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Found 943 results
  1. Content Article
    Mental health in the UK is getting worse. Sickness absence due to mental illness is soaring, rates of mental health difficulties are increasing at an alarming rate, and already overstretched services are struggling to meet rising demands. Along with over 30 organisations with an interest in mental health, the Centre for Mental Health has developed a plan to address this and build a mentally healthier nation.
  2. Content Article
    With demand for GPs outstripping supply, GP retention must be a priority in tackling the current workforce crisis. The NHS has lost the equivalent of 2,187 full-time fully qualified GPs since 2015, 8% of the current total of full-time fully qualified GPs. GPs in the UK are reporting the highest stress levels and lowest job satisfaction compared to their counterparts in nine other high-income countries. In this article, published by the King's Fund, GP Trainee, Holly Young reflects on a recent roundtable that explored solutions for GP retention, organised by the Royal College of General Practitioners.
  3. Content Article
    In this chart of the week from the Nuffield Trust, Ose Ogbebor looks at how the numbers of recommendations from 111 for further dental care have changed over the past four years. NHS 111 data indicates that demand for dental care is still at higher levels than before the pandemic, providing further evidence for the need for urgent NHS dental reform.
  4. Content Article
    In this article, published by the Institute for Government, Sam Freedman looks at the state of the NHS pre and post pandemic and how staffing, bed shortages, staff churn and other issues have had an impact.  Sam argues we are drifting further into crisis due to a stubborn refusal by the government to to engage properly with these issues.
  5. Content Article
    On 3 August 2022 an investigation was carried out into the death of Allison Vivian Jacome Aules. Allison was 12 years old when she passed away on the 19 July 2022. The investigation concluded at the end of the inquest on the 17 August 2023. The conclusion was that Allison died as a result of suicide, contributed to by neglect.
  6. Content Article
    The Association of Ambulance Chief Executives (AACE) has published a new report charting the major increase in the frequency and length of hospital handover delays over the past ten years, calling for an even greater focus on improvements that will reduce and eradicate delays, prevent more patients from coming to significant harm and stop the drain on vital ambulance resources.
  7. Content Article
    A global shortage of an estimated 18 million health workers is anticipated by 2030, a record 130 million people are in need of humanitarian assistance, and there is the global threat of pandemics such as COVID-19. At least 400 million people worldwide lack access to the most essential health services, and every year 100 million people are plunged into poverty because they have to pay for healthcare out of their own pockets. There is, therefore, an urgent need to find innovative strategies that go beyond the conventional health-sector response. WHO recommends self-care interventions for every country and economic setting as critical components on the path to reaching universal health coverage (UHC), promoting health, keeping the world safe and serving the vulnerable.
  8. Content Article
    Community hospitals play a very important role in supporting patients but, unlike with larger hospitals, little has been known until now about how they struggle with delayed discharges. Following a freedom of information request, the Nuffield Trust reveals the number of patients experiencing delays leaving community hospitals, and highlights the capacity challenges such hospitals face.
  9. News Article
    Staffing shortages are likely to restrict the use of a beneficial painkiller in birthing suites, even once its use has been recommended by national guidance. Research by HSJ suggests that just over half of trusts are already offering remifentanil to women in labour, although some are having to restrict its use due to lack of staffing. Responses to freedom of information requests from 108 trusts revealed 55 offered remifentanil during labour in 2022-23. Recent draft National Institute for Health and Care Excellence guidance on intrapartum care, published in April, suggested healthcare professionals “consider intravenous remifentanil patient-controlled analgesia” in obstetric units. This is partly because it reduces the likelihood of forceps or ventouse being required compared to intramuscular pethidine (an opioid commonly used in labour). However, the drug is not yet mentioned in official NICE guidelines and the opioid’s use in labour is currently off-label (its more common licenced use is alongside anaesthesia in surgery). A Royal College of Anaesthetists spokesperson said the use of drugs off-label “is extremely common in obstetrics given that drug trials do not often include pregnant women”. Read full story (paywalled) Source: HSJ, 1 September 2023
  10. News Article
    More than 120,000 died waiting for NHS treatment, as backlog hits all-time high. The number of NHS patients dying while waiting for treatment has doubled in five years, new figures suggest. More than 120,000 people died while on waiting lists last year, according to an analysis of health service data. The total is even higher than it was in lockdown, with health leaders saying the pandemic and NHS strikes have made clearing backlogs more difficult. Matthew Taylor, the chief executive of the NHS Confederation, said: “These figures are a stark reminder about the potential repercussions of long waits for care. They are heartbreaking for the families who will have lost loved ones and deeply dismaying for NHS leaders, who continue to do all they can in extremely difficult circumstances." “Covid will have had an impact on these figures – but we can’t get away from the fact that a decade of under-investment in the NHS has left it with not enough staff, beds and vital equipment, as well as a crumbling estate in urgent need of repair and investment.” Read full story (paywalled) Source: The Telegraph, 31 August 2023
  11. Content Article
    In February 2022, NHS England published its Delivery Plan for Tackling the Covid-19 Backlog of Elective Care, aiming for an unprecedented 30% rise in elective activity by 2024-25. In an effort to cut waiting times and the number of people waiting for first appointments, the plan set an improbably ambitious target of reducing follow-up outpatient visits by 25% by March 2023 from 2019-20, to leave more capacity for first appointments. All first appointment waits of over 52 weeks were to be abolished by 2025. In this BMJ opinion piece, David Oliver looks at why the targets are unlikely to be met.
  12. Content Article
    Even those at the top admit the NHS can’t do what is being asked of it today. But it is far from unsalvageable – we just need serious politicians who will commit to funding it, writes Gavin Francis, who shares his experience as a GP in this Guardian long read.
  13. News Article
    At least 20 patients have suffered harm due to their follow-up appointments not being booked at a hospital department where people ‘continue to come to harm’, according to an internal review. Torbay and South Devon Foundation Trust is reviewing its ophthalmology service after 22 people were harmed following “system failures” with their follow-up appointments. The trust’s initial investigation, obtained by HSJ with the Freedom of Information Act, warned there were “potentially” other patients affected by the failures who had not yet been identified. In response, the trust said its ophthalmology department had already “undertaken a significant amount of work to address a large proportion of the actions arising from the review”, including building another operating theatre and recruiting more staff. Read full story (paywalled) Source: HSJ, 21 August 2023
  14. News Article
    As junior doctors begin a four-day strike today with a two-day strike by consultants a fortnight later, Sir Julian Hartley, chief executive of NHS Providers, said: "Trust leaders are very worried about six more days of severe disruption across the NHS this month. "We could be close to a tipping point. Trusts and staff are pulling out all the stops to reduce waiting times for patients but with no end to strikes in sight the sheer volume of planned treatment being put back due to industrial action will make it almost impossible for trusts to cut waiting lists as much as the government wants. "Waiting lists are now at a record high of 7.57 million, the pressure on urgent and emergency care services is relentless and an already stretched NHS is gearing up for another high-demand winter as pressure on tight budgets mounts. "A string of strikes – which have led to more than 835,000 routine treatments and appointments being put back since December – is estimated to have cost the NHS around £1bn already including lost income and hiring expensive staff cover. "The number of rescheduled appointments could be close to 1 million after this month's strikes and consultants have called another two-day strike in September. There will be a long-lasting effect on patients who have had treatment delayed and on already low staff morale. "Concerns are mounting too over how patient safety will be maintained during August's strikes as many NHS services will be even more stretched as many staff are on much-needed summer holidays and cover is harder to secure. "It's vital that the government and unions find a breakthrough urgently. Trust leaders understand the strength of feeling among striking staff and why they're taking action. Everyone in the NHS wants to concentrate on treating more patients more quickly rather than spend days making plans to cope with strikes. "People can still rely on the NHS during strikes, calling 999 in an emergency. For less urgent cases people should use 111 online for help and advice."
  15. News Article
    Steve Gulati, Associate Professor and Director of Healthcare Leadership at HSMC (University of Birmingham) discusses the concept of "time to care" within healthcare. A UK-wide poll of healthcare workers revealed that most NHS staff think they have too little time to help patients and the quality of care that services provide is falling. This reported reduction in the time to care is perhaps inevitable after almost a decade of health funding failing to keep up with increases in demand, and is a cause for concern for all of us – patients, carers or those working in the NHS. Where does this fit in to the wider picture – and can anything be done about it? It is not just NHS workers who are feeling the pinch – levels of public satisfaction with the NHS are at an all-time low. Interestingly, the two most cited reasons relate to access (difficulties or delays in getting appointments) and, tellingly, to staff shortages. Even against this gloomy backdrop, the collectivised funding model upon which the NHS is founded continues to find significant public support. All of this points towards a painful congruence – NHS staff feel that they do not have enough time to care, and the public is noticing. Is ‘time to care’ an outdated concept, harking back to an age of long patient stays, a paternalistic bedside manner and unrealistic expectations? Both staff and patient experience suggest not. Although technology plays an increasing role in healthcare diagnostics, treatment and recovery, delivering care remains a deeply human phenomenon and is essentially a relational and personal task. Recognising that frontline healthcare workers need time to care is not a new phenomenon. Influenced by service improvement methodologies, the ‘productive ward’ initiative in the mid-2000s placed an explicit emphasis on using efficiency techniques for the express purpose of releasing nursing staff to have “time to care”. It was acknowledged that productivity was more than metrics around bed occupancy and throughput, for example, and that the driving purpose of service improvement was to time to care. Whilst research indicated a nuanced impact, the principle is long recognised. If solutions to these problems were easy, they would have been implemented by now. There is no doubt that on one level, it really is a matter of resources – no system can carry a vacancy factor of around 10% for any length of time without there being an evident impact. However, even within an environment of constrained resources, choices are made every day by caregivers and leaders alike about what receives attention and what is allowed to move into the ‘important but not urgent’ category. That is in no way to blame the hard-pressed caregivers, but instead to indicate that even when it really does not feel like it, every individual has a level of agency. Feeling as though one does not have time to do one’s job is, put simply, unpleasant for all workers but should especially concern us in care environments. The impact on clinical safety and quality is an obvious starting point, but it is also important to recognise the impacts on care workers themselves with regard to emotional labour and the impact on the psychological contract that working in a caring profession, when people feel that they don’t have enough time to care, must have. As eloquently stated by the Vice-President of the Royal College of Physicians in Wales, it is “…very clear that good clinicians, be they nurses, doctors, therapists or pharmacists, need time to train, time to care and time to rest”. Even in challenging times, self-care and compassionate, values driven leadership can make a difference. Caring is everyone’s business. Link to original article: https://www.birmingham.ac.uk/news/2023/healthcare-workers-need-more-time-to-care
  16. News Article
    The use of the private sector to tackle the NHS backlog in England is to be expanded, the government says. Ministers say they want to unlock spare capacity to get more people the treatment and operations they need. This includes opening eight privately-run diagnostic centres and using new rules to make it easier for the NHS to purchase care in the private sector. It comes as a record 7.5 million people are waiting for treatment - three million more than before the pandemic. The private sector already carries out hundreds of thousands of treatments and appointments for the NHS every year. But it has said it has the capacity to carry out about 30% more than it is. Read full story Source: BBC News, 4 August 2023
  17. News Article
    It may take seven years to get NHS Wales waiting lists of 700,000 back to 2020 levels, Wales' auditor general has said. The number of patients waiting for non-urgent treatment has doubled since February 2020, just prior to the Covid pandemic. They include Patient Michael Assender, 74, who has spent two years on a waiting list with severe back pain. After struggling with his back, Mr Assender, from Cwmbran, Torfaen, paid £1,500 for a private scan, which revealed he had two slipped discs. "At the moment I'm coping pretty well, taking pills for the pain and trying to stay active," he said. "But something that took me half hour before now takes an hour." Mr Assender said he knew others waiting for surgery who had become depressed and considered taking their lives, adding: "A lot of people out there are in a constant pain and I do pity them." "It's a dire situation really." The Welsh government said it had a plan to deal with backlogs. But Wales' Auditor General Adrian Crompton said: "Just as the NHS rose to the challenge of the pandemic, it will need to rise to the challenge of tackling a waiting list which has grown to huge proportions." "Concerted action is going to be needed on many different fronts, and some long-standing challenges will need to be overcome." Read full story Source: BBC News, 31 May 2022
  18. News Article
    The NHS has lost almost 25,000 beds across the UK in the last decade, according to a damning report says the fall has led to a sharp rise in waiting times for A&E, ambulances and operations. The Royal College of Emergency Medicine said the huge loss of beds since 2010-11 was causing “real patient harm” and a “serious patient safety crisis”. At least 13,000 more beds are urgently needed, it added, in order to tackle “unsafe” bed occupancy levels and “grim” waiting times for emergency care and handover delays outside hospitals. Patients are increasingly “distressed” by long waiting times, the college said, as are NHS staff who face mounting levels of burnout, exhaustion and moral injury. The UK has the second lowest number of beds per 1,000 people in Europe at 2.42 and has lost the third largest number of beds per 1,000 population between 2000 and 2021 (40.7%), the report said. There are currently 162,000 beds in the NHS across the UK, according to the college. “The situation is dire and demands meaningful action,” said Dr Adrian Boyle, the college’s vice-president. “Since 2010-11 the NHS has lost 25,000 beds across the UK, as a result bed occupancy has risen, ambulance response times have risen, A&E waiting times have increased, cancelled elective care operations have increased. “These numbers are grim,” Boyle added. “They should shock all health and political leaders. These numbers translate to real patient harm and a serious patient safety crisis. The health service is not functioning as it should and the UK government must take the steps to prevent further deterioration in performance and drive meaningful improvement, especially ahead of next winter.” Read full story Source: The Guardian, 31 May 2022
  19. News Article
    Dozens of patients died or suffered ‘severe harm’ after long waits for ambulances during a three-month period in a health system facing ‘extreme pressure’ on its emergency services. The 29 serious incidents in Cornwall included patients waiting many hours for assistance despite being in “extreme pain”, patients having suspected sepsis, patients in cardiac arrest, and patients experiencing a stroke. The incidents were reported to the Care Quality Commission by staff at South Western Ambulance Service Foundation Trust during an inspection of the Cornwall integrated care system’s urgent and emergency care services. According to the CQC, the pressures on the ambulance service were “unrelenting”, while “significant work” was needed to “alleviate extreme pressure”. This meant there was a “high level of risk to people’s health when trying to access urgent and emergency care in the county”, the report said. Read full story (paywalled) Source: HSJ, 27 May 2022
  20. News Article
    Waiting times for outpatient appointments, hospital procedures, emergency care, GPs and community health services have all hit record levels in Northern Ireland, with health care staff and patients declaring it the "worst ever" crisis to hit health services in the region. The impact of the COVID-19 pandemic, ever-growing patient demand, staff shortages, and the failure to put together a new Executive government following the recent Northern Ireland elections are being cited as the key drivers of the crisis, with health care staff now at breaking point. Speaking to Medscape UK, British Medical Association Northern Ireland (BMA NI) council chair Dr Tom Black said the current crisis in Northern Ireland's health services essentially boils down to "workload and workforce" issues. Waiting lists to access hospital appointments in Northern Ireland were already long before COVID-19, but the pandemic has significantly exacerbated the situation, he noted. Northern Ireland has the worst waiting lists in the UK, with more than 350,000 people currently waiting for a consultant-led appointment – more than half of them waiting over a year, with many waiting two, three, and even more years for an appointment. "We're now heading towards nearly 400,000 on hospital waiting lists, which is a huge number when you consider that is one-in-five of the total population," Dr Black commented. This week a judicial review is due to get underway at the High Court in Belfast after two patients initiated a legal case against the health services over excessive waiting times for access to care. One of the women has been waiting over five years to see a neurologist after being referred by her GP for suspected multiple sclerosis. The case is seeking a judicial declaration that the length of the waiting lists are unlawful and breached their human rights. Read full story Source: Medscape UK, 24 May 2022
  21. News Article
    A struggling ambulance trust could face a ‘Titanic moment’ and collapse entirely this summer if the region’s worsening problems with hospital handover delays are not taken more seriously, its nursing director has told HSJ. Mark Docherty, of West Midlands Ambulance Service (WMAS), said patients were “dying every day” from avoidable causes created by ambulance delays and that he could not understand why NHS England and the Care Quality Commission were “not all over” the issue. He revealed that handover delays at the region’s hospitals were the worst ever recorded, that rising numbers of people were waiting in the back of ambulances for 24 hours, and that serious incidents have quadrupled in the past year, largely due to severe delays. More than 100 serious incidents recorded at WMAS relate to patient deaths where the service has been unable to respond because its ambulances are held outside hospitals, according to the minutes of the trust’s March quality and safety committee. "Around 17 August is the day I think it will all fail,” he said. “I’ve been asked how I can be so specific, but that date is when a third of our resource [will be] lost to delays, and that will mean we just can’t respond. Mathematically it will be a bit like a Titanic moment. ”It will be a mathematical certain that this thing is sinking, and it will be pretty much beyond the tipping point by then.” Read full story (paywalled) Source: HSJ, 25 May 2022
  22. News Article
    In England, only a third of adults – and half of children – now have access to an NHS dentist. As those in pain turn to charity-run clinics for help, can anything stop the rot? It is over an hour before the emergency dental clinic is due to open, but Jodie Manning is taking no chances. She hasn’t been able to eat for four days – “I can’t physically bite down any more” – and is determined to get an appointment. Aged 19, she has been to hospital with severe toothache “three-and-a-half times” in the previous year. The half is when they sent her home without treatment; on the other occasions, she was kept in overnight after collapsing from pain and dehydration, when even drinking liquids hurt her swollen mouth. Morphine has become her crutch: she fell asleep in college recently after taking the powerful painkiller. Like many of those waiting grimly in line, she has been struck off by her NHS dentist after not attending for two years, even though surgeries were shut to all but emergency cases during Covid. The same desperation can be seen across England, particularly in the north and east. Only a third of adults – and less than half of English children – now have access to an NHS dentist, according to the Association of Dental Groups (ADG). At the same time, three million people suffer from oral pain and two million have undertaken a round trip of 40 miles for treatment, the ADG calculated recently, calling dentistry “the forgotten healthcare service”. Tooth extraction is now the most common reason for a child to be admitted to hospital, costing the NHS £50m a year. The decline of NHS dentistry has deep roots. Years of underfunding and the current government contract, blamed for problems with burnout, recruitment and retention. Dentists are paid a flat fee for services regardless of how long a treatment takes (they get the same amount if they extract one tooth or five, for example). Covid exacerbated existing challenges, with the airborne disease posing a health risk for dentists peering into strangers’ mouths all day. As the British Dental Association put it in its most recent briefing: “NHS dentistry is facing an existential threat and patients face a growing crisis in access, with the service hanging by a thread.” Read full story Source: The Guardian, 24 May 2022
  23. News Article
    Hundreds of thousands of patients referred to specialists by their GPs are being rejected by hospitals and left to deteriorate because there are no appointments available. NHS waiting lists are already buckling under record-high backlogs and now delays are being compounded as local doctors struggle to even get their patients to outpatient services. Patients’ referrals are rejected by hospital trusts if there are no appointment slots available, meaning they get bounced back to the GP who is unable to help with their complex needs, leaving them without the care they desperately need. Clare Rayner, 54, from Manchester, has been left distraught by delays which have hampered the treatment she needs for complex spinal problems. She is still waiting to find out if an upcoming appointment with a neurologist is going ahead after a request for an urgent review from her GP was ignored five times. Outpatient referrals are typically classed as having an “appointment slot issue” (ASI) when no booking slot is available within a specific time frame, under the NHS e-Referral system. According to experts, the situation varies between specialities, but is reportedly particularly bad in areas such as mental health and neurology. Ms Rayner, a former medical teacher who had to retire because of ill health, said: “I’ve been sent all around the country for neurosurgery over the last few years so have been directly affected by being bounced back to my GP." “A unit in London rejected me because they said I lived too far away, which was ridiculous as they take people from all over the UK, and a local consultant just never replied to my GP’s email. Ms Rayner said she has endured “massive delays” to her care which had left her intensely frustrated. “It’s left me with significant deterioration with my spinal problems and that’s been very distressing,” she said. Helen Hughes, chief executive of charity and campaign group Patient Safety Learning, said: “NHS England needs to urgently investigate, quantify the scale of the problem and take action if we are to prevent these capacity problems resulting in avoidable harm for patients.” A target for providers to reduce ASIs to a rate of 4% or less of their total outpatient activity was set by NHS England in 2019. Guidance in subsequent years has seen a move towards the requirement for providers to implement “innovative pathways” to support prevention of ill health. Read full story Source: iNews, 22 May 2022 Related blogs on the hub: Rejected outpatient referrals are putting patients at risk and increasing workload pressure on GPs A child left waiting for ‘urgent’ surgery, a blog by Clare Rayner
  24. News Article
    More than one in five patients at some hospitals are leaving accident and emergency departments before completing treatment, and in some cases before being seen for assessment at all, with the rate across England trebling since before the pandemic. Experts told the Observer that the increase was probably driven by a combination of long A&E waiting times and by difficulties accessing NHS facilities such as GPs, community health services and NHS 111. The figures apply to patients who left A&E before an initial assessment; after an assessment but before treatment started; or before treatment was completed. They include patients who left to find treatment elsewhere. David Maguire, a senior analyst with the King’s Fund health thinktank, linked the rise to patients having difficulty accessing other parts of the NHS and going to A&E instead. “We’re probably talking about things that won’t require an admission, but it’s important that you get seen by someone,” he said. “So for example, somebody’s got a chest pain, somebody’s got some sort of adverse indication that you would want to seek attention for. It’s a perfectly rational thing to do. But it’s a struggle to access at other points [in the NHS], so you default towards A&E.” He added that staff shortages and social care capacity were also contributing factors. “I think it’s a lot of the NHS not functioning properly. Pre-pandemic, there was a certain amount of flex in the system – even with the problems that we were seeing around performance – that meant you could come to A&E with some of these issues. That flex in the system has gone – the capacity has been absorbed by other issues.” Read full story Source: The Observer, 21 May 2022
  25. News Article
    Hundreds of overseas-born trainee GPs are at risk of deportation because of “nonsensical” immigration rules, the profession’s leader has warned Priti Patel. The NHS risks losing much-needed family doctors unless visa regulations are overhauled to allow young medics to stay in Britain at the end of their GP training, Prof Martin Marshall said. Marshall, the chair of the Royal College of GPs, has written to Patel, the home secretary, demanding that she scrap “bureaucratic” hurdles affecting would-be GPs from abroad. He told the Guardian: “At a time when general practice is experiencing the most severe workload pressures it has ever known, it is nonsensical that the NHS is going to the expense of training hundreds of GPs each year who then face potential deportation by the Home Office because of an entirely avoidable visa issue. “We cannot afford to lose this expertise and willingness to work in the NHS, delivering care to patients, due to red tape.” The threat to foreign-born GP trainees has arisen because current immigration rules state that “international medical graduates” (IMGs) can be given indefinite leave to remain only after they have been in the country for five years, but GP training lasts for only three years. Read full story Source: The Guardian, 17 May 2022
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