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Found 778 results
  1. Content Article
    This report provides an overview of the findings of Ireland's Health Information and Quality Authority (HIQA)’s monitoring programme against the national standards in emergency departments in 2022.  Throughout 2022, HIQA commenced a new monitoring programme of inspections in healthcare services against the National Standards for Safer Better Healthcare. As part of the initial phase, HIQA’s core assessment in emergency departments focused on key standards relating to governance, leadership and management, workforce, person-centred care and safe and effective care. The report highlights, HIQA has identified key areas for both immediate and longer-term attention to address safety issues in our emergency departments. 
  2. Content Article
    For decades, western Europe’s national healthcare systems have been widely touted as among the best in the world. But an ageing population, more long-term illnesses, a continuing recruitment and retainment crisis plus post-Covid exhaustion have combined, this winter, to create a perfect healthcare storm that is likely to get worse before it gets better, writes Jon Henley (Berlin), Kate Connolly (Berlin), Sam Jones (Madrid) and Angela Giuffrida (Rome) in this Guardian article.
  3. Content Article
    Writer and commentator Roy Lilley writes a daily email about what's happening on the ground in the NHS, and how this relates to policy decisions and guidance. Roy describes his eLetters as "a combination of opinion, my take on issues of the day and a news digest of things that I think are important or interesting." In this email, Roy shares several recent accounts sent to him by doctors and other healthcare professionals working in NHS hospitals. They describe dangerous staff ratios, overcrowding and medication shortages. The common theme is dangerously long working hours that could impact on patient safety. Sign up to receive Roy Lilley's daily eLetter.
  4. Content Article
    In the face of record high waiting times for elective care, The King's Fund undertook research to understand the strategies that have been used to reduce waiting times in England and elsewhere in the past 20 years. Elective care waiting lists and waiting times are a product of the fluctuations in and disparities between the demand for and available supply of healthcare. Understanding the root causes of these disparities and taking corrective action to restore balance between demand and supply and optimising the conditions within the health care system is therefore considered key to any strategy to reduce waiting times and sustain them at that level.
  5. Content Article
    The waiting list in England stood at more than seven million in September 2022, up by 1.2 million since September 2021 and 2.6 million since 2019. This analysis by the King's Fund outlines what different patients on the waiting list are waiting for, breaking this figure down into: different medical and surgical specialties whether patients are waiting for admission, diagnostics or decisions It highlights that many on the waiting list are awaiting further diagnostics or decisions before treatment can commence, and others are waiting for treatment that does not require admission to hospital.
  6. Content Article
    In this opinion piece for the Daily Mail, journalist Tom Utley recounts his recent experience of a seven hour wait at A&E after receiving abnormal blood test results from his GP. He argues that fear of litigation is causing GPs to refer patients on to A&E unecessarily, contributing to the overcrowding happening at emergency departments. He also highlights inefficiencies in the system and states that lack of staff capacity to tell him he didn't require any treatment meant he stayed an additional hour and a half in the waiting room.
  7. Content Article
    This article by Rebecca Rosen and Trisha Greenhalgh in the BMJ looks at the safety of remote GP consultations. It begins by looking at the case of student David Nash, who tragically died in 2020 after four telephone consultations with his GP; he was denied an in-person appointment for a painful ear infection that led to a fatal brain abscess. One coroner has raised concerns that this is not a one-off incident, noting that in five inquest reports they wrote during the pandemic, they question whether deaths could have been prevented by in-person consultations. The authors look at the recommendations of the ongoing 'Remote by Default 2' study, which is exploring how best to embed remote consulting in future GP services. They highlight better triage of appointment requests, active listening, checking back, increasing the use of video consulting and better training for clinicians as factors that could improve the safety of remote consultation.
  8. Content Article
    This article looks at the potential to use the continuous flow model to tackle unprecedented levels of overcrowding in emergency departments. The continuous flow model, also known as full capacity protocols, was first introduced in North America in the late 1990s. It mandates that a set number of patients are moved at set times from the emergency department to inpatient wards, regardless of whether a bed is available. This might mean putting an extra patient in a bay or two patients in a side room or boarding them in hospital corridors. In turn, this encourages wards to discharge existing patients, allows ambulances to offload new patients in the space created in the emergency department, and relieves pressure on the whole system. This article looks at the fact that evidence to support the continuous flow model is scarce, although positive, and that there are a number of important factors to consider before implementing the model, to ensure that it does not result in increased patient harm.
  9. Content Article
    A complaint from a patient was made to the Scottish Public Services Ombudsman (SPSO) about the care and treatment provided during the period January 2018 to September 2021. In January 2018 the patient underwent emergency surgery for a perforated sigmoid diverticulum (a complication of diverticulitis, an infection or inflammation of pouches that can form in the intestines). An emergency Hartmann's procedure (a surgical procedure for the removal of a section of the bowel and the formation of a stoma - an opening in the bowel) was performed. In April 2018, the patient was seen in an outpatient clinic and informed it would be possible to have a stoma reversal. The patient complained that the Board had continually delayed the stoma reversal surgery which they required, which as of September 2021 had not taken place. The patient also complained that Covid-19 could not account for the delays between the Board informing patient they were ready for surgery around December 2018 and the start of the pandemic in March 2020. The patient noted that as a consequence they had developed significant complications: a large hernia. The patient added that this had severely impacted their personal life and self-esteem, and left them unable to work and reliant on welfare benefits.
  10. News Article
    NHS England “forgot the people” when it published controversial guidelines last month which said patients faced being removed from the waiting list if they declined two appointment dates, a senior director has admitted. NHSE elective recovery chief Sir Jim Mackey said the guidance was drafted to address legitimate concerns from trusts, but that the process had been “rushed”. Following Sir Jim’s comments, NHSE told HSJ the guidance, which had sparked widespead criticism including from patient groups, would not be changing. But Sir Jim said NHSE would “spend time” better understanding patients after “reflecting” on the process which had created the controversial guidelines. Speaking at the King’s Fund annual conference, Sir Jim said: “[The guidance] was largely a response to trusts saying to us: ‘We keep offering these patients options and they won’t take them, so what do we do?’ “We rushed through a policy to try and deal with that, and in the process, I think forgot the people…We’ve reflected on that.” Read full story (paywalled) Source: HSJ, 1 November 2022
  11. News Article
    Further funding cuts to the NHS will unavoidably endanger patient safety, an NHS leader warned last week after the chancellor’s promise of spending cuts of “eye-watering difficulty”. Matthew Taylor, the chief executive of the NHS Confederation, said his members were issuing the “starkest warning” about “the huge and growing gulf between what the NHS is being asked to deliver and the funding and capacity it has available”. The warning came as figures showed that paramedics in England had been unavailable to attend almost one in six incidents in September due to being stuck outside hospitals with patients. Service leaders say wait times for A&E and other care are being exacerbated by an acute lack of nurses, with a record 46,828 nursing roles – more than one in 10 – unfilled across the NHS. "Patients are presenting more unwell," says a GP from South Wales, "Wait times in A&E have become unmanageable, so we’re seeing patients who have waited so long to be seen they’re bouncing back to us. Things we can’t deal with, like injuries and chest pain. We tell them they have to go back to A&E. "Abuse of surgery reception and admin staff began last year and it’s just scaled up from there. We’ve had staff members who have been verbally and physically threatened and we’re struggling to recruit and retain staff – people are hired and quit in a couple days. A lot of people are going off sick with stress." Five healthcare workers describe the pressures they are facing, including ambulance stacking, rising A&E wait times and difficulties discharging patients. Read full story Source: The Guardian, 1 November 2022
  12. News Article
    Scotland's NHS is in "a perilous situation" amid a staffing and funding crisis, according to the chairman of the doctors' union. Dr Iain Kennedy said urgent action was needed to tackle workload pressures ahead of a potentially "terrifying" winter period. It comes after Scotland's health secretary Humza Yousaf admitted NHS Scotland was not performing well. Mr Yousaf told BBC Scotland it would take at least five years to fix. Dr Kennedy, who is chairman of the industry body BMA Scotland, said it was good to hear Mr Yousaf being honest about the scale of the problems, but added that "frankly we cannot wait five years" for things to improve. He told BBC Radio's Good Morning Scotland programme: "The NHS in Scotland is in a perilous situation and we have a particular crisis around the workforce - we simply do not have enough doctors in general practice and in hospitals. "We need more urgent action because the pressures and the workload have really shot up." Dr Kennedy has called on the government to publish a "heat map" showing where NHS vacancies are unfilled across Scotland. He said: "The public need to see transparency on where the vacancies are. We think that there are probably 15% vacancies across hospital consultant posts across Scotland. "Even the government admits to 7% and that we are at least 800 GPs short in Scotland - and I, and others, suspect we are probably well over that figure now." Read full story Source: BBC News, 31 October 2022
  13. News Article
    Results from the recently published Community Mental Health Survey highlight that issues with access to services and support, as evidenced in the 2020 and 2021 surveys, continue to persist. The 2022 Community Mental Health Survey – coordinated by Picker for the Care Quality Commission – collected feedback from more than 13,400 people in contact with services between September and November 2021. The survey is an important source of information to help us understand the quality of person-centred care provided to mental health service users. A key feature of a high-quality person centred mental health service is timely access to care. The survey shows that there is more to be done here to ensure that service users have a good experience as nearly a third (31%) reported not being told who was in charge of organising their care and services – up from 28% in 2021. In parallel with this, 30% of service users said that they had not seen NHS mental health services enough in the last 12 months (compared to 27% in 2021 and 24% in 2020) and only 55% said they were given enough time to discuss their needs and treatment. Just over half of service users (51%) said that they did not receive any help or advice with finding support for financial advice or benefits – a 3% point increase from last year’s survey. When asked a similar question regarding support for finding or keeping work, 50% said they did not receive help or advice but would have liked it. With the financial worries that the increased cost of living is causing for many people, signposting support and advice for employment, managing money, and claiming benefits are vital for helping people maintain good mental health. Commenting on the results, Jenny King, Picker’s Chief Research Officer, said: “On the 22nd September 2022, the Secretary of State for Health and Social Care and Deputy Prime Minister at the time, Thérèse Coffey, announced the UK government’s Our plan for patients. Whilst it notes that work will continue to improve the availability of mental health support through expansion of services, there was little detail on how this would be achieved and how backlogs of care in mental health services would be resolved. With the backdrop of the cost of living crisis and its impact on people’s mental health, the findings from this survey highlight the urgent need for more to be done to address accessibility issues. And not just in mental health services but across health and social care where, as highlighted by CQC’s 2021/22 State of Care report, people are waiting too long for appointments, assessments, and treatment. Without a plan for tackling the NHS’s workforce crisis, the ability to make sustainable service improvements to address the unmet need is severely restricted.” Read full story Source: Picker, 27 October 2022
  14. News Article
    Surgeons in a London hospital have performed a week’s worth of operations in a single day, pioneering a technique that could be used to help reduce the NHS backlog. The team at Guy’s and St Thomas’ hospital performed eight robot assisted radical prostatectomy operations in under ten hours, the highest number performed in a single day in the UK in one hospital. High Intensity Theatre lists (HIT) focus on one procedure at a time and seek to minimise the turnaround time between operations. Using two theatres, the surgeon can go between cases without having to wait for a patient to come in. This helps to cut the significant amount of time it takes for medics to anaesthetise a patient, set up equipment in the theatre and help them to recover – a process which sometimes takes longer than the operation itself. The team at Guy’s assembled a large team for the HIT list, which took place on 8 October. Each theatre had a team of around 1.5 times its usual size and staff were given very specific roles. By the time the list had reached the third patient, the turnaround time between operations had dropped as low as 32 seconds. Behind the scenes, staff in the control room used Proximie software to monitor activity in the theatre in real time. Dr Ben Challacombe, a consultant urological surgeon who performed the operations with his surgical consultant colleagues Paul Cathcart, Christian Brown, and Prokar Dasgupta, told the Standard that the success of the HIT list had given staff a “huge” morale boost. “Everyone pulled together to do the job, it really helped to energise the team. Morale has been hit by Covid and other issues, but people feel galvanised by doing something different.” Read full story Source: Evening Standard, 29 October 2022
  15. News Article
    Steve Barclay is back as England's health secretary, just as the NHS prepares for what its chief executive Amanda Pritchard says could be a "very, very challenging winter". The government has said "intensive work" is under way in the 15 most under-pressure hospital trusts in England, to speed up ambulance delays, free up beds and reduce waiting times in A&E. Emergency departments across the UK are struggling to quickly treat patients. Only 57% of people who turned up at major A&E departments in England last month were seen, admitted or discharged within four hours, well below the 95% national target. The latest figures from Gloucestershire Royal show it performs slightly worse than average, with 55% dealt with in four hours. One medic, speaking anonymously to the BBC, said: "I wouldn't bring a member of my family to this hospital. And winter is going to be worse unless something changes fast." Read full story Source: BBC News, 28 October 2022
  16. News Article
    Harm to patients has become “normalised” as burned-out paramedics are working without breaks, the national care watchdog has warned. Concerns over the pressures on staff at South East Coast Ambulance Service have been raised by the Care Quality Commission (CQC). Senior staff told the CQC that patients were being adversely affected by ambulance delays but it was now being seen as “part of the culture”. The CQC found pressures on staff within the South East Coast Ambulance Service, such as long waits outside of the emergency department, had led to low morale and staff feeling they were not valued. It said: “Staff described feeling frustrated and burnout and that senior leaders did not understand or respond to the challenges or concerns they raised. Some local senior managers described that harm to patients, caused by delays in reaching them, had become normalised as a culture.” “At times there were many outstanding category 3 [urgent] patients awaiting an ambulance or assessment by a paramedic practitioner. At busy times, these patients waited for extended lengths of time for crews and callbacks. Therefore, this group of patients were at risk of deterioration whilst they were waiting for a response.” Read full story Source: The Independent, 26 October 2022
  17. News Article
    Senior staff have questioned why a major hospital did not seek support from neighbours when emergency patients were left waiting more than 60 hours to be admitted to a bed. Cambridge University Hospitals Foundation Trust’s emergency department came under severe pressure last week, with patients being bedded down in corridors and facing very long waits to be admitted to a ward. Senior sources told HSJ there were two cases where patients were waiting more than 60 hours last Monday, and the trust declared an internal incident. But the sources felt the trust should have escalated its alert level to “Opel 4”, which prompts calls for external support when trusts are under the most severe levels of operational pressure. This can include diverting ambulances to other hospitals. The trust apologised to patients who had been kept “waiting for a long time” but that the required threshold for Opel 4 had not been reached. Read full story (paywalled) Source: HSJ, 25 October 2022
  18. News Article
    An endometriosis sufferer has said her reproductive organs are so damaged by a three-year delay for surgery, it has affected her ability to have children. Claire Nicholls, 29, has been in pain for years with the condition - which involves tissue similar to the lining of the womb growing elsewhere. Ms Nicholls said she was passed from "pillar to post" and for 10 years, medical professionals did not seem to believe how much pain she was actually in. She has stage four endometriosis, which is the most severe and widespread. "The pain can be excruciating, at times I can't get out of bed and I have also had to attend the emergency department," she said. After opting to go private, her surgeon said he was unable to see many of her organs due to the amount of scarred tissue caused by the delay in surgery. "He told me the scarred tissue and adhesions were all around my organs... they couldn't remove it all as it could have damaged other organs including my bladder - it was just too severe," she said. Northern Ireland has the longest gynaecological waiting lists in the UK, according to a professional body. It is calling for two regional endometriosis centres. The report from the Royal College of Obstetricians and Gynaecologists found 36,900 women in Northern Ireland are on a gynaecology waiting list - a 42% increase since the start of the pandemic. Read full story Source: BBC News, 25 October 2022
  19. News Article
    Cancer patients in this country should have the best survival chances in the world. With its universal healthcare system and world-leading researchers, the UK should be able to offer every patient the knowledge and reassurance that their disease will be picked up quickly and treated rapidly, with the best that science can throw at it. Yet Britain languishes towards the bottom of developed nations’ league tables of cancer performance. On nearly every metric this is one of the worst places in the western world to get cancer — and some experts fear that survival rates are about to go backwards for the first time in a generation. Britain is now operating a “late diagnosis service” for the disease, a former UK cancer tsar has said, while waiting times are creeping up and up and nearly half of patients are diagnosed when their tumours have already spread, slashing their survival chances. Read full story (paywalled) Source: The Times, 22 October 2022
  20. News Article
    The NHS in Wales needs to "speed up the process" of treating people waiting over two years for hospital treatment, the health minister said. Eluned Morgan said health boards need to prioritise the "longest waiters and they're not always doing that". There are 59,350 people waiting over two years in Wales, although the number has fallen for a fifth month in a row. The Welsh NHS Confederation, which represents NHS health organisations, has been asked to comment. In Wales, there are 183,450 operations and procedures waiting more than a year. Overall waits - from referral to treatment - have passed 750,000. Scotland has 7,650 patients waiting more than two years, England has 2,646. Asked on BBC Politics Wales why so many more people are waiting longer in Wales, Ms Morgan said: "Our health boards need to make sure that they're taking people from the longest waiters and they're not always doing that." Read full story Source: BBC News, 23 October 2022
  21. News Article
    Paramedics in England cannot respond to 117,000 urgent 999 calls every month because they are stuck outside hospitals looking after patients, figures show. The amount of time ambulance crews had to wait outside A&E units meant they were unavailable to attend almost one in six incidents. Long delays in handing patients over to A&E staff meant 38,000 people may have been harmed last month alone – one in seven of the 292,000 who had to wait at least 15 minutes. Of those left at risk of harm, 4,100 suffered potential “severe harm”, according to the bosses of England’s ambulance services. Read full story Source: The Guardian, 21 October 2022
  22. News Article
    Women waiting for breast reconstruction surgery on the NHS in England face a “postcode lottery” of care, with some forced to wait more than three years, a damning report warns. Two in five women (40%) waiting for breast reconstruction during the pandemic after having their breasts removed due to cancer faced a delay of 24 months or longer, according to research involving 1,246 women who either underwent reconstruction surgery or were waiting for it. The report by charity Breast Cancer Now also warned that some breast reconstruction services are still not operating at full capacity after temporarily pausing at the start of the Covid-19 pandemic. It says there was a 34% drop in breast reconstruction activity in England in 2021-22 compared with 2018-19. The charity added that on top of the delays, women face a “postcode lottery” of care, with some women offered certain types of reconstruction while others are denied the same operation. Breast Cancer Now called on NHS England to develop a plan to address the backlog of breast reconstruction services. One woman told the authors of the report she waited for three and a half years for breast reconstruction surgery, while another said she “wants to move on with my life” but has no idea when her surgery will go ahead. Baroness Delyth Morgan, the chief executive of Breast Cancer Now, said: “For women who choose breast reconstruction, it is a core component of their recovery – far from a solely aesthetic choice, this is the reconstruction of their body and indeed their identity after they have been unravelled by breast cancer treatment and surgery. “We hear of patients affected by delays to reconstruction surgery and the significant emotional impact this has on them, including altered body confidence, loss of self-esteem and identity, anxiety and depression, and hindering their ability to move forward with their lives, knowing their treatment is incomplete." Read full story Source: The Guardian, 19 October 2022
  23. News Article
    Staff at accident and emergency departments across Scotland have expressed “deep concern” at the daily “excessively long waiting times” that are forcing a record number of patients to wait more than 12 hours, according to a leading NHS consultant. Dr John-Paul Loughrey, vice-chair of the Royal College of Emergency Medicine Scotland national board, warned that while such long waits were once regarded as “never events,” they are now daily occurrences. Amid fears the delays will spike significantly over the winter months, especially with another wave of Covid-19 expected, Dr Loughrey said staff were already “burned out,” “exhausted,” and “overwhelmed with a system facing increasing strain.” The latest weekly data on A&E treatment shows that in the week ending 2 October, the number of patients waiting more than 12 hours had soared by 45% week-on-week. “There is deep concern among staff around the excessively long waiting times,” Dr Loughrey said. “The weekly data that show significant increases in long waits translates to real patients on the ground or in the community who are seeking urgent and emergency care. “The system is failing them. We know that long waiting times are associated with patient harm and even death. Staff face moral injury daily, but they are working incredibly hard and doing all they can to minimise this harm to patients.” Read full story Source: The Scotsman, 16 October 2022
  24. News Article
    The number of people waiting for hospital treatment with the NHS in England has topped 7 million for the first time in August. Other unwelcome records were recorded elsewhere, with just 56.9% of patients attending major A&Es in September seen within four hours – a record low. Just 72.9% of patients received their first treatment for cancer within two months after seeing a consultant while one-month waits for radiotherapy also reached a new low at 90.5% of patients against a target of 94%. The service failed to meet seven out of eight of its stated cancer targets. The number of patients waiting more than a year for treatment grew to 387,257 by the end of August, up from 377,689 the month before, equivalent to one in every 18 patients on the waiting list. Eighteen-month waits fell from the high of 123,969 in September 2021 but still affect 50,888. The latest data, covering August or September depending on the metric, shows that the NHS is under increasing pressure even before winter begins. There are currently 10,522 patients in hospital with Covid, double the number seen last month (4,630 on 13 September). On Wednesday, the NHS warned that hospitals in England may be forced to cancel operations to protect their stocks because of staff shortages. The service pointed to successes elsewhere, saying the number of people waiting 18 months for treatment continues to fall and was almost 60% lower in August as compared with the same month last year (121,711) and noting that 255,055 people received an NHS cancer check following an urgent GP referral in August – the highest number since records began. Read full story Source: The Guardian, 13 October 2022
  25. News Article
    Senior doctors have sent a warning over the “shambles” of heart attack care after pressures on the NHS have left patients waiting eight hours for an ambulance. The caution comes as several hospitals in the past week have declared critical incidents over the level of pressure on their emergency care services. Portsmouth Hospital said on Monday: “Demand for an emergency response is far outstripping the capacity available in Portsmouth and South East Hampshire at this time.” Professor Mama Mamas, a consultant cardiologist in Stoke and Professor of Cardiology at Keele University, told The Independent: “I was on call this weekend and I was seeing delays of eight hours. It was several people, three or four this weekend with heart attacks that waited between four and eight hours … it’s a national disgrace that we’re in this situation. “I think that patient care is being compromised. We know that time is muscle and an eight-hour delay getting an ambulance to a patient with a heart attack is impacting on the survival levels.” Read full story Source: The Independent, 13 October 2022
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