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Found 373 results
  1. News Article
    A ‘disappointingly slow’ transformation of community services means thousands of mental health patients are still presenting at emergency departments within weeks of being discharged from an inpatient facility. Experts said an NHS England-led community transformation programme, launched in 2019 as part of a £2.3bn investment in mental health services, should have helped reduce readmission rates, but internal data seen by HSJ suggests the rates have actually increased since then. The data reveals for the first time the proportion of patients discharged from inpatient care who then present to accident and emergency within two months. The proportion of adult patients was 11 per cent in 2018-19, when the investment programme was launched, and had increased to 12 per cent by 2022-23, representing around 6,000 adult cases. The situation appears worse for children, with an 18 per cent readmission rate within two months, up from 17 per cent in 2018-19. Read full story Source: HSJ, 8 August 2023
  2. News Article
    Dangerous allergic reactions are rising in England and now cause some 25,000 NHS hospital stays a year, according to data gathered by the NHS and analysed by the Medicines and Healthcare products Regulatory Agency. Health officials say the rate has more than doubled over 20 years, prompting them to issue advice reminding people how to recognise allergies and respond. For severe food-related allergic reactions, the rise in admissions is even greater. The figures suggest anaphylaxis is on the increase, though some of the rise could be attributed to the growth in population. Anaphylaxis can be fatal and develop suddenly at any age. People who know they are at risk should always carry two adrenaline pens which they, or someone else, can administer in an emergency. In addition, people at risk of an anaphylactic reaction should regularly check the contents of their adrenaline pens have not expired. They should see a pharmacist to get a new one if a pen is close to expiring. Read full story Source: BBC News, 28 July 2023
  3. News Article
    The Royal College of Nursing (RCN) has said patients are waiting for days in corridors at Belfast's Royal Victoria Hospital's Emergency Department. Rita Devlin, NI director of the RCN, visited the unit on Thursday after getting calls from nursing staff. She described the situation as "scandalous". Speaking to Radio Ulster's Evening Extra programme, Ms Devlin said while it was the Royal Hospital on Thursday, the situation is "bad right across the EDs". She said talking to nurses at the Royal, she was struck by "the absolute despair" some are feeling. "I spoke to some young, newly qualified nurses who are leaving because they just can't take the stress and the pressure any more," she said. Read full story Source: BBC News, 20 July 2023
  4. News Article
    Senior sources have described a ‘culture battle’ in NHS England’s approach to urgent care recovery after systems were told to carry out “maturity” self-assessments, and appoint “champions” to drive improvements. Systems were last week told by NHSE to ”self assess” their compliance against key asks in the UEC recovery plan, and asked to nominate urgent care “recovery champions” to “create a community, close to the front line, who can help drive improvement” in emergency care. The “champions” and self-assessments are part of a new “universal offer” of support being drawn up by NHSE under its scheme for urgent care recovery, in which Integrated Care Boards are also being placed in “tiers” of intervention. It is the first project carried out under NHSE’s new service improvement banner, called “NHS Impact” or “improving patient care together”, which was established after an internal review recommended it should focus on a “small number of shared national priorities”. Read full story (paywalled) Source: HSJ, 18 July 2023
  5. News Article
    An ambulance trust at the centre of an inquiry into alleged cover-ups has shown signs of improvement, according to the Care Quality Commission (CQC). North East Ambulance Service Foundation Trust has been accused of withholding information from coroners. An ongoing inquiry chaired by former acute trust chief executive Dame Marianne Griffiths is looking at how it deals with serious incidents, whistleblowers’ concerns and whether the trust complies with the “duty of candour” as well as its processes around inquests. The CQC report suggests it has made progress on many of these areas since inspections last year – which triggered a warning notice – and has raised the rating for its emergency and urgent care division from “inadequate” to “requires improvement”. The inspectors said it was a “mixed picture” but they had seen “the beginnings of a safety culture emerging within the trust”. Read full story Source: HSJ, 7 July 2023
  6. News Article
    A major acute site has issued a ‘full capacity’ alert to staff, just days before the services are due to move into a replacement hospital with fewer beds. In an email seen by HSJ, medical leaders at the Royal Liverpool Hospital alerted staff to extreme pressures on the site, with ambulances being held outside and “no space” in resuscitation areas. The RLH currently has around 685 beds, but at the end of this month the services are due to start transferring to the long-awaited new Royal Liverpool, on an adjacent site. The new hospital has 640 beds, and several frontline staff have told HSJ this is causing significant concern, with the current services under so much pressure. One senior source at the trust said there has been a push since 2017 to reduce inpatients beds at the current hospital, to try and match the capacity of the new build, but this hasn’t been achieved. They added: “Surgeons are concerned that their beds will get filled with medical outliers. The whole issue is all the patients who are waiting for social care. It was supposed to have been sorted by now.” Read full story (paywalled) Source: HSJ, 13 September 2022
  7. News Article
    Liz Truss has been warned against “fantasy predictions” that the NHS can return to normal without radical change and was told that “unacceptable standards” are being normalised. In a rare political intervention, the professional standards body for the UK’s 220,000 doctors agreed that the NHS was routinely letting down patients. The Academy of Medical Royal Colleges said politicians must be prepared for radical changes to save the health service. Closing smaller hospitals, accepting that routine dentistry cannot be free for everyone and a return of Covid volunteers to allow doctors to treat more patients were all suggested by the head of the academy. The academy released a report that declared the NHS was in crisis, writing: “The system is providing increasing proportions of care or services which are sub-standard, threaten patient safety, and should not be acceptable in a country with the resources that we have in the United Kingdom. If we do not act with urgency, we risk permanently normalising the unacceptable standards we now witness daily.” The report sets out a series of recommendations for reform, including boosting staff numbers, reforming social care and spending more on technology. Helen Stokes-Lampard, the academy’s chairwoman, said patients were facing a “dismal winter” and that politicians must take difficult decisions. “If we don’t make changes it will inevitably deteriorate further,” she said. “The demand isn’t going away, the pressure isn’t going away, which is why the challenge for our government and for our whole society is to confront these issues and have a difficult conversation.” Read full story (paywalled) Source: The Times, 9 September 2022
  8. News Article
    The NHS needs to do more to support care homes and people who have fallen with alternatives to ambulance calls and hospital admissions, the NHS England chief executive has said. Speaking at the Ambulance Leadership Forum, Amanda Pritchard acknowledged this winter would be a difficult one for the health service, saying: “The scale of the current and potential challenge mean that we do need to continue to look further for what else we can do… We need to pull out all the stops to make sure that they [patients] get that treatment as safely as possible and as quickly as possible.” She added one area of focus should be making sure certain patient groups can access other – more appropriate – forms of care, rather than calling an ambulance by default and often resulting in hospital admission. On care homes, she said: “Can we wrap around even more care for these care homes so they get to the point where they don’t need to call for help at all or, if they do, there are alternatives pathways [to the emergency department]?” She suggested another area where responses could be made more consistent was for patients who had fallen but without serious injuries, which she said made up a “really significant part of activity”. These patients took a long time to reach and, if admitted to hospital, risked long admissions, she said. Some areas were working to find other ways of responding to non-injury falls patients and trying to keep them away from hospital, she said. Read full story (paywalled) Source: HSJ, 6 September 2022
  9. News Article
    On a Thursday in mid-August, the doors of a hospital's emergency department two hours west of Toronto were shut. A note posted on the front said the ER was closed for the day. It would reopen the following morning at 08:00, but close again for the evening. Patients who needed urgent care were asked to go to nearby hospitals - a 15- to 35-minute drive away. It was the ninth time since April that the Huron Public Healthcare Alliance - a network of four hospitals serving around 150,000 people in western Ontario - had to temporarily close or cut back hours at one of its emergency departments. Canada is one of the richest countries in the world. Its universal publicly funded healthcare system has been touted by progressive politicians in the US, the country's southern neighbour, who see it as a needed alternative to an American system where millions remain uninsured. But in recent months, Canada's system has been described by workers and hospital executives as being in a state of "crisis". That includes struggling emergency rooms. Toronto ER physician Dr Raghu Venugopal said he has seen stretchers lining the hallways, occupied by patients suffering from ailments like a broken hip or abdominal pains. On some days, those patients may wait anywhere from two to four days to be admitted to hospital, all while a team of two nurses tends to a total of 50 to 60 patients on the unit. Other patients are being examined in the waiting room because the lack of staff has forced parts of the ER to close, meaning there is limited space for doctors to see them privately. "We are in a standard-less void where anything goes, and it is shocking," Dr Venugopal said. Read full story Source: BBC News, 2 September 2022
  10. News Article
    Firefighters have resorted to taking people to hospital in fire engines amid rocketing call-outs to medical emergencies. Fire and rescue services now respond to more “non-fire incidents” than fires in England, including cardiac arrests, suicide attempts and elderly people trapped in their homes after falls. Official statistics show that they attended more than 18,200 medical incidents in 2021-22, an increase of a third from the previous year, and that firefighters rather than ambulances were the “first responder” in almost half of those calls. Chris Lowther, who chairs the National Fire Chiefs’ Council’s operations committee, said the figures showed a “new reality” as firefighters step in to help struggling ambulance services. Read full story Source: The Independent (22 August 2022)
  11. News Article
    Patients may come to harm as a result of NHS 111 chaos, experts claimed on Tuesday as patients were advised to avoid the service this weekend. The helpline for urgent medical advice was targeted by cyberhackers earlier this month, leaving staff working on pen and paper. The Adastra computer software, used by 85 per cent of 111 services, was taken offline after the attack leaving call handlers unable to book out-of-hours urgent appointments and fulfil emergency prescriptions. But almost three weeks on, most staff are still operating without the system, leaving GPs unable to see patients’ medical records during urgent consultations or automatically forward prescriptions to pharmacies. The NHS has told hospitals to prepare public awareness campaigns to “minimise” pressures on urgent and emergency care services this winter. Some hospitals have already issued messaging urging patients not to turn up at accident and emergency (A&E), unless they are facing a “serious emergency.” Helen Hughes, chief executive of the charity Patient Safety Learning, said the continuing chaos raises “serious patient safety concerns” and will “inevitably result in avoidable harm”. Telling patients not to go to A&E “unless it is absolutely necessary” is only possible if GPs and NHS 111 “have the capacity and the resources to meet the demands that this places on them”, Ms Hughes said. “Significant delays in receiving a response are potentially missed opportunities for patients to receive timely medical advice and treatment that may prevent future harm,” she added. “Delays in receiving timely care and treatment will inevitably result in avoidable harm to patients.” Read full story (paywalled) Source: The Telegraph (23 August 2022)
  12. News Article
    Department of Health and Social Care (DHSC) officials are concerned that many more people are dying than expected in recent months – particularly older working-age people – with NHS care delays and interruptions a likely cause. HSJ understands there is concern and analysis under way across the chief medical officer’s team and in the Office for Health Improvement and Disparities. The DHSC told HSJ initial work showed the biggest causes of the “excess deaths” were cardiovascular disease (heart attacks and strokes) and diabetes. This supports the case they are being caused by a combination of the current very long delays for ambulances and other emergency care, and by people with heart disease and diabetes missing out on routine checks due to Covid and its knock-on effects, HSJ was told. Read full story (paywalled) Source: HSJ, 17 August 2022
  13. News Article
    The chief executive of a trust trialling the new emergency care standards being considered by the government has called for a new six-hour target to either move patients out of accident and emergency, or for them to receive treatment. North Tees and Hartlepool Foundation Trust chief executive Julie Gillon told HSJ a new target should be set as a “body of evidence” indicates patients are at risk of deterioration following A&E waits of six hours or more. The proposal is likely to be broadly welcomed by many clinicians, but could prove controversial in some quarters. NHS England did not include a six-hour target in the bundle of new A&E metrics being piloted, and the proposal could be interpreted by some as a watered-down version of the existing four-hour standard. However, Ms Gillon cited analysis by the Royal College of Emergency Medicine last year which revealed thousands of excess deaths resulting from overcrowding and long stays in A&Es. Read full story (paywalled) Source: HSJ, 4 August 2022
  14. News Article
    Several trusts have now started reporting thousands of 12-hour waits in their emergency departments, representing a huge difference to the numbers published nationally under a slightly different measure. This year, trusts have started submitting data to NHS England on the number of patients waiting over 12 hours from time of arrival in ED, until discharge, admission or transfer. Many trusts are now reporting these statistics in their public board reports. This is a slightly different measure to the publicly reported “trolley wait” figures, which count waits of over 12 hours from decision to admit until admission. Experts have long argued the trolley wait measure does not capture the true problem of ED overcrowding and delayed care. The new data captures a far higher number of patients and has not been published nationally by NHSE. Read full story (paywalled) Source: HSJ, 2 August 2022
  15. News Article
    Mental health patients who arrive at emergency departments (ED) in crisis are increasingly facing ‘outrageous’ long waits for an inpatient bed, with some being forced to wait several days. HSJ research suggests ED waits of more than 12 hours have ballooned in 2022, and are now around two-and-a-half times as high as pre-Covid levels. Early intervention for patients in mental health crisis is deemed to be crucial in their care and recovery. The Royal College of Emergency Medicine said the findings are a “massive concern”, while the Royal College of Psychiatrists described them as “unacceptable”. RCEM president Katherine Henderson said the experience of mental health patients in accident and emergency departments “is not what it should be from a caring healthcare system”. She said: “We have massive concern for this patient group. We feel they are getting a really poor deal at the moment. “The bottom line is there are not enough mental health beds. There are not enough community mental health services to support patients and perhaps therefore prevent a crisis and the need for beds in the first place. “Mental health crisis first responder teams work – a mental health practitioner working with the ambulance service can prevent the need for an ED visit.” Read full story (paywalled) Source: HSJ, 19 July 2022
  16. News Article
    Physicians must continue to offer abortions in cases of medical emergencies without exception, Joe Biden’s administration said on Monday, as it insisted federal law would overrule any total state bans on abortion. In a letter to healthcare providers, the president’s health and human services secretary, Xavier Becerra, said the federal Emergency Medical Treatment and Active Labor Act (EMTALA) protects providers from any purported state restrictions should they be required to perform emergency abortions. “Under the law, no matter where you live, women have the right to emergency care – including abortion care,” Becerra said. “Today, in no uncertain terms, we are reinforcing that we expect providers to continue offering these services, and that federal law preempts state abortion bans when needed for emergency care.” Becerra said medical emergencies include ectopic pregnancies, complications arising from miscarriages, and pre-eclampsia, NBC News reported. Becerra said in his letter to medical providers: “If a physician believes that a pregnant patient presenting at an emergency department, including certain labor and delivery departments, is experiencing an emergency medical condition as defined by EMTALA, and that abortion is the stabilizing treatment necessary to resolve that condition, the physician must provide that treatment. “And when a state law prohibits abortion and does not include an exception for the life and health of the pregnant person – or draws the exception more narrowly than EMTALA’s emergency medical condition definition – that state law is preempted.” Read full story Source: The Guardian, 12 July 2022
  17. News Article
    A spike in Covid absences and the extended heatwave have left NHS hospitals and ambulance services struggling to cope. The hot weather is also driving more patients to A&E departments, and callers are being urged not to use 999 except in serious emergencies. All 10 ambulance trusts in England are on black alert, the highest level, while health leaders warn that “ill-equipped” hospital buildings are struggling to store medicines correctly amid the abnormally high temperatures. Martin Flaherty, managing director of the Association of Ambulance Chief Executives, said: “The NHS ambulance sector is under intense pressure, with all ambulance services operating at the highest level of four within their local resource escalation action plans, normally only ever reserved for major incidents or short-term periods of unusual demand. “Severe delays in ambulance crews being able to hand over their patients at many hospital emergency departments are having a very significant impact on the ambulance sector’s ability to respond to patients as quickly as we would like to, because our crews and vehicles are stuck outside those hospitals.” Read full story Source: The Independent, 12 July 2022
  18. News Article
    Patients may be turned away at A&E in Portsmouth as the UK’s heatwave drives extreme hospital pressures. Staffing pressures coupled with additional strain from the current heatwave have forced Portsmouth Hospitals University Foundation Trust to declare a critical incident. The trust said it only had space in its emergency department for patients with life-threatening illnesses and critical conditions and so would be forced to redirect other patients elsewhere. In a statement, Portsmouth Hospitals University FT said: “Our emergency department remains full with patients and we have very limited space to treat emergency patients. We are only able to treat patients with life-threatening conditions and injuries, so anyone patients who arrive at ED without a life-threatening condition or injury, will be redirected to alternative services that can help... “Our immediate priority is to ensure there are beds available to admit our most seriously ill patients into and we are focusing on safely discharging as many patients as possible. We ask that families and loved ones support us with this and collect patients as soon as they are ready to be discharged.” Read full story Source: The Independent, 11 July 2022
  19. News Article
    There are plans for a major overhaul of how people are rescued from car wrecks amid growing evidence that current methods where people wait to be cut free may be harmful. Last year there were 127,967 casualties and 1,560 deaths in England caused by motor vehicle collisions. During the same period, more than 7,000 patients needed to helped out of the vehicle through a process known as extrication, where rescue crews use “Jaws of Life” and other tools to pry apart the wreckage, and then carefully lift people out. “Since at least the 1980s, firefighters have been trained with movement minimisation as the absolute paradigm,” said Dr Tim Nutbeam, an NHS emergency medicine consultant, and medical lead for the Devon air ambulance. “They’ve been told that one millimetre of movement could turn someone into a wheelchair user, so will often disassemble the car around the patient, to avoid movement of the neck.” Yet, doing so takes time – 30 minutes on average – and if that person has another serious injury, such as a head, chest, or abdominal injury, every minute counts. Nutbeam began researching the issue and discovered that trapped patients were almost twice as likely to die as those who were rapidly freed from the wreckage. Further, that the prevalence of spinal injuries among such patients was, in fact, extremely low – just 0.7% – and in around half of these cases, they had other serious injuries needing urgent medical attention. “Our absolute focus on movement minimisation works for maybe 0.3% of patients, but it extends the entrapment time for 99.7% of them,” Nutbeam said. “Potentially hundreds of people in this country have died as a result of extended entrapment times, and if you multiply that worldwide, it’s many, many people.” Read full story Source: The Guardian, 6 July 2022
  20. News Article
    Next week’s rail strikes will ’probably end up killing people’ as they will prevent staff working for already struggling ambulance trusts from getting to work, a senior NHS leader has told HSJ. Both London Ambulance Service Trust and South Central Ambulance Service Foundation Trust have moved to ”Reap 4”, This is the highest level of alert, meaning they are under extreme pressure. Ambulance trusts are already experiencing high demand amid soaring temperatures and continuing problems with lengthy handovers at the accident and emergency departments. Fears are now growing that next week’s rail strikes will push services to breaking point as many ambulance staff travel to work by public transport. The three days of rail strikes – on Tuesday, Thursday and Saturday next week – will see many lines with very limited services. Tube services in London will also be hit by a strike on Tuesday and the London Overground and some tube lines will be affected on rail strike days. A senior leader closely involved in southern England’s emergency and urgent care services told HSJ: “Next week’s rail strikes will probably end up killing people because they’ll prevent ambulance trust staff getting to work.” Other ambulance trusts are understood to be monitoring the situation closely. Trusts in REAP 4 (REAP stands for resource escalation action plan) normally take a series of measures including diverting more staff to frontline duties, asking some patients to make their own way to hospital and concentrating on reaching the most serious patients. Read full story (paywalled) Source: HSJ, 16 June 2022
  21. News Article
    The number of patients stuck in hospitals despite being ‘medically fit’ to leave has continued to increase in recent months, leading to warnings from NHS Confederation that trusts are finding it ‘impossible’ to make progress on reducing the numbers. Official statistics for April suggest an average of 12,589 patients per day in NHS hospitals in England – 13% of all occupied beds – did not meet the “criteria to reside”. At 31 trusts, the proportion was 20% or more. NHS England has since told local leaders to make reducing the numbers of delayed discharges an operational priority. The issue is a key factor behind the long waits in emergency care, as ward beds are taking longer to become available to accident and emergency patients. Rory Deighton, acute lead at NHS Confederation, said targets to reduce delayed discharges “will not be met” unless the government “invests in domiciliary care wages,” amid high numbers of vacancies in the social care sector. Read full story (paywalled) Source: HSJ, 1 June 2022
  22. News Article
    Emergency doctors in Scotland are “dreading” the Queen’s Jubilee weekend as fears grow that the public holiday will add to long patient queues. One accident and emergency consultant has pleaded with patients to be considerate to NHS staff as they deal with long backlogs at a time when other workers will be on holiday. Calvin Lightbody, at Hairmyres Hospital in Lanarkshire, said that the GP out-of-hours service in his region had been so short-staffed they had to send patients to A&E instead of treating the people themselves, adding to the delays in hospitals. He said a four-day bank holiday weekend, when doctors’ surgeries will be shut, threatened to add to the pressure on “creaking” services. “If you go to A&E you are going to have a very long wait to be seen, several hours probably,” he said. “Please be kind. Our staff are working extremely hard, they are flat out, they are exhausted, they are doing their best.” He appealed to patients not to delay seeking medical attention if they were seriously unwell including those suffering chest pain, heavy bleeding and stroke symptoms even though services were “overwhelmed”. Read full story Source: The Times, 1 June 2022
  23. News Article
    More than 500 seriously ill patients died last year before they could get treatment in hospital after the ambulance they called for took up to 15 hours to reach them, an investigation by the Guardian reveals. The fatalities included people who had had a stroke or heart attack or whose breathing had suddenly collapsed, or who had been involved in a road traffic collision. In every case, an ambulance crew took much longer to arrive than the NHS target times for responding to an emergency. Bereaved relatives have spoken of how the pain of losing a loved one has been compounded by the ambulance crew having taken so long to arrive and start treatment. Coroners, senior doctors and ambulance staff say the scale of the loss of life illustrates the growing dangers to patients from the implosion of NHS urgent and emergency care services. “These 500-plus deaths a year when an ambulance hasn’t got there in time are tragic and avoidable,” said Dr Adrian Boyle, the president of the Royal College of Emergency Medicine, which represents A&E doctors. “These numbers are deeply concerning. This is the equivalent of multiple airliners crashing.” Read full story Source: The Guardian, 9 March 2023
  24. News Article
    An NHS whistleblower has sacrificed his career to capture on hidden camera the brutal reality of working in an ambulance service. After watching yet another patient die needlessly in the back of his ambulance, Daniel Waterhouse became a whistleblower. That decision would end his career with the NHS at the age of only 30. Waterhouse, from Finchley, north London, said his decision to go undercover for a Channel 4 Dispatches programme to be broadcast on Thursday was not easy. “I thought about it for quite a while,” said Waterhouse, an emergency medical technician who wore hidden cameras and microphones while on shift for the East of England Ambulance Service. “It was a moral choice, and there’s a caveat to that as well, because going undercover in those situations could be considered immoral and will draw criticism I’m sure. “But I think patient safety outweighs that, and those occasions were so strong in my head that I thought, ‘If only some change can happen, where some people don’t have to go through that and die or suffer permanent disability, then it would be worth it’.” Read full story (paywalled) Source: The Times, 3 March 2023
  25. News Article
    One patient is dying every 23 minutes in England after they endured a long delay in an A&E unit, according to analysis of NHS figures by emergency care doctors. In all, 23,003 people died during 2022 after spending at least 12 hours in an A&E waiting for care or to be admitted to a bed, according to the Royal College of Emergency Medicine (RCEM). That equates to roughly 1 every 23 minutes, 63 every day, 442 a week or 1,917 each month. The college said its findings, while “shocking”, were also “unsurprising” and reflected the fact that emergency departments are often overwhelmed and unable to find patients a bed in the hospital. Rosie Cooper, the Liberal Democrats’ health spokesperson, said “patients are now dying in their droves” due to successive Conservative governments neglecting the NHS, and added that the lives lost due to A&E snarl-ups constituted a “national disaster”. “Long waiting times are associated with serious patient harm and patient deaths,” said Dr Adrian Boyle, RCEM’s president. “The scale shown here is deeply distressing.” Read full story Source: The Guardian, 28 February 2023
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