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News ArticleElective activity levels were significantly lower in January than were achieved before Christmas, according to provisional NHS data seen by HSJ. In the three weeks to 20 December, the NHS was reporting around 110,000 day cases and 18,000 ordinary admissions each week. But during January these totals dropped to around 85,000 day cases and 10,000 ordinary admissions per week. This equates to a reduction of 23% and 44%, respectively. Regions that were more severely impacted by the third wave of coronavirus saw steeper reductions as covid pressures forced staff working in routine care services to be redeployed. In London and the South East, day case activity reduced by around 40 per cent between the same periods, while ordinary admissions fell by around 57%. Data for the Christmas fortnight was discounted, as activity always falls dramatically in this period. However, the activity levels in January appear to be significantly higher than those reported in the first wave of coronavirus in the spring. Read full story (paywalled) Source: HSJ, 10 February 2021
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News Article
Urgent children’s ops routinely cancelled due to covid pressure
Patient Safety Learning posted a news article in News
Dozens and potentially hundreds of urgent operations for children have been cancelled during the third wave of the covid pandemic, HSJ can reveal. There are also concerns that national guidance for prioritising surgery “disadvantages” young people. Several well placed sources told HSJ that urgent operations for children have been delayed in recent weeks because of covid pressures. This is because of a combination of staff being diverted to help with adults sick with covid, and space in children’s facilities — including intensive care — being taken over for adult covid care, as well as other staff being absent due to covid. The royal college of surgeons has told HSJ that urgent children’s operations “are increasingly being cancelled around the country”. Dozens and potentially hundreds of children’s operations rated as priority two — those which are urgent and should be carried out within a month — have been cancelled and delayed in recent weeks in the capital, according to several well placed sources. This is alongside potentially thousands of priority three operations being cancelled, which are those needing to be carried out within three months. Read full story Source: HSJ, 31 January 2021 -
News Article
‘Catastrophic’ threat to cancer ops at England’s third largest hospital trust
Patient Safety Learning posted a news article in News
Cancer services at large hospital trust have been at ‘catastrophic’ risk of being overwhelmed, after two of its hospital sites had to suspend life-saving cancer surgeries in the last month due to COVID-19. In its latest board papers Mid and South Essex Foundation Trust rated the “cancellation of cancer elective activity” at its highest risk level of 25 – which based on their own risk-scoring key is “catastrophic”. It said the expected consequences at this risk level include “permanent disability or death, serious irreversible health effects” and an “unacceptable… quality of service”. The trust runs three general acute hospitals in the county. Its 2,000 plus beds make it the third largest trust in England after University Hospitals Birmingham FT and Leeds Teaching Hospitals. The same board papers, dated 28 January, said cancer surgery at Southend University Hospital, one of three hospital sites run by the trust, “ceased on 24 December”. At a second hospital site, Mid Essex Hospital covid “hit hard just before Christmas” and elective work was “dramatically impacted with short period of life and limb only carried out on site”. This meant all P2 cancer surgery — which requires treatment in less than four weeks — did not take place. Both hospital sites said they hoped the independent sector could help them restart cancer surgeries this month with a focus on “long waiting and clinical urgent patients”. It is not clear how much capacity the sector has to work through waiting lists and the board papers said “some of this capacity may be reduced” because of recent changes to a new national contract for the independent sector. Read full story (paywalled) Source: HSJ, 29 January 2021 -
News Article
Cancer operations down 800 in first two weeks of January
Patient Safety Learning posted a news article in News
There were 800 fewer cancer surgeries in the first two weeks of January than usually take place during the period, according to provisional data seen by HSJ. The bulk of this reduction came in London and the surrounding counties such as Essex, Bedfordshire, and Surrey. London and the south east have been severely hit by coronavirus pressures, causing widely reported mass cancellations of non-urgent elective surgery. However, the impact on cancer cases has, so far, been less clear. NHS England has insisted in the last week that urgent cancer cases should be given the same priority as coronavirus patients. Read full story (paywalled) Source: HSJ, 25 January 2021 -
Content ArticleGood patient communication is key, particularly when a patient is waiting for planned care or treatment. From referral by a primary care clinician through to discharge from secondary care – clear, accessible communication is vital throughout. The Elective Recovery Delivery Plan commits to providing better information and support to patients. As we begin to implement new, innovative ways of delivering healthcare, it is more important than ever that patients feel confident they are supported throughout their journey. Prolonged periods of industrial action and continuing pressures have inevitably had an impact on planned care. In this context, it is important that integrated care boards (ICBs) and providers do all they can to offer support to those affected by delays, including with patient communications. This guide sets out key communication principles to help providers deliver personalised, patient-centred communications. It includes considerations for communicating to patients about new models of care as well as helpful information and resources.
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News Article
Gender identity development service for children rated inadequate
Patient Safety Learning posted a news article in News
The UK’s main gender identity development service for children is leaving thousands of vulnerable young people at risk of self-harm as they wait years for their first appointment, according to a highly critical report. The Care Quality Commission (CQC) took immediate enforcement action against the Tavistock and Portman NHS foundation trust when it completed the inspection in November, which rated the service overall “inadequate” and highlighted overwhelming caseloads, deficient record-keeping and poor leadership. The commission, which heard from young people using the service, parents, carers and staff in the course of its inspection, told the trust that services and waiting times in the Gender Identity Development Services (GIDS) in both their London and Leeds clinics “must improve significantly”, demanding monthly updates on numbers on waiting lists and actions to reduce them. The service has faced major scrutiny in recent years, with some former staff and campaigners raising concerns about the “overdiagnosing” of gender dysphoria, the consequences of early medical interventions and the significant increase in referrals of girls questioning their gender identity. Read full story Source: The Guardian, 20 January 2021 -
News ArticleNearly a quarter of a million people have been waiting more than a year for operations and other hospital procedures, HSJ has learned. Official NHS England data for November, released on Thursday, showed 192,000 patients had been waiting for treatment for more than a year. However, figures leaked to HSJ of weekly data up to 3 January showed a steep increase to 223,000 patients — the highest reported so far throughout the COVID-19 pandemic and before. According to the leak, just under 4.2 million people are waiting for treatment, of which year-long waiters comprise 5.4%. The data also showed 175 patients across England had waited more than two years for treatment. In February, before the pandemic, 1,613 patients were waiting more than a year — meaning there has been a 138-fold increase. Read full story (paywalled) Source: HSJ, 15 January 2021
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News Article
Complex dental care 'threatened by NHS targets'
Patient Safety Learning posted a news article in News
Patients needing complex dental work might have to wait longer under new NHS targets, dentists warn. The British Dental Association (BDA) fears NHS England will impose penalties on practices that fail to reach 45% of their normal activity level, after negotiations broke down. And practices may have to prioritise routine check-ups over more time-consuming treatments. An NHS official said: "The NHS and the government are working to determine a safe and reasonable contractual arrangement with dentists, which recognises the constraints on practices and the need to maximise access for patients to see their dentist." The waiting list for NHS dentistry could reach eight million by New Year's Eve, according to the Association of Dental Groups. Dave Cottam, who chairs the BDA's General Dental Practice Committee, said: "This move will actively undermine patient care. "Ministers are instructing dentists to churn through routine appointments against the clock, rather than deal with a huge backlog of urgent cases. Dentists wanting to do the right thing by their patients will now be punished for it." Read full story Source: BBC News, 16 December 2020 -
News Article
Cancer waiting list has almost doubled, leak reveals
Patient Safety Learning posted a news article in News
The waiting list for cancer patients has almost doubled over the last seven months, according to internal NHS data which has never been made public. A slide set seen by HSJ suggests the total number of patients waiting for cancer treatment on the 62-day pathway has increased from around 90,000 in mid-May, to around 160,000 at the start of December. However, the data suggests the NHS has made good progress in treating patients waiting the longest. Read full story (paywalled) Source: HSJ, 15 December 2020 -
News ArticleNHS patients in rural areas of England face extra long waits for treatment, according to a study. The Nuffield Trust think-tank says urban areas benefited most from measures put in place to help the NHS cope with the coronavirus pandemic. Researchers found rural hospitals now faced an uphill challenge when it came to restoring services to normal. NHS England says that funding reflects the higher costs of delivering care in rural communities. The Nuffield Trust report says while the number of Covid cases in rural areas was lower than in big urban centres, the pandemic's impact on services has been much greater. It says the coronavirus crisis highlighted pre-existing problems facing rural trusts. For example, it can be hard to recruit and retain doctors and nurses who are willing to work in smaller hospitals, which means trusts rely more heavily on expensive agency staff to fill gaps in rotas. This, in turn, has a detrimental effect on the finances of hospital trusts which struggle to balance the books. In addition, rural trusts often have only a limited capacity to treat any extra patients as they are often already very busy. Read full story Source: BBC News, 11 December 2020
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News Article
Number of people on NHS waiting lists hits 12-year high
Patient Safety Learning posted a news article in News
At least 162,000 patients are waiting more than a year for routine NHS operations, the highest number for more than 12 years. Latest statistics from NHS England show 162,888 people were waiting over 52 weeks for hospital treatment in October this year. The total NHS waiting list for routine treatments at the end of October had reached 4.4 million with more than a third of patients waiting over 18 weeks – the NHS target for waiting times from referral to treatment. Earlier this year health think tanks had predicted the waiting list could hit 10 million, but NHS England said this had not come to pass because of the work of hospitals and NHS staff to keel waiting lists lower than they were last year. The median waiting time was just over 11 weeks, NHS England said Some experts have warned of hidden demand for NHS surgeries with many patients yet to be referred to treatment because of the covid pandemic. A spokesperson for NHS England, said: “Although Covid hospitalisations almost doubled during November, for every Covid inpatient the NHS treated, hospitals managed to treat five other inpatients for other health conditions. With cancer referrals and treatments now back above usual levels, our message remains that people should continue to come forward for care when they need it." Read full story Source: The Independent, 10 December 2020 -
News ArticleA woman has become blind after her monthly eye injections were delayed for four months during lockdown. Helen Jeremy, 73, said everything she enjoyed doing has "gone out of the window" after losing her eyesight. She has glaucoma and was diagnosed with age-related macular degeneration four years ago. Monthly injections controlled the condition and meant she could still drive and play the piano. However, her appointments were cancelled when the pandemic struck and her eyesight deteriorated. "I was panicking. It was terrifying. Because I'm a widow I'm on my own and it was awful," she said. "Suddenly my eyesight was basically gone. By the time of my next appointment I was told there was no point in going on with these injections because the damage had been done to the back of my eye." Thousands more people in Wales are at risk of "irreversible sight loss" because of treatment delays, RNIB Cymru warns. The Welsh Government said health boards are working to increase services. Read full story Source: BBC News, 27 November 2020
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News ArticleA transgender boy is taking NHS England to court over delays in accessing gender identity treatment. The 14-year-old, who was referred to the UK’s only youth gender identity clinic in October 2019, has been told he may have to wait at least another year to be seen. He said he was experiencing “fear and terror” while he waits for treatment. Young people are currently facing “extensive waits” to see a therapist, with the average delay being 18 months or more, according to the Good Law Project, which is representing the boy. The not-for-profit organisation said the health service was legally required to ensure patients referred to gender identity development services (GIDS) are seen within 18 weeks. Gender clinics for adults across the country have reported similar delays, with the Devon Partnership NHS Trust reporting “lengthy waiting times” while the Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust said patients were facing delays “in excess of 32 months” for an initial appointment and 62 months from referral to treatment. Trusts have blamed a surge in demand as well as reduced capacity, including staffing problems. The teenager involved in the case said in a statement: “The length of the NHS waiting list means the treatments which are essential for my well being are not available to me." “By the time I get to the top of the list it will be too late, and in the meantime I suffer the fear and terror that gender dysphoria causes, every day.” Read full story Source: The Independent, 23 November 2020
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Content ArticleIn this article, published by the Harvard Business Review, authors discuss how to safely tackle the backlog of elective surgeries, created by the initial wave of the pandemic. They highlight the significant role of human factors such as stress or fatigue, and suggest strategies to mitigate them.
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News Article
Top teaching trust blames surge in long A&E waits on covid measures
Patient Safety Learning posted a news article in News
A top teaching hospital has blamed covid measures for a dramatic rise in the number of trolley waits in its accident and emergency department. In October, 111 patients at Cambridge University Hospitals (CUH) Foundation Trust, which runs Addenbrooke’s Hospital, waited more than 12 hours for admission, despite the region’s relatively low covid rates. CUH recorded just nine 12-hour waits in September and 27 in August. It had no 12-hour waits in either June or July this year, and in October 2019, it had only one. The trust also had 761 patients who waited more than four hours from the decision to admit to admission last month, out of a total of 2,998 emergency admissions. CUH director of operations Holly Sutherland said: “We have had to reorganise the hospital to meet infection control requirements and to reduce the risk of covid-19 transmission. With limited side room availability due to the age of our facilities, this has reduced the number of beds in the hospital by around 100 and has impacted on patient flow from the emergency department." “We would like to apologise to anyone affected by this, and to reassure our patients that their safety is our utmost priority and we are doing everything we can to treat them as quickly as possible.” Read full story (paywalled) Source: HSJ, 18 November 2020 -
News Article
Labour demands new NHS investment as patients wait longer for surgery
Patient Safety Learning posted a news article in News
Labour is demanding new investment for the NHS as part of the government’s spending review next week, after analysis shows hundreds of thousands of patients are waiting for life-changing operations. The party’s shadow health secretary, Jonathan Ashworth, will challenge Matt Hancock in Parliament on today over the latest NHS data, which reveal almost 500,000 patients are waiting for surgery on their hips, knees and other bones. Last week, NHS England published new data showing more than 1.7 million people were waiting longer than the NHS target of 18-weeks for treatment. The target was last met in February 2016. An analysis of NHS England data reveal which specialities have been hardest hit by the growing backlog of operations, which has soared since the first wave of coronavirus caused widespread hospital cancellations earlier this year. There were 4.3 million patients on NHS waiting lists for hospital treatments in September. Labour said this included 477,250 waiting for trauma and orthopaedic surgery, with 252,247 patients waiting over 18 weeks. The next worst specialty was ophthalmology, which treats eye disorders, with 444,828 patients on waiting lists, 233,425 of whom have waited more than 18 weeks. There were six figure waiting lists over 18 weeks for other specialties including gynaecology, urology, general surgery, and ear, nose and throat patients. Read full story Source: 17 November 2020 -
Content ArticleNew analysis by the Health Foundation shows there were 4.7 million fewer people referred for routine hospital care – for things like hip, knee and cataract surgery – between January and August 2020 compared to the same period in 2019, representing a potential hidden backlog of unmet care needs. The research highlights the scale of the challenge facing the NHS as it looks to resume services following the disruption caused by the first wave of COVID-19. The number of patients in hospital with COVID-19 is growing as we head into winter, a time when the NHS always experiences greater pressures from flu and other seasonal illnesses. If the virus is not controlled and emergency pressures surge, even more routine treatment will need to be postponed which will only add to the challenge of recovering from the pandemic.
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News ArticleThe number of people waiting over a year for hospital treatment in England has hit its highest levels since 2008. Patients are meant to be seen within 18 weeks - but nearly 140,000 of the 4.35 million on the waiting list at the end of September had waited over a year. Surgeons said it was "tragic" patients were being left in pain while they waited for treatment, including knee and hip operations. And others warned the situation could become even worse during winter. In recent weeks, major hospitals in Bradford, Leeds, Nottingham, Birmingham and Liverpool, which have seen high rates of infection, have announced the mass cancellation of non-urgent work. Read full story Source: BBC News, 12 November 2020
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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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News Article
Fears of 'two-tier' system as NHS waiting lists prompt more people to go private
Patient Safety Learning posted a news article in News
Concerns are growing that long NHS waiting times caused by the coronavirus crisis are exacerbating pre-existing health inequalities and creating a “two-tier” system, as more people turn to the private sector for quicker treatment. As leading doctors warn mass cancellations of NHS operations in England are inevitable this winter after waiting times reached the highest levels on record this summer, data shows a rise in the number of people self-funding treatment or investing in private health insurance. “COVID-19 has not impacted everyone equally, and there is clearly a risk that the backlog in routine hospital treatment is going to add to those inequalities if some people are able to get treatment faster because they’re able to pay,” said Tim Gardner, from the Health Foundation thinktank. As the NHS heads into winter and a growing second wave of the virus, experts stressed the need to help those affected by the backlog now. “There is a need to prioritise the most urgent cases, but simply because someone’s case isn’t urgent doesn’t mean it’s not important. It doesn’t mean that people aren’t waiting in pain and discomfort, or waiting anxiously for a diagnosis,” said Gardner. “We think it’s incumbent on the health service to make the best possible use of the capacity it’s got. But also it needs to make sure it’s supporting people while they’re waiting. We just can’t have people left in limbo.” Read full story Source: The Guardian, 27 October 2020 -
Content ArticleDr Kathryn Leask outlines steps GPs can take to try and avoid patients coming to harm as a result of delayed referrals and provides advice on dealing with patient complaints on this issue. There are some steps GPs can take to try to avoid patients coming to harm while putting themselves in the best position to address the potential medico-legal ramifications. In their guidance on Delegation and referral the GMC says that you are not accountable for the actions or omissions of colleagues to whom you make referrals. However, you are accountable for your decisions to transfer care and the steps you have taken to make sure that patient safety is not compromised. If you are aware that there are delays for a particular service and your patient is likely to be affected by this, you should make this clear to them and manage their expectations from the outset. In this GP Online article, Kathryn gives practical tips for GPs and shares a case example.
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News ArticleAt the age of 49, Sarah Fisher feels her life is on a knife-edge. She had a heart attack during lockdown and has subsequently been diagnosed with heart failure. In July, she was told she needed to have an implantable cardioverter defibrillator (ICD) fitted, which can shock the heart back into rhythm when it detects a potential cardiac arrest. But 12 weeks on, she is still waiting. "I could have a cardiac arrest at any point," Sarah says. "It is awful not knowing what is going to happen. "I am on the urgent list – but the infection rates are rising and the clinics are closing." "I don't know when I will get it. "There are so many people in my position – we don't have Covid but our lives are at risk too. We are the forgotten victims of this pandemic." British Heart Foundation analysis of Office for National Statistics data for England and Wales found almost 800 extra deaths from heart disease among under-65s from March to July - 15% more than would be expected. The rate of death was highest during the full lockdown - but, worryingly, the trend continued afterwards. The charity blames delays in people seeking care, as well as reduced access to routine tests and treatments. And NHS England figures show a sharp rise in the numbers waiting over six weeks for a whole range of key tests, including echocardiograms for hearts. Read full story Source: BBC News, 15 October 2020
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Content Article
NHS e-Review platform
Patient Safety Learning posted an article in Regulatory bodies/standards/guidance
A national bespoke system, called NHS e-Review, has been developed and launched as part of the NHS Covid Incident Recovery programme. The online system has been developed to support clinicians record the clinical priority of patients on a waiting list and to identify alternative pathways for patients if required. -
News ArticleThe numbers waiting over a year for hospital treatment have hit a 12-year high in England as hospitals struggle to get services back to normal. Nearly 2m patients have been waiting more than the target time of 18 weeks for routine care with 111,000 left for over a year, NHS England figures show. The numbers starting cancer treatment and getting urgent checks are also below the levels seen a year ago. But NHS England said "progress" was being made. It pointed out more patients were starting to be seen - although there are now warnings service may have to be cut back on again as admissions for Covid continue to rise. About 500 patients a day are being admitted to hospital with the disease - double the number two weeks ago. Health Secretary Matt Hancock said the UK was in a "perilous" position and the ability of the NHS to see non-Covid patients was under threat. Health minister Nadine Dorries predicted within 10 days hospitals would be a "critical" point. Read full story Source: BBC News, 8 October 2020
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News ArticleThere could be a "tsunami" of cancelled operations this winter as the NHS copes with rising numbers of coronavirus patients, leading surgeons are warning. Members of the Royal College of Surgeons of England say they doubt the NHS can meet targets to restore surgery back to near pre-pandemic levels. Planned procedures such as hip replacements were paused to free up beds during lockdown in the spring. And hospitals have since been dealing with a backlog. In July, NHS England boss Sir Simon Stevens told trusts hospitals should by September 2020 be performing at least 80% of their September 2019 rates of: overnight planned procedures outpatient or day-case procedures And by October, this proportion should rise to 90%. But data suggests more than two million people have been waiting longer than 18 weeks for routine operations, with 83,000 waiting more than a year - up from 2,000 before the pandemic. Read full story Source: BBC News, 6 October 2020
