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Content ArticleNaming, shaming, and blaming the “poor performers” or “outliers” won’t help the staff working there, or the patients using their services—but it makes politicians appear to be taking tough action, holding the NHS to account for its use of public money, and acting as patients’ champions, writes David Oliver in this BMJ article.
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Content ArticleThe Covid-19 pandemic has led to the reorganisation of healthcare services to limit the transmission of the virus and deal with the sequelae of infection. This reorganisation had a detrimental effect on cardiovascular services, with reductions in hospitalisations for acute cardiovascular events and the deferral of all but the most urgent interventional procedures and operations. Aortic stenosis (AS) is the most common form of valvular heart disease. Once stenosis is severe, symptoms follow and the prognosis is poor, with 50% mortality within 2 years of symptom onset. Thus, timely treatment is of paramount importance. There was a large decline procedural activity to treat severe AS during the COVID-19 pandemic. As we move into an era of ‘living with’ COVID-19, plans must urgently be put in place to best manage the additional waiting list burden for treatment of severe AS. In this study, Stickels et al. used mathematical methods to examine the extent to which additional capacity to provide treatment of severe AS should be created to clear the backlog and minimise deaths of people on the waiting list.
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Content ArticleThe 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.
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Content ArticleAhead of the government's medium-term fiscal plan, the annual Institute for Government/Chartered Institute of Public Finance and Accountancy (CIPFA) public services stocktake reveals that public services won’t have returned to pre-pandemic performance by the next election, which in most cases was already worse than when the Conservatives came to power in 2010. Performance Tracker reviews the state of nine public services – general practice, hospitals, adult social care, children’s social care, neighbourhood services, schools, police, criminal courts and prisons – and their comparative and inter-connected problems.
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Content ArticleIn this Guardian article, parents reveal their heart-wrenching struggles to access NHS services, which have sometimes been too late to help their children.
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Content ArticleWith emergency departments beyond capacity throughout the country, some hospitals have been trialling an approach of moving a set number of patients into inpatient wards each hour, regardless of bed availability. Is this a viable solution to the problems faced throughout the system? Dr Louella Vaughan assesses the evidence and argues for further caution before rolling out such a model.
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Content ArticleAmbulance services in England are under immense pressure. In July 2022, all ambulance services in England declared REAP (Resource Escalation Action Plan) level four, reflecting potential service failure. Volumes of calls to 999 are increasing, patients in distress and pain are waiting longer for help to reach them, and ambulance teams feel unable to do their job well. The new Secretary of State for Health and Social Care has previously named cutting ambulance waits as his number one priority. As he takes up the role for the second time, he will again need to include ambulances in his list of priorities for the health and care system. Steps taken to date to help address the underlying issues have not yet had an impact on the pressures facing ambulance services. This analysis from The Health Foundation looks at ambulance service performance and explores the contributing factors and priorities for improvement.
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Content ArticleIn this letter, campaign group Hysteroscopy Action, have written to Women’s Minister, Maria Caulfield, to raise its concerns about the levels of pain and trauma experienced by many women undergoing outpatient hysteroscopy procedures. The letter, which has over 20 signatories, including Helen Hughes, Chief Executive of the Patient Safety Learning charity. It calls for more theatre space for women to have procedures under general anaesthetic as well as offering women the choice of intravenous sedation. Related reading Horror as women are facing major medical procedures without anaesthetic, warn experts Guidance for outpatient hysteroscopy: Consultation Response (Patient Safety Learning) Patient experiences shared with us in our community thread Pain during ambulatory hysteroscopy: A presentation by Richard Harrison (3 minute video) 2020: Raising awareness about painful hysteroscopies (8 minute video) Pain-free day surgery? Evaluating pain and pain assessment during hysteroscopy Ministers respond to concerns about painful hysteroscopies: Northern Ireland, Scotland and Wales Read the letter to Maria Caulfield in full below.
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Content ArticleNHS Confederation chair Lord Victor Adebowale and chief executive Matthew Taylor wrote to Rt Hon Rishi Sunak MP on his appointment as Prime Minister. Their letter both highlights the critical role of health in driving growth and sets out urgent action needed to help relieve some of the pressures on the NHS this winter, including: support for the NHS workforce urgently bolstering social care capacity protecting the NHS's capital budget supporting communities during the cost of living crisis asserting the government’s commitment to health protection and prevention.
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Content ArticleWe need urgent radical solutions for the crisis in social care, to prevent the collapse not just of the NHS but of the entire UK economy. Social care is facing extreme difficulties with funding and workforce shortages. Staff are poorly paid, and 10% of posts are vacant. The situation is about to get worse: 19% of the UK population is over 65. In Northern Ireland the number of people over 65 more than doubled between the censuses in 2011 and 2021. Projections show that each person will need an average of 10 years of social care. We must, then, focus on prevention. The need for social care is not inevitable. Ageing does not have to be associated with a loss of fitness. Exercise and strength training can restore muscle and balance and are proved to reduce the impact of falls and fractures.
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Content Article'State of Care' is the Care Quality Commission's annual assessment of health care and social care in England. The report looks at the trends, shares examples of good and outstanding care, and highlights where care needs to improve.
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Content ArticleThis report from Skills for Care provides a comprehensive analysis of the adult social care workforce in England and the characteristics of the 1.50 million people working in it. Topics covered include recent trends in workforce supply and demand, employment information, recruitment and retention, demographics, pay, qualification rates and future workforce forecasts.
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Content ArticleThis 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.
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Content ArticleIdentifying improvements in maternity care to help reduce the risk of delays in crucial interventions during labour when a baby is suspected to be unwell is the focus of this latest Healthcare Safety Investigation Branch (HSIB) report. The report was compiled after a review of 289 of our maternity investigations into intrapartum stillbirths, neonatal deaths and potential severe brain injuries. In 14.9% of the cases the delay was a contributory factor. The review identified issues such as inadequate staffing, poor infrastructure and high workload as contributory factors to the delays. Evidence from national reports confirms that such delays are a recognised patient safety risk.
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Content ArticleThe onset of COVID-19 caused some patients throughout the United States to delay their surgeries as many hospital systems postponed nonemergent procedures. This led to a potentially large backlog of case volume. In a recent McKinsey survey of health system leaders, hospital executives said they may struggle to address this backlog given workforce availability, enhanced sanitation protocols, and reserved inpatient capacity. Without healthcare systems recalibrating demand and capacity, patients could face long backlogs for procedures, and potentially experience higher morbidity and mortality rates. Solutions may include 1) reducing the unnecessary deferral of care, 2) effectively addressing new throughput challenges, 3) using advanced analytics to better forecast demand and manage capacity in real time, and 4) reimagining operating room operations to increase long-term capacity. Berlin et al. explore these solutions further in this article.
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Content ArticleTelemedicine has potential to address inequity in healthcare but not until certain barriers are addressed. This article from Joanna Pearlstein in Wired discusses how physicians and care organisations have to be creative and rely on partnerships and local resources, such as school district hot spots or public library broadband access, to make the system reliably work for all their patients.
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Content ArticleDue to the concerns around ambulance waiting times, the Healthcare Inspectorate Wales undertook a local review of the Welsh Ambulance Service Trust (WAST). The review explored how the risks to patients’ health, safety and wellbeing are managed whilst they are waiting for an ambulance. It assessed how patients are being managed by WAST’s three Clinical Contact Centres across Wales, from when a request for an ambulance is received to the point the ambulance arrives at the scene.
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Content Article
Patient referrals and waiting lists: A ticking time bomb
Jerome P posted an article in By health and care staff
Jerome, a patient safety manager, discusses the impact the pandemic is having on patient referrals and waiting lists, and the subsequent increases in serious incidents and never events that will arise. With an already overstretched and exhausted workforce, how will these be investigated, how will this be managed? Jerome urges NHS England to give guidance.- Posted
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Content ArticleInadequate access to anaesthesia and surgical services is often considered to be a problem of low- and middle-income countries. However, affluent nations, including Canada, Australia, and the United States, also face shortages of anesthesia and surgical care in rural and remote communities. Inadequate services often disproportionately affect indigenous populations. A lack of anaesthesia care providers has been identified as a major contributing factor to the shortfall of surgical and obstetrical care in rural and remote areas of these countries. In this report, Orser et al. summarises the challenges facing the provision of anaesthesia services in rural and remote regions
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Content ArticlePatient Safety Learning, Health Plus Care and BD are holding a series of webinars on patient safety on the frontline, exploring burning patient safety issues and engaging with frontline health care workers, clinical leaders and patient safety experts. The first of these webinars is at 11.00am (BST) on Wednesday 16 September: Responding to the treatment backlog safely. This blog sets out some of the key points to inform the webinar.
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Content ArticleThe association between higher registered nurses (RN) staffing (educational level and number) and better patient and nurse outcomes is well-documented. This discussion paper from Van den Heede et al. aims to provide an overview of safe staffing policies in various high-income countries to identify reform trends in response to recurring nurse workforce challenges.
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Content ArticleIn 2019 The King's Fund discussed the following eight key problems facing social care and called for reforms to address them: means testing: social care is not free at point of use like the NHS catastrophic costs: some people end up paying large amounts and even selling their homes to pay for care unmet need: many people go without the care and support they need quality of care: a wide spectrum of concerns, from 15-minute care visits to neglect and lack of choice and control workforce pay and conditions: staff are underpaid, leading to high vacancy rates and turnover market fragility: care providers go out of business or hand back contracts disjointed care: health and care is not integrated around the individual and causes issues such as delayed transfers of care from hospital the ‘postcode lottery’: there is unwarranted variation between places in access to care and its quality. The pandemic has shone an uncompromising light on the social care sector. In this article, Simon Bottery explores how COVID-19 has exacerbated these pre-existing challenges.
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Content ArticleIn this candid blog, 'The Secret Midwife', gives her account of the pressure and lack of resource and support that makes it so difficult to provide safe care.
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Content ArticleADASS, is a charity that provides a national voice and leadership for adult social care. In 2019, they published a report, Sort out social care, for all, once and for all, setting out what they believe needs to be done by the Government to tackle the crisis. The report called for: Short-term funding, including continuation of the Better Care Fund and Improved Better Care Fund, to prevent the further breakdown of essential care and support over the course of the next financial year. Long-term funding and reform following, to enable us to build care and support for the millions who need it and create a social care system that is truly fit for the 21st century. A long-term plan for adult social care which means a support system in place that links with other public services including the NHS and supports resilient individuals, families and communities.
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Content ArticleInformation overload can be defined as a difficulty a person can have in comprehending issue and making judgments that are caused by the presence of too much information. Information overload occurs when the amount of input to a system surpasses its processing capability. Decision-makers have a limited cognitive processing ability. Consequently, when information overload happens, it is possible that a decline in decision quality will take place. Decision-makers, such as medical consultants, have fairly limited cognitive processing capacity. Consequently, when information overload occurs, it is likely that a reduction in decision quality will occur. The aim of this study, originally published by the Journal of Biosciences and Medicines, is to assess the impact of information overload on medical consultants’ life, its causes, and potential ways to deal with it.
