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Content ArticleEven 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.
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Content ArticleMany patients struggle to book a GP appointment in England. Once people have been successful in getting a booking to see their doctor, however, how long are they having to wait for their appointment? Charlotte Paddison looks at the latest data to reveal the answer – and argues that quick access to GP appointments is not the only factor to consider.
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Content ArticleRecovering services from the covid crisis is the big task for NHS leaders for the foreseeable future. The Recovery Watch newsletter tracks prospects and progress. This week by HSJ bureau chief and performance lead James Illman.
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Content ArticleSince February 2020, the elective waiting list has grown by 61% from 4.57 million to 7.47 million. The delivery plan for tackling the COVID-19 backlog of elective care set out the system-wide response to reducing this backlog.
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Content ArticleAuthors conducted a before and after, retrospective, observational study using anonymised, routinely collected, patient-level data from a single English NHS ED between April 2018 and December 2019. The primary outcomes of interest were the proportion of admitted patients, that is, the admission rate, the length of stay in the ED and ambulance handover times. They used interrupted time series models to study and estimate the impact of removing the 4-hour access standard.
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Content ArticleNew research from Healthwatch shows that people are currently facing multiple cancellations or postponements of care which are having a significant impact on their lives and symptoms, while further increasing health inequalities. Healthwatch cmmissioned a survey of 1084 people who have seen their NHS care either cancelled or postponed this year to understand the extent of disruption to care amid rising waiting lists, workforce issues, and industrial action, and other pressures on the NHS.
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Content Article
This is part of our series of Patient Safety Spotlight interviews, where we talk to different people about their role and what motivates them to make health and social care safer. Martin talks to us about the role of Professional Nurse Advocates (PNAs) in improving patient safety through restorative clinical supervision for nurses. He also talks about the need to recognise the close relationship between staff safety and patient safety, and the impact that long waiting lists and limited NHS capacity are currently having. -
Content ArticleNHS urgent and emergency care is under intolerable strain. This strain is increasingly causing harm to patients. Timely and high quality patient care is often not being delivered due to overcrowding driven by workforce and capacity constraints. While the covid-19 pandemic has accentuated and arguably expedited the crisis; the spiral of decline in urgent and emergency care has been decades long and unless urgent action is taken, we may not yet have reached its nadir, writes Tim Cooksley and colleagues in this BMJ opinion article.
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Content Article
The pain and distress of not being able to see an NHS dentist are "totally unacceptable", an inquiry has told the government. A review was launched after a BBC investigation found 9 in 10 NHS dental practices across the UK were not accepting new adult patients. Some people drove hundreds of miles for treatment or even resorted to pulling out their own teeth, the BBC found. The government says it invests more than £3bn a year in dentistry. But a damning report, by the Commons' Health and Social Care Committee, says more needs to be done, and quickly. The House of Commons Committee report with recommendations to government can be viewed at the link below. The Government has two months to respond. -
Content ArticleThe government has published its mandate to NHS England. This mandate is intended to apply from 15 June 2023 until a new mandate is published. NHS England has a duty to seek to achieve the objectives in the mandate. The Secretary of State keeps progress against the mandate under review, setting out his views in an annual assessment which is laid in Parliament and published. The government will agree with NHS England how it should report on overall progress against the mandate to support the Secretary of State in keeping this under review. This will include reporting at agreed intervals on other delivery expectations listed beneath the objectives.
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Content ArticleThis editorial in The Guardian looks at the Government's approach to relieving pressure on GPs, which involves diverting patients to other areas of primary care, including pharmacies. The article highlights potential risks and issues associated with the approach, including the workforce issues currently facing community pharmacy and the comparative lack of standards and regulations for pharmacies. It argues that the Government's approach simply moves the issue to other areas of the healthcare system, rather than dealing with the root cause of the issue facing GP surgeries—retention and recruitment.
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Content ArticleThis report by The King's Fund is part of new research project that explores how NHS providers and integrated care systems (ICSs) are approaching inclusive recovery. It highlights that in 2022, people in the most deprived areas were twice as likely to be waiting more than a year for elective care compared to people in the least deprived areas. The report explores three big questions health and care leaders should be asking themselves and their teams about inequalities in their elective backlog:How are we measuring inequalities and whyDo we know why inequalities existHow will we know if things are improving?
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Content Article
Attention deficit hyperactivity disorder (ADHD) is a condition that affects people's behaviour. It has a wide range of symptoms and can affect both children and adults—people with ADHD may find it hard to focus on or complete tasks, feel restless or impatient, experience impulsiveness and find it hard to organise their time and their things.[1] ADHD can have devastating mental health implications and research studies have linked ADHD to increased suicide and mortality rates. This means that being unable to access effective treatment can be a patient safety risk for people with ADHD. In this blog, Lotty Tizzard, Patient Safety Learning’s Content and Engagement Manager, explores the state of ADHD diagnosis and treatment in the UK. She looks at why many are concerned about the waiting times for adults and children seeking an ADHD assessment and speaks to Elsa*, who was diagnosed with ADHD in her 30s, about her experiences. *Name changed -
Content ArticleThis white paper from CEMBooks aims to unpick some of the deeper issues surrounding bed block and emergency department crowding from the perspective of a frontline medic with two decades of emergency and flow management experience. It aims to provide a greater understanding of the factors influencing the current situation and the measures used to define it followed by some practical implementable solutions.
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Content ArticleThe results from the 2022 British Social Attitudes survey made for very difficult reading for those of us working in the NHS right now. Overall satisfaction with the NHS is at the lowest level ever recorded and similarly satisfaction with individual services is at record lows across the board, but it was satisfaction with A&E services that saw the sharpest fall in 2022. Kelly Ameneshoa, an Emergency Medicine Doctor working across South London and Surrey, reflects on the findings.
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News Article
Woman screaming in pain waiting years for hip op
Patient Safety Learning posted a news article in News
"Seeing how much pain she's in is killing me," the mother of a woman waiting four years for a hip operation has said. It is only by screaming that Marie Morgan, from Carmarthenshire, can express her level of suffering. The 30-year-old, who has multiple brain conditions, can speak only a few words and needs round-the-clock care. "Her hip is out and is rubbing against bone... there's no socket there," Marie's mother Sandra said. "She can't travel because every time I move her she's screaming in pain. Marie has cerebral palsy, severe epilepsy and fluid on the brain and the constant agony caused by the wait has meant these conditions, including her seizures, have become "horrendous". Sandra said: "She used to be so happy, we used to go to the pool, play music... Now she's gone downhill. I don't think she can last much longer to be honest with you." Marie, from Penygroes, is on a waiting list to have surgery in Morriston Hospital, Swansea. Her mother said staff have told her she is considered to be high priority, but despite her best efforts, she is still in the dark about when the operation will happen. "They said because of Covid they weren't operating, now they say it's staff shortages so it's something all the time. "I feel I'm knocking my head against a wall. It's not fair, she's only 30 and suffering the way she is." Swansea Bay Health Board said it hoped to tackle the backlog by increasing capacity at one of its hospitals. Read full story Source: BBC News, 17 February 2022 -
News Article
‘Don’t overwork staff’, says trust with just one 52-week waiter
Patient Safety Learning posted a news article in News
Allowing staff enough rest has been ‘the key’ to elective recovery for an acute trust which has the lowest number of 52-week waiters in England, it has said. Maidstone and Tunbridge Wells (MTW) Trust currently has just one patient who has waited 52 weeks or more on its lists, compared with a high of 976 at one point in April 2021. MTW is one of a handful of trusts with very few long waiters. All are relatively small trusts – and are not regional centres for specialist/tertiary patients – but their 52-week-waiters also represent less than 1% of their total list. MTW chief of service for the surgery division Greg Lawton told HSJ its success in tackling long waiters was down to “attention to detail” in tracking each patient, and not expecting staff to run too many extra sessions. “Any problems patients are having getting through their pathways are identified early and addressed,” he said. "Treatment had been prioritised on the grounds of clinical need, he added, with cancer treatments still going ahead and cancer targets being met." The trust, in the South East, has put on extra operating sessions to clear some of its backlog of patients but these had been limited in number, Dr Lawton said. “What we have never done is try to run too many and I think that may be the key. If you try to do too much you will burn staff out,” he said. The trust had “been mindful that staff need a break,” he added. “Morale is very important.” Read full story (paywalled) Source: HSJ, 16 February 2022 -
News Article
Concerns over 'enormous' backlog for NHS dentistry
Patient Safety Learning posted a news article in News
Scotland's dental leaders say the backlog for patients getting NHS treatment is "enormous". Official data shows people in more affluent areas of Scotland were much more likely to be seen by a dentist in the last two years compared to poorer communities. Meanwhile, patients on long waiting lists are resorting to costly private treatment in order to be seen sooner. The Scottish government said it was committed to tackling the pandemic-related backlog in routine dental care. The shutdown of dental services in the early days of Covid, and then severe restrictions on working practices meant emergency care was prioritised in Scotland. Denise Hesketh is one of thousands of Scots who couldn't see a dentist during the start of the pandemic. The 58-year-old from Edinburgh has battled dental problems for years, but being unable to see a dentist during Covid meant her oral health has taken a turn for the worse. She told BBC Scotland: "It was over a year before I was able to see a dentist and by then it just got too bad. Everything was unstable. It needn't have happened - it could have been repaired." She now faces a bill of £20,000 for private care, with her NHS dentist unable to offer any help. Some patients have raised fears that those who pay for private dental treatment are being prioritised. BBC Scotland has seen an email to patients from one practice in Lanarkshire. It states "Due to NHS restrictions and waiting lists on routine care… there are other options for check-ups for adults and children to pay privately". Read full story Source: BBC News, 16 February 2022 -
News Article
Waits for diagnosis and decision rise to over 38 weeks
Patient Safety Learning posted a news article in News
Waiting times to diagnosis and decision rose by more than a week in December, reaching 38.6 weeks at month end. This matters because many urgent conditions are only detected when the patient reaches diagnosis, including nearly a quarter of all cancers, and such very long waits put those patients at risk. Looking at the whole referral-to-treatment waiting list, which includes patients who have a diagnosis and decision, waiting times remained roughly steady at 43.4 weeks, compared with the standard of 18 weeks that is still required by legislation. Waiting times are a function of both the size and shape of the waiting list, and in December the former got worse and the latter improved. There were 6,067,326 patients on the waiting list as December ended, which is the first time the official figures have topped six million. As many as 310,813 of them had waited over a year (strictly, 52 weeks), and 20,065 over two years (104 weeks). The NHS’s backlog recovery plan has committed that “By July 2022, no one will wait longer than two years for an elective treatment”. Read full story (paywalled) Source: HSJ, 10 February 2022 -
News Article
Surgery delays: Man feels forgotten after six-year wait
Patient Safety Learning posted a news article in News
A County Tyrone man who has been waiting six years for a gall bladder operation has said he feels forgotten about by the health service. John Doherty, 55, said he could not understand why he was unable to get updates on his operation. BBC News NI can reveal almost 475,000 people are waiting for surgery or to see a consultant for the first time. The Royal College of Surgeons wants patients to be told how long they will have to wait for treatment. Mr Doherty said he felt anxious and depressed waiting for a telephone call from his local hospital and blamed the government for "letting him down". "I feel forgotten about, they don't even get in touch with you, not even a letter to say it could happen three months down the line... they say they'll phone back but never do," he added. "I feel neglected." Mark Taylor, a consultant surgeon, people who had been languishing for years on lists deserved to know when to expect their surgery so they could attempt to get in shape for it. He said about a one third of operations had to be cancelled daily as a result of people not being ready, either their blood pressure was too high, they were overweight or their diabetic control was not right. "Pre-habilitation schemes can help to get patients ready for their operation as much as possible, a more personalised pre operation plan is required," he said. Mr Taylor called on the government to have a proper conversation with the public about how hospitals might look in the future. "This is not about closure, this is about the redesign and re-profiling of hospitals to get maximum gain," he said. Read full story Source: BBC News, 15 February 2022 -
News ArticleTwo years of the pandemic have meant drops in essential screening and detection in Australia, while cancer patients undergo treatments alone and isolate to avoid Covid risks. When Claire Simpson turned 50 in early 2020, she received a letter telling her to get a mammogram. Then the pandemic hit, and Victoria went into lockdown. “Like many people, I put it off until we were coming out of that lockdown, but by then it was September and I couldn’t get an appointment until December,” she says. In February 2021 she was diagnosed with breast cancer and had a mastectomy. Tests showed she was positive for the aggressive HER2 receptor, so she began 12 weeks of chemotherapy as well as a treatment called Herceptin, which she received an IV infusion of every three weeks. Simpson says the delay in screening “really, really delayed diagnosis for me, by a good six months”. “I can’t help but feel that [an earlier screening] could have probably saved me from having to have chemotherapy and this Herceptin infusion therapy that I’m having,” she says. Her last Herceptin treatment was last Wednesday. She has been living in self-imposed lockdown, terrified as the Omicron wave built that she would have to isolate due to Covid and disrupt her treatment. That self-imposed isolation will continue until her final surgery, an elective operation scheduled for mid-year. Cancer screening dropped by 10% in Victoria alone in the first year of the pandemic. In 2021, referrals to the Peter MacCallum Cancer Centre, a leading treatment and research facility in Melbourne, were down 40%. “That is certainly going to bounce back at some point,” says Prof Sherene Loi, an oncologist and researcher at Peter MacCallum. “It is potentially going to be a real problem in a few years’ time. At the moment we have a lot of very young cancer diagnoses, a lot of breast cancer … we are just flat chat.” Read full Source: The Guardian, 13 February 2022
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News Article
Soaring trolley waits spark warnings A&E pressures getting ‘worse and worse’
Patient Safety Learning posted a news article in News
The number of 12-hour waits in accident and emergency departments rose by 27% in one month to reach record levels in January amid warnings overcrowding is harming an increasing number of patients. Official monthly performance data prompted the Royal College of Emergency Medicine’s president to warn that the problems facing emergency departments were getting “worse and worse”, while pointing out the real number of 12-hour A&E breaches is likely higher than official data records. The figures also revealed the waiting list had hit a new high of 6.1 million, while the number of two-year breaches also rose a record level. Trusts recorded 16,558 patients last month waited 12 hours or more in an emergency department from decision to admit to being discharged or admitted. This was up from 12,986 in December. RCEM president Katherine Henderson warned on Twitter: “This is [decision to admit] plus 12 – a concept which must be retired as a performance metric. We should have 0-12 hour data. You cannot fix a problem if you [are] unwilling to face up to what it actually is. We estimate reality is 20 x more. This is getting worse and worse.” Read full story (paywalled) Source: HSJ, 10 February 2022 -
News Article
NHS waiting-list backlog will take years to clear
Patient Safety Learning posted a news article in News
The waiting list for hospital treatment will not start falling for two years, ministers say, despite unveiling a plan to tackle England's backlog in care. Six million people are on a waiting list - one in nine of the population. But Health Secretary Sajid Javid said this number would probably increase, with demand expected to rise now Covid pressure was easing. He also set out plans to reduce waiting times for cancer treatment. These include a 28-day target for cancer diagnosis by March 2024, which should have been introduced last year but was delayed by the pandemic. The proportion of cancer patients starting treatment within 62 days would return to its pre-pandemic level by March 2023, Mr Javid said, although this would still leave it some way short of the 85% target.* Waiting times would be cut by a 30% rise in the NHS's capacity for treatment, he said. Crucial to this will be the establishment of a network of 160 community diagnostic centres along with surgical hubs focused on high-volume routine surgery away from major hospital sites - to increase efficiency and reduce the chance of emergency cases leading to cancellations. Extra investment of £8bn over the next three years, funded through a national-insurance rise, will pay for these new facilities. To free up staff time, follow-up appointments would be arranged on a case-by-case basis, rather than for all patients automatically, Mr Javid said. And a new online service, My Planned Care, will inform patients about waiting times and how to prepare for treatment. The plan would not just "reset" the NHS to where it had been before Covid, Mr Javid said, but build on what had been learned and make it "fit for the future". Read full story Source: BBC News, 8 February 2022 Delivery plan for tackling the COVID-19 backlog of elective care -
News Article
Only a third of children in need accessed mental health support in the pandemic
Patient Safety Learning posted a news article in News
The number of children experiencing mental health problems has risen sharply during the Covid-19 pandemic, but fewer have been able to access support because of disruptions to services, says a report by the Children’s Commissioner for England. Around one in nine children had a probable mental health disorder in 2017, the report says, but this jumped to one in six in 2021 with only around a third (32%) able to access treatment. While the number of children referred to mental health services by GPs and teachers has been growing in recent years, referral rates fell back in 2020-21 to 497 502 (equivalent to 4% of all children in England), compared with 539 000 (4.5% of children) the previous year. “It is likely that even though more children have mental health problems, fewer were being referred to services during lockdowns because of disruptions caused by the pandemic,” said children’s commissioner for England, Rachel de Souza. “Numbers referred into services are likely to increase again in the coming years. The health secretary will be publishing a review later this year to explore how we can tackle this increased level of need and adopt a more preventive approach.” Lynn Perry, interim co-chief executive of children’s charity Barnardo’s, said, “Covid-19 has taken a serious toll on children’s mental health and schools are the first place many of them seek help. Being able to reach this support early at school will reduce the number of children who need specialist help from mental health services. This is why Barnardo’s is calling on the government to speed up the rollout of mental health support teams to help pupils and teachers get the support they need, when they need it.” Read full story Source: BMJ, 7 February 2022 -
News Article
NHS England waiting times for cancer referral and treatment at record high
Patient Safety Learning posted a news article in News
The numbers of cancer patients facing delays in seeing a specialist for the first time and starting their treatment have hit record highs in England, amid fears that overstretched NHS services can no longer provide prompt care. The disclosure comes as a new row over how quickly hospitals can clear the record 6 million-strong NHS backlog has forced ministers to delay publication of the long-awaited plan to tackle it. Half a million people in England with suspected cancer will have to wait longer than the supposed two-week maximum to see an oncologist this year, an analysis for the House of Commons library reveals. The number of patients confirmed to have the disease who are unable to start treatment such as surgery or chemotherapy within the 31 or 62 days that hospitals try to guarantee is expected to exceed 75,000 for the first time. Experts, who claim significant shortages in the NHS cancer workforce are to blame, fear delays in getting diagnosed and starting care could reduce a patient’s chances of survival. Cancer charities highlighted the “unimaginable distress and anxiety” they induce in patients. “Cancer care is in crisis,” the shadow health secretary, Wes Streeting, said. “As this new analysis shows, terrifyingly large numbers of people are waiting longer than they should to receive vital cancer care and treatment with the insecurity of not knowing.” Read full story Source: The Guardian, 6 February 2022
