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Found 167 results
  1. News Article
    Technology that accurately predicts when patients will be ready to leave hospital upon their arrival in A&E is being introduced to solve the NHS bed-blocking crisis. The artificial intelligence (AI) software analyses data including age, medical conditions and previous hospital stays to estimate how long a patient will need to remain. Hospital managers can then alert social care services in advance about the date when patients are expected to be discharged, allowing care home beds or community care packages to be prepared. Nurses said the technology had “revolutionised” their ability to discharge patients on time, meaning people who would otherwise have been stuck in hospital had got home for Christmas. The new technology, developed by the British AI company Faculty, is being tested at four NHS hospitals in Wales belonging to the Hywel Dda health board. Analysis suggests that the tool will save NHS trusts 3,000 bed days and £1.4 million a year by speeding up discharges, which in turn frees beds for elective procedures such as hip replacements. Read full story (paywalled) Source: The Times, 26 December 2022
  2. News Article
    Patients are spending an extra day in hospital on average when admitted as an emergency compared to before covid, consuming millions of additional ‘bed days’, HSJ analysis has found. The finding explains in part why fewer people are being treated in hospitals, but more resources are being consumed to do so. This has prompted concerns about an apparent big drop in productivity. NHS England chief finance officer Julian Kelly told HSJ the marked increase in length of stay meant hospitals needed to focus on “discharge and decongest” of emergency care, to help recover activity rates and productivity in elective care. The NHS also needs to create more elective capacity insulated from emergency care, he said, and for “local leadership [to] keep people focused”. Read full story (paywalled) Source: HSJ, 19 December 2022
  3. News Article
    All ambulance services have declared the highest level of alert due to ‘extreme pressures’ facing the urgent and emergency care system. One senior ambulance chief told HSJ that ambulance response times have dropped dramatically in the last few days, while A&E handover delays have surged. They said: “The wheels are falling off [the emergency care system] now, we’re in a really awful situation.” They said ambulance leaders have major concerns about the planned strike action by nurses on Thursday, fearing this will exacerbate discharge delays and have a knock-on effect on ambulance handover problems. It also comes ahead of strike action planned by ambulance staff for next week. HSJ has seen internal communications which confirm all ten ambulance trusts in England are now in level four of their “resource escalation action plan”, which means they can seek assistance from other nearby trusts or services. However, this is more difficult when an entire sector is under pressure, as is the case currently. Read full story (paywalled) Source: HSJ, 13 December 2022
  4. News Article
    A former chief executive of the NHS has said most data collected about hospital discharges by NHS England is ‘useless’ and biased against social care. Sir David Nicholson, who was chief executive of the NHS from 2006 to 2013, and of NHS England until 2014, has said “almost all” of the data around delayed discharges “is designed to show how bad social care is”. Sir David, who is now chair of Worcestershire Acute Hospitals Trust and Sandwell and West Birmingham Trust, added that data on the number of patients with the “right to reside” in hospital is “wholly useless” when trying to improve discharge rates. NHSE publishes figures on the numbers of patients who “no longer meet the criteria to reside” in hospital – and during the winter months will publish this every week. NHSE has said the data collected on discharges helps to improve patient care and flow. In an interview with HSJ editor, Sir David said: “The problem we have with a lot of the data we collect [is that] it is designed for accountability reasons, not operational reasons. “And if you want a good example of that, have a look at the debate around discharge at the moment. There is a myriad of data, almost all of it is useless […] and almost all of it is designed to show how bad social care is. It’s extraordinary". Read full story (paywalled) Source: HSJ, 30 November 2022
  5. News Article
    Lack of beds in the NHS and social care sector have been highlighted by the case of an 81-year-old woman discharged home at night, her family said. Janice Field attended Colchester Hospital in Essex with a suspected heart attack. She was returned to her flat at midnight, despite having no home care at that time of day. The hospital trust said it focused on keeping patients safe and was "sorry to hear about the concerns raised". Ms Field was checked out at the hospital last week and deemed fit to go home, but her family said she should have stayed in hospital overnight, or be found a community care bed. Her daughter-in-law, Sarah Field, a qualified nurse, said: "To discharge an 81-year-old lady and have them having to be transferred in the middle of the night is totally unacceptable. "But the nurse we spoke to was emphatic. She was desperate. She said, 'no, we have no beds. This has got to happen. She's clinically fit. She has got to go'. "The NHS is broken, under-resourced and not fit for purpose. This is not the fault of those that work in it, but the fault of the system." Read full story Source: BBC News, 26 November 2022
  6. News Article
    The government has been urged to protect “catastrophically” under-resourced mental health social services after a vulnerable man was discharged from a hospital into a Travelodge. Will Mann, a 42-year-old with long-term mental health illness, was “abandoned” by social care services after he was discharged from an NHS hospital, his mother Jackie has said. Speaking with The Independent, Jackie Mann, explained how Will, who had to declare himself homeless before his discharge this year, was told the only available housing accommodation for him was a Travelodge. Mr Manns story has sparked warnings over the state of the shortage of social care and supported accommodation for those with severe mental illness, from the charity Rethink Mental Illness, which warned: “This is another reminder of how the crisis engulfing social care is impacting people’s lives, and why the government must protect mental health in the upcoming budget.” In an interview with The Independent, Jackie Mann, Mr Mann’s mother said: “He had to go straight from there to a Travelodge in Christchurch, which was a very unsuitable place because it was just a room, no cooking facilities. “During the time he was there, nobody came to visit him, he was just sort of abandoned there and during his time there, he was told he had to leave the Travelodge and go to another one because that Travelodge was overbooked.” According to our major charity Rethink, the shortage of “appropriate accommodation” is one of the biggest drivers of delayed discharges for mental health patients. Read full story Source: The Independent, 21 November 2022
  7. News Article
    Ambulance waiting times for stroke and suspected heart attacks have quadrupled in four parts of England since before Covid-19 – whereas others have only grown by half – underlining the severe impact of long accident and emergency handovers. Response times have leapt across England over the past two years, particularly for category 2 and 3 incidents, but the data makes clear that the steepest increases are in areas where hospitals have the biggest handover delay problems. Of the 10 patches with the largest increases in average category 2 performance between 2018-19 and 2021-22, four are served by major hospitals which make up NHS England’s “cohort one” of trusts selected for the worst handover problems; and four more are on government’s list of 15 which accounted for the most long handover delays last winter. The increase in handover delays – in turn linked to delayed discharge, staffing, lack of community services and social care’s collapse – are the stand-out reason for areas with a steep rise in response times. Read full story (paywalled) Source: HSJ, 18 November 2022
  8. Content Article
    The NHS and social care systems need more money. If there is anything else that they need as much, it is honesty from the government. Post-Covid, the UK’s health systems are in a perilously fragile state. As analysis by the Guardian showed this week, logjams created by delayed discharges appear to be getting worse. An average of 13,600 hospital beds in England are occupied by patients with nowhere else to go. As well as making new admissions impossible, unnecessarily long stays can make it harder for people to regain their independence after leaving. So far, a £500m emergency fund promised by ministers to ease the pressure has failed to materialise. It is a symptom of the social care crisis that hospitals find it so hard to discharge people who are well enough to leave.
  9. News Article
    A policy change to speed up hospital discharge could save the NHS more than £7bn over a decade, according to a government evaluation – but ministers have not funded it. A Department of Health and Social Care impact assessment of the Health and Care Act, passed earlier this year, says that wider use of discharge to assess could free up as many as 6,000 hospital beds and save the NHS £7bn by 2031, the equivalent of £800m a year. It adds: “The overall societal benefits of this would likely be higher as beds could be allocated to patients with more urgent health care needs.” The “discharge to assess” approach, which has been used on a temporary basis for several years and more widely during the pandemic – with government funding to back it – sees patients discharged more quickly, and provided with support at home while their long-term care needs are assessed. It was credited with significant reductions in the amount of time patients spent in hospital. Changes in the Health and Care Act were intended to remove legal obstacles to the approach, by revoking a requirement for an assessments be carried out before discharge, which often leads to delays in the patient leaving hospital. Read full story (paywalled) Source: 15 November 2022
  10. News Article
    One of the country’s most senior doctors has said he is “desperate” to keep his elderly parents out of hospital, which he said are like “lobster traps”. Dr Adrian Boyle, president of the Royal College of Emergency Medicine, said hospitals are easy to get into but hard to get out of. His comments come after figures showed the number of patients in hospital beds in England who no longer need to be there has reached a new monthly high. An average of 13,613 beds per day were occupied by people ready to be discharged from hospital in October. That was up from 13,305 in September and the highest monthly figure since comparable data began in December 2021, according to analysis by the PA news agency. In an interview with the Daily Mail, Dr Boyle said: “Hospitals are like lobster traps – they’re easy to get into and hard to get out of. “If social care was able to do its job in the way we want it to, these poor people wouldn’t be stranded in hospital. “I have elderly parents and I’m desperate to keep them out of hospital. “For someone who is frail, hospital is often a bad place for them. They’re being harmed by being in hospital.” Read full story Source: The Independent, 14 November 2022
  11. News Article
    A Guardian analysis has found that as many as one in three hospital beds in parts of England are occupied by patients who are well enough to be discharged, with a chronic lack of social care meaning many do not have suitable places to go. Barry Long's 91-year-old mother has Alzheimer’s and was admitted to Worthing hospital on 30 May after a minor fall. She was a bit confused but otherwise unhurt, just a bit shaken. Whilst in hospital, she caught Covid and had to be isolated, which she found distressing, and became increasingly disoriented. She was declared medically fit to be discharged but no residential bed could be found for her. Then, in August, she was left unsupervised and fell over trying to get to the toilet and she fractured her hip, which required surgery. Her hip was just about healed when she caught her shin between the side bars and the frame of the bed, cutting her shin so badly that she is being reviewed by a plastic surgeon to see if it needs a skin graft. "Since the operation, my mum is pretty much bedbound and lives in a state of confusion and anxiety", says Barry. "Her physical health and mental wellbeing have deteriorated considerably in the almost five months she has spent in the care of the NHS. She spends all day practically trapped in bed, staring into space or with her eyes shut, just rocking to and fro. She has little mental stimulation." Read full story Source: The Guardian, 13 November 2022
  12. News Article
    NHS England has ordered the collection of identifiable patient data from hospitals by US data firm Palantir, for a pilot scheme aimed at accelerating recovery of elective waiting lists. The regulator has instructed NHS Digital, with which it will merge in January, to use Palantir’s Foundry platform to collect data about patients’ admission, inpatient, discharge and outpatient activity at acute hospitals. Identifiable data such as patients’ NHS numbers, date of birth, and postcode will be collected through Palantir’s software. Patients cannot opt out of having their data collected. But NHS Digital’s Caldicott Guardian – who is meant to safeguard use of data – has identified “risks” in the pilot and said it needs additional work before it can meet confidentiality requirements. The data collected will be “anonymised in accordance with the ICO’s (Information Commissioner’s) Anonymisation Code of Practice”. However, privacy campaigners Medconfidential claimed this code is not fit for purpose and warned that NHS chiefs were making the same mistakes as previous failed efforts to use patient data appropriately. Read full story (paywalled) Source: HSJ, 1 November 2022
  13. News Article
    Many people who are medically ready to leave hospital are not able to go home because of pressures in social care. Health and social care teams across Scotland are working to create more room in hospitals as we go into winter when it traditionally gets busier. In Lothian, they are using care homes as an interim measure to help rehabilitate people before they can go back home. Nineteen rooms at the Elsie Inglis Nursing Home in Edinburgh are being used in an effort to help people get out of hospital. Archie McQuater, who spent seven months in The Royal Infirmary of Edinburgh after one of his big toes was removed because of an infection, has finally got out of hospital and is now staying at the Elsie Inglis. The 94-year-old has been in the care home for two months and is trying to improve his mobility so that he can return home. Archie is among 200 people in Edinburgh who have been moved from a hospital to a care home between November 2021 and September 2022. NHS Lothian estimates it has saved about 13,000 bed days in hospitals during that time. Read full story Source: BBC News, 2 November 2022
  14. News Article
    Further funding cuts to the NHS will unavoidably endanger patient safety, an NHS leader warned last week after the chancellor’s promise of spending cuts of “eye-watering difficulty”. Matthew Taylor, the chief executive of the NHS Confederation, said his members were issuing the “starkest warning” about “the huge and growing gulf between what the NHS is being asked to deliver and the funding and capacity it has available”. The warning came as figures showed that paramedics in England had been unavailable to attend almost one in six incidents in September due to being stuck outside hospitals with patients. Service leaders say wait times for A&E and other care are being exacerbated by an acute lack of nurses, with a record 46,828 nursing roles – more than one in 10 – unfilled across the NHS. "Patients are presenting more unwell," says a GP from South Wales, "Wait times in A&E have become unmanageable, so we’re seeing patients who have waited so long to be seen they’re bouncing back to us. Things we can’t deal with, like injuries and chest pain. We tell them they have to go back to A&E. "Abuse of surgery reception and admin staff began last year and it’s just scaled up from there. We’ve had staff members who have been verbally and physically threatened and we’re struggling to recruit and retain staff – people are hired and quit in a couple days. A lot of people are going off sick with stress." Five healthcare workers describe the pressures they are facing, including ambulance stacking, rising A&E wait times and difficulties discharging patients. Read full story Source: The Guardian, 1 November 2022
  15. Content Article
    This National Institute for Health and Care Excellence (NICE) guideline covers the components of a good experience of service use. It aims to make sure that all adults using NHS mental health services have the best possible experience of care. It includes recommendations on: access to care assessment community care assessment and referral in crisis hospital care discharge and transfer of care assessment and treatment under the Mental Health Act
  16. News Article
    Hospitals and care homes have not received a single penny of a £500m emergency fund promised by the government to prevent the NHS becoming overwhelmed this winter, the Guardian has learned. Ministers announced they were injecting the cash into the health and social care system last month, to help get thousands of medically fit patients out of hospital into either their own home or a care home as soon as possible in an effort to better prepare the NHS for the coming months. “At the moment, one of the key challenges is discharging patients from hospital into more appropriate care settings to free up beds and help improve ambulance response times,” Thérèse Coffey, the then health and social care secretary, said on 22 September. “To tackle that, I can announce today that we are launching a £500m adult social care discharge fund for this winter.” However, the Guardian has been told that none of the funding has materialised. Senior health and social care sources described the government’s failure to release the promised cash as “inexplicable” and “outrageous”. More than 13,000 of the 100,000 NHS hospital beds in England currently contain “delayed discharge” patients, which has led to A&E units becoming heavily congested and long delays in ambulance handovers. As a direct result, thousands of 999 patients are suffering potential “severe harm” every month because ambulances are stuck outside hospitals. “Leaders across the NHS and local authorities are yet to see a single penny of this investment or any official detail on how it will be allocated,” said Matthew Taylor, the chief executive of the NHS Confederation. “Currently, only two-fifths of patients in hospital are able to leave when they are ready to do so, including due to problems accessing social care, yet health leaders still do not know how and when the £500m will be released to the system. So close to winter, this is unbelievable. Read full story Source: The Guardian, 31 October 2022
  17. News Article
    A trust chief executive says the Care Quality Commission’s (CQC) inspection regime is still overly focussed on individual organisations, rather than systems, and this is driving the “risk aversion” which is partly responsible for the emergency care crisis. Mid Yorkshire Hospitals Trust CEO Len Richards acknowledged the CQC has started to scrutinise system-wide issues but suggested the “heat” of its regulation is still on individual providers. Mr Richards told the House of Lords’ public services committee on Wednesday that care homes and nursing homes in his area have declined to take patients ready to be discharged from hospital, due to concerns it would put their CQC accreditation at risk. He said: “[Last winter] we asked nursing homes and care homes to take patients and they couldn’t take them beyond a certain limit because it would put their accreditation at risk. “We went to the CQC to try and create some flexibility. Their perspective was very much of an independent regulatory body that would look at the organisation and not look at the system. I think we’ve got an awful long way to go there. “I think regulation does drive risk aversion… [and] the heat of regulation right at the moment is on individual organisations. “Therefore, when the CQC come and look at my organisation, they will talk about congestion in the A&E department. They won’t talk about the assessment that we made around there being a greater risk in the community if we didn’t offload ambulances.” Read full story (paywalled) Source: HSJ, 28 October 2022
  18. 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
  19. Content Article
    In this blog, Jen Flatman, medicines safety and governance pharmacist, discusses a resource to support people to continue to use their medicines safely once they leave hospital. The medicines safety checklist was designed by patients and carers, for patients and carers, helping bridge the transition between hospital and the next destination. The points on the checklist are designed to act as a prompt, ensuring individuals are aware of key information to continue to use their medicines safely. They also act as a reminder to the reader to ask questions if they are unsure about anything.
  20. Content Article
    Transitions of care between hospital departments are necessary, but they may disrupt care coordination, such as discharge planning. Family carers often serve as liaisons between the patient and healthcare professionals, but they frequently experience exclusion from care planning during intrahospital transfers (IHTs). This has the potential to decrease their awareness of patients’ clinical status, postdischarge needs and carer preparation. This study aimed to explore family carers’ perceptions about IHTs, patient and carer ratings of patient discharge readiness and carer self-perception of preparation to engage in at home care.
  21. News Article
    NHS England is developing plans for a new universal ‘community recovery service’ with a 24-hour target to provide ‘step down care’ once a patient is deemed ready to leave hospital, HSJ has revealed. Slides presented to an NHS England webinar reveal it is seeking to pilot “one single intermediate care step-down service [organised] at place through one lead commissioner”. It would include a target, or standard, requiring that when patients no longer meet the “criteria to reside in hospital”, they enter the new community recovery service within 24 hours. NHSE’s “vision” is that this 24-hour standard is met for all acute hospital patients within five years, the slides seen by HSJ reveal. The documents do not specify whether they would also be discharged within 24 hours. Delayed discharges have been a problem for many years, but have caused particularly huge difficulties in the past 18 months, leading to emergency department overcrowding and ambulance handover delays. In August, one in seven patients in acute hospitals were medically ready to be discharged, NHSE figures suggest. According to the documents seen by HSJ, key objectives for the new service also include reducing long-term care costs “by decreasing demand and acuity”, and ”increasing people’s functional outcomes” by giving more people better rehab care on discharge. This appears to be a recognition that at present many people discharged receive inadequate rehab, which can exacerbate their condition, requiring more care. Read full story (paywalled) Source: HSJ, 12 October 2022
  22. News Article
    An IT failure has left clinicians at ‘a number of trusts’ which use the Cerner Millennium system unable to access patient records or write discharge summaries, according to an internal trust email seen by HSJ. The email, sent to staff at Barts Health Trust this afternoon, said there was a “performance issue” with Cerner PowerChart which was affecting “a number of other trusts”. The Powerchart programme is the part of the Cerner Millennium electronic patient record system used by clinicians to process document notes, request tests, view blood tests and scan reports. At least 13 trusts in the English NHS are known to use the Cerner Millennium system but it is not yet clear how many trusts aside from Barts have been affected. One clinician told HSJ the outage was “overwhelmingly unsafe” for patients. Read full story (paywalled) Source: HSJ, 11 October 2022
  23. Content Article
    This Nuffield Trust Quality Watch blog from Sophie Flinders and Sarah Scobie takes a closer look at the rising number of patients facing delays in leaving hospital – and explores the reasons for why it’s happening.
  24. News Article
    A “perilous” shortage of homecare workers is the biggest reason thousands of people are languishing longer in hospital than needed, driving up waiting lists and making people sicker, figures reveal. Almost one in four people unable to be discharged – sometimes for weeks – were trapped in hospital because they were waiting for home care, as agencies hand back contracts because staff are quitting owing to low pay, leaving 15% of jobs vacant. A fifth of people unable to be discharged were also waiting for short-term rehabilitation and 15% were waiting for a bed in a care home, according to analysis of data obtained using freedom of information requests and public records by Nuffield Trust and the Health Foundation. It estimated that in April this year, one in six patients were in hospital because of delayed discharge, and the discharge of patients with a hospital stay of more than three weeks was delayed by 14 days on average. “People are ending up in hospital for malnutrition and dehydration, problems which, even if you supported people a little bit at home, would stop,” said Jane Townson, the director of the Homecare Association. “More providers are having to turn down work than usual and some are having to hand back people because they can’t do it.” Read full story Source: The Guardian, 3 October 2022
  25. Content Article
    This information sheet produced by South Australia Health's Safety and Quality Unit describes how patients and staff can work together to make sure that if clinical deterioration occurs, it will be acted upon in a timely and effective manner. The information also applies to carers, family members, friends or the patient’s appointed responsible person. It includes information relating to deterioration during an emergency department visit or hospital stay, and at and after discharge.
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