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Content ArticleDr Katherine Henderson is a senior A&E consultant in London and the president of the Royal College of Emergency Medicine. In this article for The Guardian, she describes the deep crisis facing urgent and emergency care in the UK. She describes hospital warnings of dangerous delays that have seen vulnerable patients waiting hours to be seen and admitted to hospital. This is dangerous, frustrating and undignified for patients, but also distressing for staff, who are finding themselves unable to offer the quality of care they want to deliver. Dr Henderson attributes the issues to shortfalls in healthcare staff and hospital beds, but also a lack of capacity in community care that is delaying patients being discharged from hospital. The situation is exacerbated by staff absence due to Covid-19. To tackle the crisis, she calls for clear plan to increase bed capacity and a robust, fully funded long-term workforce plan.
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Content ArticleRecovering services from the covid crisis is the big task for NHS leaders for the foreseeable future. HSJ's Recovery Watch newsletter tracks prospects and progress. This week HSJ bureau chief and performance lead James Illman discusses virtual wards and why staffing pressures are ‘likely to be under-estimated’ and are a patient safety risk.
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Content ArticleNow that the national plan to tackle the elective backlog is public, thoughts will be turning to how to achieve the challenging task ahead. A week before the plan was published, the King's Fund held a roundtable, supported by Novartis, with local health care leaders to discuss just that. The overwhelming theme from this discussion was that effective communication within local systems will be essential to success. The national strategy has set out the ambition, but ultimately solutions will be implemented locally. Five relationships stood out as being vital. Local areas and their neighbours. Primary and secondary care. Leaders and their workforce. NHS and patients. Local systems and their data.
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Content ArticleThis Health Foundation long read explores how the NHS in England can better use routine health data to help address current challenges, including winter pressures, the ongoing coronavirus response and the growing elective care backlog. It examines the longstanding barriers to widespread use of data and data science, consider what actions might help to overcome these, and explore whether the data strategy for health and social care will deliver the change needed.
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Content ArticleEarlier this month The BMJ and the Nuffield Trust hosted a roundtable discussion about the workforce crisis. It took in a wide range of perspectives, but the message was clear: the workforce crisis is urgent, it is affecting staff morale and wellbeing, it is damaging patient care, and it requires immediate action. It’s not just a UK problem; it’s a global crisis, but some countries are better at recognising the relation between staff morale and wellbeing, better patient care and economic growth. Simply put, your economy won’t grow if your population is unhealthy; your population won’t be healthy if your health professionals are demoralised and unwell.
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Content ArticlePutting patients in tents outside hospitals is a completely unacceptable ‘solution’ to the ambulance handover problems and the funding would be far better spent on staff in the community, says Royal College of Emergency Medicine president Katherine Henderson in this HSJ opinion piece.
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Content Article“Hi, I’m the doctor. First I need to apologise for how long you’ve been waiting.” An apology is now the default way I introduce myself to patients in the busy emergency department where I work, writes an emergency medicine consultant in an article for the Independent newspaper. An apology for the shortage of beds, an apology for the shortage of staff and most importantly for the person in front of him, an apology for how long they’ve waited, in pain and distress, to be seen.
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Content ArticleExtrapolation from a recent poll suggests that about 16 million adults in the UK found it difficult to access healthcare services during the pandemic, and of these, one in eight opted to access private healthcare. This could create the conditions for a two tier system, whereby those with the means to pay have access to healthcare more quickly than those who don’t. This would jeopardise the high levels of support the NHS has enjoyed since its establishment and have serious implications for equity in access to healthcare services. But this is unlikely because of limited capacity in the private sector writes Michael Anderson and Elias Mossialos in this BMJ editorial.
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Content Article
ECRI: Top 10 Patient Safety Concerns 2022
Patient Safety Learning posted an article in International patient safety
ECRI's annual Top 10 list helps organisations identify imminent patient safety challenges. The 2022 edition features many first-time topics, and emphasis is on potential risks that could have the biggest impact on patient health across all care settings. The number one topic on this year’s list has been steadily growing throughout the COVID-19 pandemic and impacts patients and staff on all levels: staffing shortages. Prior to 2021, there was a growing shortage of both clinical and non-clinical staff, but the problem has grown exponentially. In early January 2022, it was estimated that 24% of US hospitals were critically understaffed, while 100 more facilitates anticipated facing critical staff shortages within the following week. The list includes diagnostic and vaccine-related errors that can impact patient outcomes. In addition, several topics on this year's list reflect challenges that have arisen as a result of the stresses associated with delivering care during a global pandemic. -
Content ArticleWaiting is a feature of public healthcare systems but must be managed to avoid adverse impacts on patients. The NHS sets performance standards for waiting times for elective and cancer care. Its performance against these was deteriorating before the COVID-19 pandemic and has worsened since it began. Millions of patients’ care was disrupted, meaning backlogs increased. This report looks in detail at backlogs and waiting times for elective and cancer care in the NHS in England. It explains how the current increased backlogs and waiting times have arisen, including the impact of the COVID-19 pandemic. The report sets out: how waiting times performance for elective and cancer care are tracked in the NHS, and how long patients have been waiting relative to the performance standards; the causes of increasing longer waits before the pandemic and the disruption caused by the pandemic; and the steps the Department and NHSE&I have already taken to address the increasing backlogs and waiting times, and the constraints and challenges the NHS faces in making a full recovery.
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Content ArticleThis census of the consultant physician workforce in the UK conducted by the Royal College of Physicians shows that the number of doctors needed to meet patient demand continues to significantly outnumber the supply.
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Content ArticleThis publication by National Voices, the leading coalition of health and social care charities in England, highlights the factors currently affecting timely access to care for people living with ill health, disability or impairment. It calls for system leaders to prioritise rebuilding timely access to health and care, and to take an approach that considers the whole system and its context and the whole person and their circumstances.
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Content ArticleThe Ipsos Global Health Service Monitor is an annual study that explores the biggest health challenges facing people today and how well-equipped people think their country’s healthcare services are to tackle them. It ran the survey in 30 countries between 30 August and 3 September 2021. The survey found that public perceptions of healthcare services have not been adversely affected by the pandemic, according to our 30-country survey. Britons are generally happy with the quality of healthcare but are acutely aware of the challenges facing healthcare services.
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Content ArticleContinuity, usually considered a quality aspect of primary care, is under pressure in Norway, and elsewhere. An association lasting more than 15 years between a patient and a specific GP reduces the probability of any of these factors by 25-30%, a study by Sandvik et al. found. The researchers said 'promoting stability among GPs' should be a priority for health authorities, and warned that continuity of care was under pressure.
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Content ArticleThis report by The Hearts, Minds and Genes Coalition for Eating Disorders aims to highlight the cost of eating disorders in the UK. It examines: the financial cost of eating disorders to the NHS the financial, social and emotional impact on individuals, families and wider society the ongoing loss of lives to treatable illnesses. It estimates the costs of eating disorders, highlights current gaps in data and gives recommendations for change.
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Content ArticleMany elective orthopaedic procedures were cancelled due to the Covid-19 pandemic and the number of patients on waiting lists for surgery is rising. This study looks at the disparities between inpatient and day-case orthopaedic waiting list numbers and the ‘hidden burden’ that exists due to reductions in elective secondary care referrals. The authors looked at elective procedures at a single District General Hospital in the UK between 1 April and 31 December 2020 and compared data with the same nine-month period from 2019. The study found: a 52.8% reduction in elective surgical workload in 2020 the total number of patients on waiting lists had risen by 30.1% in just 12 months inpatient waiting lists have risen by 73.2%, compared to a 1.6% rise in the day-case waiting list new patient referrals from primary care and therapy have reduced by 49.7%. The authors highlight the disparity between inpatient and day-case waiting lists and predict an influx of new referrals as the pandemic eases. They call for robust planning and allocation of adequate resources to deal with the backlog.
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Content ArticleAs COVID-19 hit England last spring, the health service faced workforce shortages of over 100,000 staff. Around 40% of the staffing shortfall was in nursing. Capacity constraints of all kinds have been an important backdrop to the management of the pandemic. Equipment and buildings matter, but throughout COVID-19 the key risk was not having enough staff to safely treat all the patients needing care. Anita Charlesworth discusses what action is now required.
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Content ArticleThe Royal College of Nursing (RCN)’s 'Nursing Workforce Standards' have been created to explicitly set out what must happen within workplaces to ensure the delivery of safe and effective patient care. The RCN's Nursing Workforce Standards are the first ever blueprint for tackling the nursing staff shortage levels across the UK. They set the standard for excellent patient care and nursing support in all settings, and all UK countries. Developed by the RCN's Professional Nursing Committee, the Nursing Workforce Standards suggest a roadmap for designing a workforce in both the NHS and the wider health and social care sector that can offer patients the quality of care they deserve. The 14 standards – the first of their kind – have been designed for use by those who fund, plan, commission, design, review and provide services which require a nursing workforce. They can also be used to help nursing staff understand what they should expect to be in place to enable them to do their jobs safely and effectively. The standards apply across the whole of the UK and to every setting where nursing care is delivered. They’re being launched as new polling reveals seven in 10 people believe there are too few nurses to provide safe care. Of the 1,752 members of the public who were surveyed, more than a quarter said they felt themselves or their families may not get the care required when needed.
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Content ArticleNew research by the Health Foundation shows that the amount of hospital care received by those living in care homes in England rapidly declined in the first three months of the pandemic in 2020 and was substantially lower than in the same period in 2019. The research, which is due to be peer reviewed, provides the first comprehensive and national analysis of all hospital care provided to care home residents during the first wave of the pandemic. It appears to substantiate concerns that care home residents (including those in nursing homes and residential care) may have faced barriers to accessing hospital treatment as the NHS rapidly reorganised to free up hospital capacity to care for critically ill COVID-19 patients.
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Content ArticleWe need a twin track approach in workforce planning – one for the medium-term and other for the long-term – writes Rob Smith, Director of Workforce Planning and Intelligence, Health Education England, in this HSJ article.
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Content Article
Communication is key to building patient trust in ‘the system’
Lotty posted an article in Patient-centred care
In this blog, Lotty Tizzard, Patient Safety Learning's Content and Engagement Manager, looks at how positive, proactive communication improves patient trust in health services. She highlights that negative past experiences can prevent patients accessing the support and treatment they need, and looks at possible ways to build patient trust in the health system.- Posted
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Content ArticleDelays to timely admission from emergency departments (EDs) are known to harm patients. In this study, Jones et al. assessed and quantified the increased risk of death resulting from delays to inpatient admission from EDs, using Hospital Episode Statistics and Office of National Statistics data in England.
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Content ArticleAfter nearly two years of pandemic, 5,000 inpatients and 1,000 deaths, the staff of one of the largest hospitals in north-west England are frustrated and exhausted. While ministers talk of encouraging signs that the Omicron wave may be receding in parts of England, staff at the Royal Preston are struggling to keep their heads above water. The hospital has seen a near four-fold increase in Covid patients since Christmas Day, rising to 103 last week. It is one of the largest hospitals in a region with the highest infection levels in the UK and two neighbouring NHS Trusts have declared critical incidents. Despite a recent slowdown in admissions, the “horrendous” levels of staff absence means the pressure is ratcheting up.
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Content Article
Hospitals are in serious trouble (7 January2022)
Patient Safety Learning posted an article in Blogs
Omicron is inundating a healthcare system that was already buckling under the cumulative toll of every previous surge, writes Ed Yong in an article for the Atlantic. When a healthcare system crumbles, this is what it looks like. Much of what’s wrong happens invisibly. At first, there’s just a lot of waiting. Emergency rooms get so full that “you’ll wait hours and hours, and you may not be able to get surgery when you need it,” says Megan Ranney, an emergency physician in Rhode Island. When patients are seen, they might not get the tests they need, because technicians or necessary chemicals are in short supply. Then delay becomes absence. The little acts of compassion that make hospital stays tolerable disappear. Next go the acts of necessity that make stays survivable. Nurses might be so swamped that they can’t check whether a patient has their pain medications or if a ventilator is working correctly. People who would’ve been fine will get sicker. Eventually, people who would have lived will die. This is not conjecture; it is happening now, across the United States. -
Content Article
The Integrator: The discharge debacle (HSJ, 13 January 2022)
Patient Safety Learning posted an article in Discharge
HSJ’s inboxes are currently heaving with frustration and fury on a rare consistency of theme; the build up of medically fit patients who can’t be discharged from hospitals. Here’s one example from an exasperated, experienced manager, who spoke of “real failure in social care – long stays growing and no capacity to discharge to, a. Homes closed due to infection, b. Homes going out of business c. Homes unable to come and assess patients as no spare staff, d. No care packages as staff sick or none available due to lack of capacity e. social workers and others needed to make assessments in very short supply”. “We keep getting told we’ll cope and get through but we’re really not… The will to continue is beginning to break down with refusals to redeploy and high sickness absence on top of enforced absence due to covid. A seemingly mad commitment to grind through elective stuff…
