The Telegraph, 23 April 2023
  17. Content Article
    Traditional approaches to patient safety and handoffs need redesigning to acknowledge the different constraints, goals, and requirements necessary for each individual patient. There is no “one size fits all” approach to patient safety, handoffs or a perfect checklist. Despite the inherit complexity present in healthcare systems, we tend to reduce our thinking about handoffs into simple solutions of checklists and cognitive aids. In studies of these tools, their association with patient outcomes is unclear with mixed results in large studies. Incorporating general resilience engineering principles of visibility, understanding, anticipation, and learning provides new opportunities for increased patient safety. This involves situating the handoff in the context of the system - understanding the process of summarising pre-handoff and of developing understanding post-handoff, tracing flows of information and patients, and considering the role of feedback and control loops in the system. Direct observations, analysis of multiple outcomes, focus on patient evolving specific exceptions, reducing the number of handoffs, taking time for two-way discussions, and user-centred design and redesign may promote acceptability and sustainability of a new view of handoffs for improved patient safety.
  18. News Article
    A woman who may only have months to live has told the BBC she is "angry and frustrated" at being in hospital five months after being cleared to go home. Charlotte Mills-Murray, 34, said attempts to organise care at her family home had been repeatedly delayed. Charlotte lives with intestinal failure caused by a severe form of Ehlers-Danlos syndrome, which weakens her body's connective tissue. She was admitted to St James's Hospital in Leeds in June 2022 following an infection, and a new Hickman line - a tube that allows feeding and the administering of pain relief - was inserted. By November, Charlotte was told she was well enough to be cared for at home, but she remains in hospital following delays in the hiring and training of staff able to support her. With limited access to a hoist which would enable her to use her wheelchair, Charlotte said she had spent 10 months "stuck in bed". Because of the complexity of her condition, Charlotte only has months to live. She believes her situation merits greater urgency because of the increased risk of infection in hospital. Charlotte qualifies for 24-hour home care support through the NHS Continuing Healthcare scheme, but she said decisions over how this would be put in place had been slow and unclear. The BBC has found a 16% rise over the past year in the number of patients in England who are in hospital despite being well enough to leave. The Department of Health and Social Care said it was "fully committed to speeding up the safe discharge of patients who no longer need to be in hospital" and was making £1.6bn available in England over the next two years to support this, on top of £700m of extra funding in 2022 to ease NHS pressures over the winter. Read full story Source: BBC News, 9 April 2023
  19. News Article
    Delays in people leaving hospital in England could be costing an average of £395 per night, according to researchers at a health think tank. The direct costs of delayed discharges, where patients are considered medically fit to leave hospital, is estimated to be around £1.89 billion for the past financial year, the King's Fund said. This estimate does not count extra costs, including cancelled operations or staff time spent arranging care packages. Ambulance handover delays are often linked to a shortage of space caused by people who no longer need to be in hospital beds. The most recent PA analysis of NHS figures showed an average of 13,300 beds per day in the week to March 26 were filled by people ready to be discharged, compared with 12,643 at that point last year. Overall, 42% of medically fit patients in England were discharged, though the rate varied between regions, from 31% in the North West to 52% in eastern England. Read full story Source: Medscape, April 2023
  20. News Article
    A new scheme in Wales to help people who have suffered falls has prevented 50 ambulances being unnecessarily sent this year. St John Ambulance works with Hywel Dda health board in Pembrokeshire to send its people when someone calls 999. The pilot has been used 96 times since January but it needs more health board funding to continue after March. Ageing Well in Wales estimates that between 230,000 and 460,000 over 60s fall each year. When people dial 999, it can be directed to the St John Ambulance falls response team, who are sent to perform an assessment and identify whether the person can stay home or needs an ambulance to take them to hospital. St John Ambulance operational team leader Robert James said in 60% of cases, the person was well enough to stay at home. "You can imagine if you were sending an ambulance crew out and it has wasted 60% of the crew's time, well it's a big saving towards the NHS and the ambulance service in itself," he added. "Provided there are no injuries, or reason for them to go to hospital, they can be discharged on the scene." Read full story Source: BBC News, 10 March 2023
  21. Content Article
    A UK national survey of primary care physicians has indicated that the medication information on hospital discharge summary was incomplete or inaccurate most of the time. Internationally, studies have shown that hospital pharmacist's interventions reduce these discrepancies in the adult population. There have been no published studies on the incidence and severity of the discrepancies of the medication prescribed for children specifically at discharge to date. The objectives of this study, published in International Journal of Pharmacy Practice, were to investigate the incidence, nature and potential clinical severity of medication discrepancies at the point of hospital discharge in a paediatric setting.
  22. News Article
    Nearly half of NHS patients with a learning disability or autism are still being kept inappropriately in hospitals, several years into a key programme to reduce inpatient care, a national review reveals. The newly published review by NHS England suggests 41% of inpatients, assessed over an eight-month period to May 2022, should be receiving care in the community. Reasons given for continued hospital care in the NHSE review included lack of suitable accommodation, with 19% having needs which could be delivered by community services; delays in moving individuals into the community with appropriate aftercare; legal barriers, with one region citing “ongoing concerns for public safety” as a barrier for discharge; and no clear care plans. In some cases, individuals were placed in psychiatric intensive care units on a long-term basis, because “there was nowhere else to go”, while another instance cited a 20-year stay in hospital. Other key themes included concerns about staff culture, particularly “institutionalisation” and suggestions that discharge delays were not being sufficiently addressed. The report adds: “While the process around discharge can be time consuming, staff may perpetuate this by accepting such delays as necessary or inevitable.” Read full story (paywalled) Source: HSJ, 22 February 2023
  23. Content Article
    This report details the findings of a thematic review of Safe and wellbeing reviews (SWRs) between October 2021 and May 2022. SWRs are undertaken for children, young people and adults that are autistic and/or have a learning disability who are being cared for in a mental health inpatient setting.  SWRs are part of the NHS response to the safeguarding adults review concerning the tragic deaths of Joanna, Jon, and Ben at Cawston Park Hospital, who were each detained for a long period of time and did not receive appropriate care.
  24. Content Article
    Difficulties discharging over thirteen thousand patients safely are slowing the flow through hospitals while being stuck in hospital when you don’t need medical care is both mentally and physically harmful. People risk picking up hospital acquired infections, muscle loss and impaired mobility, reduced confidence and independence skills. However, according to Gilda Peterson, Leeds KONP and Secretary, End Social Care, there are ten things wrong with the Government's plan to give the NHS £200m to buy beds in care homes, hotels, hospices and independent hospitals.
  25. News Article
    "It would be much better if I was out there than in here," said Roger. The 69-year-old looked wistfully across Newport from the window next to his bed at the Royal Gwent Hospital in Wales. He has been here for three weeks after being admitted with an infection and although he is now well enough to leave, and desperate to do so, he can't. Roger has cerebral palsy and the impact of his recent illness means he needs extra care to be arranged before he can safely go home. Roger is not alone. "At least a quarter of patients in our care of the elderly beds are in a similar position," explained Helen Price, a senior nurse at the hospital. "It is very much a waiting game for that care to be available," she said. Hospitals in Wales are fuller than ever, according to the latest statistics. In the final week of January more than 95% of all acute beds in the Welsh NHS were occupied, which is the highest figure ever recorded. Paul Underwood, who manages urgent care in Aneurin Bevan University Health Board, said there are well over 350 patients medically fit enough to leave hospital. "Roughly a third of patients do not need to be accommodated on those sites and that's extremely difficult," he said. Read full story Source: BBC News, 16 February 2023
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