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Found 167 results
  1. Content Article
    Surgical site infections (SSIs) can have a significant impact on patients, their families and healthcare providers. With shortening inpatient periods, the post-discharge element of surveillance is becoming increasingly important. Proactive surveillance, including digital wound images using patient smartphones, may be an efficient alternative to traditional methods for collecting post-discharge surveillance (PDS). The aim of this study was to determine success in patient enrolment and engagement including reasons for non-response, the time for clinicians to respond to patients, SSI rates, and carbon emissions when conducting PDS using patient smartphones.
  2. Content Article
    To support recovery of the NHS by improving waiting times and patient experience, a joint Department of Health and Social Care (DHSC) and NHS England plan sets out a number of ambitions, including: Patients being seen more quickly in emergency departments: with the ambition to improve to 76% of patients being admitted, transferred or discharged within four hours by March 2024, with further improvement in 2024/25. Ambulances getting to patients quicker: with improved ambulance response times for Category 2 incidents to 30 minutes on average over 2023/24, with further improvement in 2024/25 towards pre-pandemic levels. NHS England has engaged with a wide range of stakeholders to develop the plan, and it draws on a diverse range of opinion and experience, as well as views of patients and users. The Department of Health and Social Care, who produced the content on actions being taken in social care, have led on engagement with the sector.
  3. Content Article
    Emergency access to healthcare is in crisis. Unmet need in primary and community care and low capacity in hospitals and social care has left the emergency health services gridlocked and overwhelmed, unable to provide safe care. This Cross party House of Lords Public Services Committee report recommends that a COBR Committee be assigned the responsibility to address the crisis in emergency healthcare. In the long-term, it recommends a a substantial overhaul is needed, one which sets out a bold new operating model for the system as a whole, and which is backed by equally bold leadership.
  4. Content Article
    In this blog Patient Safety Learning considers the impact on patient safety of the shortage of hospital beds facing the NHS this winter. It focuses on two specific issues stemming from this, the increasing numbers of patients being cared for in corridors and other non-clinical areas, and current proposals to reduce the number of patients waiting to be discharged.
  5. Content Article
    This document summarises the current landscape of virtual wards from the perspective of healthcare for older people, and provides advice to those looking to set up such services for older people living with frailty.
  6. Content Article
    This paper from Natalie Offord and colleagues describes a service redesign in which has gained learning and experience in two areas. First, a description of measured improvement by the innovation of redesigning the traditional hospital-based assessment of frail older patients’ home support needs (assess to discharge) into their own home and meeting those needs in real time (discharge to assess). In combination with the formation of a collaborative health and social care community team to deliver this new process, there has been a reduction in the length of stay from completion of acute hospital care to getting home (from 5.5 days to 1.2 days for those patients that require support at home). Second, the methodology through which this has been achieved. The authors describe their translation of a Toyota methodology used for the design of complex cars to use for engaging staff and patients in the design of a healthcare process.
  7. Content Article
    NHS England has published its planning guidance for 2023/2023. The 2023/24 priorities and operational planning guidance reconfirms the ongoing need to recover our core services and improve productivity, making progress in delivering the key NHS Long Term Plan ambitions and continuing to transform the NHS for the future.
  8. 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
  9. 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
  10. 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
  11. 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
  12. 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
  13. 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
  14. 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
  15. 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
  16. 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
  17. News Article
    Ministers are setting up a £500m emergency fund to get thousands of medically fit patients out of hospital as soon as possible in an attempt to prevent the NHS becoming overwhelmed this winter. Thérèse Coffey, the new health secretary, unveiled the move in the Commons on Thursday as part of her plans to tackle the growing crisis in the health service, especially patients’ long delays for care. The newly created adult social care discharge fund is intended to relieve the pressure on overstretched hospitals in England by ensuring that patients whom doctors have judged well enough to leave can be safely discharged either to their home or into a care home. In her first speech since becoming the health secretary 16 days ago, Coffey told MPs: “I can announce today that we are launching a £500m adult social care discharge fund for this winter. “The local NHS will be working with councils with targeted plans on specific care packages to support people being either in their own home or in the wider community. This £500m acts as the downpayment in the rebalancing of funding across health and social care as we develop our longer-term plan.” Read full story Source: The Guardian, 22 September 2022
  18. News Article
    Adult social care in England is in serious crisis, Tory council leaders have warned the government, as it faces a £3.7bn funding gap and a growing staffing shortage that has brought many local care providers to the brink of collapse. The intervention by the County Councils Network, which represents 36 mainly Tory-run authorities, comes amid widespread local government concern over the increasing fragile state of social care. Care costs have accelerated recently, fuelled by unexpected wage and energy inflation. “We face the perfect storm of staffing shortages, fewer care beds, and higher costs – all of which will impact on individuals waiting for care and discharges from hospital,” said Martin Tett, the Tory leader of Buckinghamshire county council. Cathie Williams, the chief executive of the Association of Directors of Adult Social Services, said: “Too many people are missing out on vital care and support – we estimate that over half a million people are waiting for assessments, care, or reviews. With over 165,000 staff vacancies, this is only set to get worse. ” A government spokesperson said: “The health and social care secretary is focused on delivering for patients and has set out her four priorities of A, B, C, D – reducing ambulance delays, busting the Covid backlogs, improving care, and increasing the number of doctors and dentists. Read full story Source: The Guardian, 21 September 2022
  19. 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.
  20. 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.
  21. 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
  22. 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
  23. 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
  24. 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
  25. 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
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