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News Article
The mystery of the capital’s ‘high-volume’ treatment centres
Patient Safety Learning posted a news article in News
Next Thursday we’ll see more waiting list data released. What is contained in it is probably why Sir David Sloman’s office has taken nearly a month to not answer this question: Your letter to system leaders said you would “eliminate” 52-week waits, by when? The regional director’s office could not answer, nor could it reveal which hospitals were going to be the high-volume centre to burn through the lists in the six major specialities. There are a couple of likely reasons for their not being able to say when the long waiters would be eliminated. NHSI/E’s phase three letter set “mad” targets that don’t feel very real to many on the ground. I/E central will know this and have their own reasons for setting stretching-to-the-point-of-snapping targets, but trusts don’t really want to be held to submitting impossible commitments then being chastised for missing them (management teams have been moved on for this kind of thing in less fraught times). The second reason is that the picture is likely to be scary and also to have an impact on the ongoing three-way negotiation between the NHS, the independent sector - which will be hosting a lot of this work - and the workforce that will actually do it in both places. There is even less transparency than usual from the regional director’s office and I/E generally when asked anything at all about how effectively private sector facilities are being used, or how much it is costing. Much more surprising is the fact that Sir David’s office cannot yet name where each of the ICS’s six high-volume centres will be. Read full story (paywalled) Source: HSJ, 1 October 2020 -
Community Post
Should patients be actively involved in following up their referrals?
Steve Turner posted a topic in Improving patient safety
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I've been posting advice to patients advising them to personally follow up on referrals. Good advice I believe, which could save lives. I'm interested in people's views on this. This is the message I'm sharing: **Important message for patients relating to clinical referrals in England** We need a specific effort to ensure ALL referrals are followed up. Some are getting 'lost'. I urge all patients to check your referral has been received, ensure your GP and the clinical team you have been referred to have the referral. Make sure you have a copy yourself too. Things are difficult and we accept there are waits. Having information on the progress of your referral, and an assurance that is is being clinically prioritised is vital. If patients are fully informed and assured of the progress of their referrals in real-time it could save time and effort in fielding enquiries and prevent them going missing or 'falling into a black hole', which is a reality for some people. It would also prevent clinical priorities being missed. Maybe this is happening, and patients are being kept fully informed in real-time of the progress of their referrals. It would be good to hear examples of best practice. -
Content ArticlePatient Safety Learning’s formal response to the Health and Social Care Committee inquiry report Delivering core NHS and care services during the pandemic and beyond, which calls for urgent action to assess and tackle a backlog of appointments and an unknown patient demand for all health services, specifically across cancer treatments, mental health services, dentistry services, GP services and elective surgery.
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Content ArticleIn March, the charity Breast Cancer Now asked people with breast cancer to tell us how coronavirus had affected their treatment and care. 580 people responded. Many reported that they or their loved ones had experienced delays or cancellations to treatment and monitoring scans. Others had not experienced any changes to their treatment. To understand how people’s experiences may have changed and try to better quantify some of the impacts, Breast Cancer Now ran a second survey between 9 July and 6 August. 2,124 people with breast cancer responded. They also spoke to 12 healthcare professionals from different parts of the breast cancer pathway including radiographers, surgeons, oncologists specialising in drug treatment and radiotherapy, and clinical nurse specialists. This was supplemented by data available on the impact of the pandemic, for example on referrals to see a specialist. This report sets out their findings and recommendations for what needs to happen next to tackle the challenges identified. The content is split into four sections: Diagnosis Treatment Clinical trials and research Care and support.
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News ArticlePeople awaiting a CT or MRI scan will be able to have one on the high street under NHS plans to improve access to diagnostic tests. NHS England plans to set up a network of new “one-stop shops” where patients will be able to have scans closer to home rather than having to go hospital. They are intended to reduce the risk of patients getting COVID-19 in hospital and speed up the time it takes to undergo diagnostic testing by having more capacity. NHS England’s governing board approved a plan on Thursday by Prof Sir Mike Richards to create “community diagnostic hubs across the country over the next few years”. It is part of a planned “radical overhaul” in the way patients access a range of diagnostic tests, screening appointments and other services. The hubs, which would open six days a week, may also perform blood tests, lung function checks and endoscopies, in which a camera is put down the throat. The new facilities would be sited in disused shops or in shopping centres. They are part of the NHS’s drive to make it easier for people to be tested without having to go to hospital, amid concern that reluctance to do so is part of the reason fewer people are undergoing cancer screening. It is already undertaking lung cancer tests in 10 mobile centres that are parked at supermarkets and shopping centres. Bigger hubs could also offer mammograms, eye health checks, scans for pregnant women, hearing tests and gynaecological services. Hospital bosses welcomed the plan, which they said should reduce waiting times. Miriam Deakin, the director of policy and strategy at NHS Providers, which represents NHS trusts, said: “Doing these checks in the community rather than in hospital could support trusts as they grapple with a second wave of Covid-19, winter pressures and tackling backlogs of care.” Read full story Source: The Guardian, 1 October 2020
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News ArticleAlmost one million women in the UK have missed vital breast screening due to coronavirus, a leading charity has estimated. Breast screening programmes were paused in March as the NHS focused resources on tackling the pandemic. Breast Cancer Now calculates that around 8,600 women who have not had a scan have undetected breast cancer. The scanning programme is running again, but social distancing measures have reduced capacity. Combined with the significant backlog of women waiting for a scan, and more women starting to come forward with concerns about possible symptoms, the charity warns the service is under intense pressure. Breast cancer diagnosed at a later stage can be harder to treat. Breast Cancer Now estimates that a total of 986,000 women across the UK missed their mammograms due to breast screening programmes being paused. The estimate is based on the average number of women screened per month, and the approximate length of time the screening programme was suspended, in each part of the UK. This breaks down to almost 838,000 women in England, 78,000 in Scotland, 48,000 in Wales and 23,000 in Northern Ireland. The charity is calling for an action plan and new resources to tackle the problem. Baroness Delyth Morgan, Breast Cancer Now chief executive, said: "That nearly one million women across the UK were caught up in the backlog waiting for breast screening is cause for grave concern. "Mammograms are a key tool in the early detection of breast cancer, which is critical to stopping women dying from the disease. "We understand that the breast screening programme was paused out of necessity due to the global Covid-19 pandemic, but we must now press play to ensure that all women can access breast screening, and we cannot afford for the programme to be paused again." Read full story Source: BBC News, 30 September 2020 Breast Cancer Now press release
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News Article
Leaked data gives first view of growing cancer waiting list post covid peak
Patient Safety Learning posted a news article in News
Official data from mid-September shows that nearly 6,400 people had waited more than 100 days following a referral to cancer services. The leaked data reveals for the first time the length of the cancer waiting list in the wake of the first pandemic peak, during which much diagnostic and elective cancer care was paused. The list consists of those waiting for a test, the outcome of a test, or for treatment. NHS England and Improvement only publish waiting times for patients who have been treated – not the number still waiting – so this information has been secret. The data, obtained from official emails seen by HSJ, showed the total number of people on the cancer waiting list grew substantially, from 50,000 to around 58,000, between the start of August and the middle of September. Of the 6,400 people recorded to be waiting more than 104 days on 13 September, 472 had a “decision to treat classification”, meaning they have cancer and are awaiting treatment. NHS England has said reducing the cancer waiting list would be overseen by a national “taskforce”, which is being chaired by national director for cancer Peter Johnson. Experts have warned the delays already stored up in the system could cost tens of thousands of lives as patients go undiagnosed or have their diagnosis and treatment later than they otherwise would. HSJ asked NHS England if harm reviews had been carried out for those on the waiting list and whether it had discovered if those waiting longer than104 days had been harmed, but did not receive an answer. Read full story (paywalled) Source: HSJ, 29 September 2020 -
News Article
Coronavirus: NHS faces pandemic 'triple whammy' this winter
Patient Safety Learning posted a news article in News
The NHS is facing a "triple whammy" of rising COVID-19 cases, a major backlog in treatment and reduced capacity due to infection-control measures, according to health bosses. The NHS Confederation report on the English NHS said more investment was desperately needed. The NHS bosses also called on ministers to be "honest and realistic" about waiting lists for treatment. It comes despite the government promising an extra £3bn this winter. That money - announced over the summer - was intended to help hospitals cope with the extra-infection control measures required and to pay for patients to be treated privately for routine treatment, such as knee and hip replacements. But hospitals are still performing only half the number of routine operations they normally would. Two million patients have already waited longer than 18 weeks for treatment, the highest number since records began, in 2007. And services in other areas, such as cancer care, are running at about three-quarters capacity. Of the more than 250 bosses who responded to the confederation's survey: fewer than one in 10 said the current level of funding allowed them to deliver safe and effective care nearly nine in 10 said a lack of funding would be a significant barrier to achieving waiting-time targets for everything from mental-health care to cancer treatment and routine operations. Read full story Source: BBC News, 29 September 2020 -
News ArticleMore than 1,500 breast cancer patients in UK face long waits to have reconstructive surgery after hospitals could not operate on them during the pandemic because they were tackling COVID-19. The women are facing delays of “many months, possibly years” because the NHS has such a big backlog of cases to get through, according to research by the charity Breast Cancer Now. When the lockdown began in March the NHS stopped performing breast reconstructions for women seeking one after a mastectomy as part of its wider suspension of care. That was because so many operating theatres were being used as overflow intensive care units and because doctors and hospital bosses feared that patients coming into hospital might catch Covid. The NHS started doing them again in July, but not everywhere and not in the same numbers as before. “We are deeply concerned by our finding that over 1,500 breast cancer patients may now face lengthy and extremely upsetting delays for reconstructive surgery,” said Delyth Morgan, the chief executive of Breast Cancer Now. “This will leave many women who want to have reconstruction with one breast, no breasts or asymmetric breasts for months, possibly even years.” Lady Morgan said: “Reconstructive surgery is an essential part of recovery after breast cancer for those who choose it. “Women with breast cancer have told us these delays are causing them huge anxiety, low self-esteem and damaged body confidence, and all at a time when the Covid-19 pandemic has denied them access to face to face support from healthcare professionals and charities.” Read full story Source: The Guardian, 18 September 2020
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Content ArticleThis is the first of a series of webinars Patient Safety Learning, Health Plus Care and BD are holding on patient safety on the frontline, exploring burning patient safety issues and engaging with frontline healthcare workers, clinical leaders and patient safety experts. COVID-19 has had a devastating impact on access to non-COVID care and treatment. We know there are over a million extra patients awaiting hospital treatment. The NHS has issued guidance for ‘accelerating the return to near-normal levels of non-COVID health services, making full use of the capacity available in the ‘window of opportunity’ between now and winter.’ In this webinar, the panel discusses these issues with frontline clinicians and patient safety experts.
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EventA record excess of four million people are now awaiting hospital treatment in England. This number includes more than 83,000 who have been waiting more than a year. On Thursday 17 September, RSM President Professor Roger Kirby will interview Professor Derek Alderson, immediate past President of the Royal College of Surgeons, Ben Challacombe, Consultant Urological Surgeon at Guy’s and St Thomas’ and Hannah Warren, Specialist Registrar at King’s College Hospital to discuss the impact of the COVID-19 pandemic on surgeons, surgery and surgical waiting lists. In addition, the panel will discuss whether the mass testing proposed by the Prime Minister in his “Operation Moonshot” initiative could help to resolve the situation. The webinar will include plenty of opportunities for questions. Registration
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Content ArticlePatient Safety Learning, Health Plus Care and BD are holding a series of webinars on patient safety on the frontline, exploring burning patient safety issues and engaging with frontline health care workers, clinical leaders and patient safety experts. The first of these webinars is at 11.00am (BST) on Wednesday 16 September: Responding to the treatment backlog safely. This blog sets out some of the key points to inform the webinar.
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News Article
Plans for 150 new diagnostic hubs to cut rising waits
Patient Safety Learning posted a news article in News
Plans for up to 150 new community diagnostic hubs to tackle the NHS’ ballooning diagnostic waiting lists are included in NHS England ‘blue print plans’ leaked to HSJ. The document pointed out the hubs “were highlighted in the phase 3 letter [from Sir Simon Stevens] and will be recommended as part of new service models for diagnostics in the forthcoming [Sir Mike] Richards’ Review of Diagnostics Capacity”. It said “at least 150 community diagnostic hubs should be established in the first instance (broadly equivalent to the number of acute hospitals)” although it appears many of these may be temporary facilities. The phase 3 letter said systems should mange the “immediate growth in people requiring cancer diagnosis and/or treatment returning to the service by… the development of community diagnostic hubs” among other measures The Richards review was commissioned by NHS England in 2019 as it had long been recognised that England has one of the lowest levels in Europe of diagnostic equipment as well as a shortage in facilities and staff. Last month think-tanks warned of significant worsening of cancer outcomes because of the backlog in diagnosis and treatment created by a fall in referrals during the pandemic..." Read full story (paywalled) Source: HSJ, 4 September 2020 -
News ArticleHospitals are not equipped to deal with the surge in screenings and tests as the health service restarts care – leaving patients facing delays in diagnosis and treatment for conditions including cancer, according to medical leaders. As the NHS tries to recover from the worst of the coronavirus crisis, more than a million laboratory samples from cancer screening services are expected in pathology labs, while as many as 850,000 delayed CT and MRI scans need to be carried out. But 97% of labs do not have enough pathologists to carry out the work – with staff already working unpaid hours to tackle the existing backlog – while the number of radiology posts nationally would need to be increased by a third to deal with the rise, experts say. Precautions to protect against the spread of coronavirus also limits the number of scans that can be carried out. The royal colleges of pathologists and radiologists warned that cancers would go undiagnosed and treatments for all patients across the NHS could be further delayed as a result. Read full story Source: The Independent, 27 August 2020
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News Article
Trust declares critical incident over ‘relentless demand’
Clive Flashman posted a news article in News
Gloucestershire Hospitals FT declares critical incident after ‘relentless demand’ on emergency care Pressure comes two months after trust downgraded one of its A&Es ‘Tired’ staff warned a ’Herculean effort’ is needed to reset emergency system NHS 111 cited as pinch point A trust has declared a critical incident after experiencing “relentless demand” on urgent and emergency care, months after downgrading one of its emergency departments. The internal critical incident was raised by Gloucestershire Hospitals Foundation Trust yesterday. An internal memo said the previous three days “have seen unprecedented demand fall on the Gloucestershire urgent and emergency care system”. Clinicians have been told that early discharges need to be identified on both its Cheltenham General and Gloucestershire Royal hospital sites, to try to free up bed-space, and that all non-essential meetings, besides those at executive level, should be cancelled. The incident comes after the trust decided in June to downgrade the A&E department at Cheltenham General to a minor injuries unit, operating from 8am to 8pm. Previously, the unit offered a full A&E service between 8am and 8pm, with a “nurse-led” minor injuries service outside these hours. The problems appear to be unrelated to covid-19, although infection control measures are known to have reduced capacity in many A&Es and wards. HSJ understands that local managers believe NHS 111, run by Care UK Health Care, has been a particular cause of the problems in recent days, because it has not been directing enough people to alternative services; as well as workforce pressures and the hot weather. Read full (paywalled) article here in the HSJ. -
Content ArticleResearch by the British Medical Association (BMA) concludes that over a million planned operations and treatments as well as over twenty thousand cancer treatments have been cancelled or delayed between April and the end of June this year because of the pandemic. The Association’s research also estimates that more than two and a half million first time outpatient appointments were cancelled during the same time period. This paper coincides with the BMA’s latest survey of 5,905 doctors in England and Wales, asking about the impact of the pandemic on their patients and their working lives. As part of the survey, they were asked if, within the last week, they had treated patients with conditions at a later stage (e.g. cancer, heart disease) than they would normally expect. A little over 40% said that they had. Behind this data are the scores of patients whose routine surgery or procedure has been put aside in the rush to reconfigure the NHS to cope with COVID-19. Even worse, doctors know there are those whose illnesses are far more serious than they were, some now beyond cure.
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News Article
The NHS’ approach to waiting list management needs urgent reform
Patient Safety Learning posted a news article in News
Waiting lists for treatment in 2019 were at record levels, with the proportion of patients waiting less than 18 weeks for treatment at its lowest level in a decade. Cancer waiting times were the worst on record, with 73% of trusts not meeting the 62-day cancer target. Waiting for diagnostic tests was at the highest level since 2008: 4.2% of patients were waiting over six weeks against a target of less than 1%. On 17 March 2020, NHS England and NHS Improvement asked trusts to postpone all non-urgent elective operations to free up as much inpatient and critical care capacity as possible. At this point, there were 4.43 million people on waiting lists for consultant-led elective treatment. It is imperative that we open a national debate on what the NHS can deliver in a resource-constrained environment. To translate into action, this must involve patients, clinicians, system and regional leaders, the public and politicians. Such a debate is long overdue: current methods for prioritising elective care, such as referral to treatment or the 62-day cancer standard, are no longer fit for purpose. Read full story (paywalled) Source: HSJ, 14 July 2020 -
News Article
NHS patients in England face longest waits on record for surgery and cancer care
Patient Safety Learning posted a news article in News
Far fewer people are having surgery or cancer treatment because COVID-19 has disrupted NHS services so dramatically, and those who do are facing the longest waits on record. NHS figures reveal huge falls in the number of patients who have been going into hospital for a range of vital care in England since the pandemic began in March, prompting fears that their health will have worsened because diseases and conditions went untreated. Patients have been unable to access a wide range of normal care since non-COVID-19 services were suspended in hospitals in March so the NHS could focus on treating the disease. Many patients were also afraid to go into hospital in case they became infected, which contributed to a fall in treatment volumes. Tim Gardner, a senior policy fellow at the Health Foundation thinktank, said: “The dramatic falls in people visiting A&E, urgent referrals for suspected cancer and routine hospital procedures during lockdown are all growing evidence that more people are going without the care they need for serious health conditions." “Early diagnosis and prompt treatment of cancer is crucial to saving lives, and delays in referrals and treatment during the pandemic are likely to mean more people are diagnosed later when their illness is further advanced and harder to treat.” Read full story Source: Guardian, 9 July 2020 -
Content ArticleThe scale of the challenge facing the NHS after the first wave of COVID-19 in England is only just coming to light. The NHS adapted at speed to redeploy staff, change estate configurations, reduce non-COVID-19 face-to-face appointments and redesign patient pathways. The deployment of the NHS physician workforce provides an insight into the NHS response. In the middle of May, 32% of Royal College of Physicians (RCP) members reported working in a clinical area that was different from their normal practice.By the start of June this had reduced by 10% to 22%, but that still means one-fifth of the workforce were working outside their usual area. This has knock-on effects for patients and the resumption of services. The RCP, in partnership with our specialist societies, has been working with NHS England to plan specialty-specific restart activity. This is based on different scenarios regarding specialty capacity across the country, and the impact of COVID-19 is being felt unevenly. Consultants in respiratory medicine and gastroenterology expect it to take 2 years to recover from the backlog created by COVID-19, while those in cardiology are expecting it to take 18–21 months. Providing accurate estimates and projections about what the next 12 months hold for the NHS is difficult, as we can’t be certain about whether there will be future outbreaks and waves of COVID-19. This report highlights just why it is so important that the government, the NHS and politicians openly discuss the significant unmet need in the patient population.
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News ArticleWaiting times for tests and treatment not related to COVID-19 are likely to increase significantly in the second half of 2020 because of the fallout from the pandemic, the head of NHS England has acknowledged. Giving evidence to the Commons health select committee on 30 June, NHS England’s chief executive Simon Stevens said that contrary to some commentary, the NHS’s overall waiting list actually dropped by over half a million people between February and April 2020 because fewer people were coming forward for treatment. But, he added, “As referrals return we expect that will go up significantly over the second half of the year.” Stevens said that there were 725 000 fewer elective admissions to NHS hospitals during March and April, but that number has begun to recover significantly. “As we speak, we think we’re now somewhere north of 55% of pre-covid-19 elective activity levels,” he said. He added that he hoped the NHS would return to around three quarters of normal activity levels by July or August. Stevens told MPs that the NHS would pursue a range of measures to increase capacity over the coming months, including extending the deal with the private sector to use its facilities, and repurposing some of the Nightingale hospitals for diagnostic testing. Read full story Source: BMJ, 1 July 2020
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News Article
It'll take four years for NHS to recover from COVID-19, health chiefs warn
Patient Safety Learning posted a news article in News
The NHS will not be able to get back to providing its full range of services for as long as four years because of the huge disruption caused by COVID-19, hospital bosses have warned. Patients will face much longer waits than usual for operations and diagnostic tests because hospitals’ drive to remain infection-free means they are closing beds, and surgeons’ need to wear protective clothing means they are carrying out fewer procedures than before the pandemic. In a stark admission of the complexity of reopening the NHS, a key health service leader has predicted that some hospitals will be able to provide only 40% of the care they previously delivered. Hospitals are under pressure from ministers and health charities to restart services as soon as possible for patients with conditions such as cancer, obesity and joint problems. But the chief executives of three NHS trusts in England have told the Observer that the “sheer complexity” of getting back to normal amid the lingering effects of COVID-19 means progress will be very slow. “It could be four years before waiting times get back to pre-Covid levels. We could see that. It’s certainly years, not months,” said Glen Burley, the group chief executive of Warwick hospital, George Eliot hospital in Nuneaton and County hospital in Hereford. Read full story Source: The Guardian, 27 June 2020 -
News Article
Cancer charities fear 18,000 extra deaths a year due to test delays
Patient Safety Learning posted a news article in News
Almost half a million people are waiting at least six weeks for tests which could diagnose cancer – up from just 30,000 before lockdown, new analysis shows. Ministers have been urged to urgently bring forward plans to tackle the backlog of patients waiting for care, with calls for weekly testing of staff to keep coronavirus infections off the wards. Cancer charities fear there will be an extra 18,000 deaths a year because those with symptoms are not receiving prompt diagnosis and treatment. Read full story (paywalled) Source: The Telegraph, 23 June 2020 -
News Article
Private provider’s contract suspended pending safety review
Patient Safety Learning posted a news article in News
An independent provider’s NHS contract has been suspended, and a harm review is to be carried out on patients who have faced a long wait. Kent and Medway Clinical Commissioning Group suspended DMC Healthcare’s contract to provide dermatology services in north Kent “to ensure patient safety” on Friday. It said it had showing some patients had been on waiting lists longer than they should have been. It is unable to say how many patients are likely to be involved in the harm review, but it is expected to focus on those who have waited longer than they should or where harm is suspected. Read full story (paywalled) Source: HSJ, 24 June 2020 -
News Article
10 million on NHS waiting lists by Christmas
Patient Safety Learning posted a news article in News
Leading clinicians have written to Boris Johnson warning the UK faces a "second health catastrophe" because so many non-Covid patients are missing out on treatment as a result of the pandemic. The letter warns that “lives are being put at risk” and that action is needed immediately. It comes as new figures show as many as one in six (10 million) people will be on the NHS waiting list by the end of the year. The letter, signed by ten specialists, including cancer doctors, patient safety experts, CQCs and medical negligence lawyers, states: “We are increasingly concerned about the impact, including avoidable harm and death caused by the continuing unavailability of urgent diagnostics and treatment for thousands of non-COVID patients. “The backlog of such cases is now significant and worsening. We implore the central and devolved Governments of the UK to take urgent strategic action, including in co-ordination and co-operation with each other, to prevent this becoming a second and perhaps even more serious health catastrophe arising from the pandemic in the UK.” The letter was also signed by barrister Theo Huckle QC, Professor John Fairclough of Swansea and Cardiff Met Universities, Nick Brown of Doughty Street Chambers and Helen Hughes, Chief Executive, Patient Safety Learning. Cases which have come to the attention of the signatories include Sherwin Hall, 27, a father of one from Leeds, who made 13 visits to hospital during the COVID-19 lockdown before getting a cancer diagnosis for the pain in his groin. He said of his case: “I am very angry at the way I have been treated due to COVID-19 and the delay on my cancer treatment and now I am fighting for my life. Read full story Source: Express, 21 June 2020 -
News Article
NHS England considers ‘mandated’ system-level waiting lists
Patient Safety Learning posted a news article in News
NHS trusts could be asked to create shared waiting lists for elective care under plans being considered by national leaders. HSJ understands that NHS England chief executive Sir Simon Stevens is to write to all NHS organisations early next month to lay out plans for phase three of the recovery from covid. The letter is expected to focus on the importance of working at a system level to get more services up and running. Senior NHS sources said the recovery plans are likely to include proposals for creating pooled system-level waiting lists between trusts, but there is still internal debate over the extent to which changes could effectively be mandated; for example, by attaching significant incentive funds. The move appears to be aimed at ensuring an “equitable level of care” across a patch. In a statement, NHSE said individual providers’ would ultimately still have responsibility and accountability for their waiting lists, even where this might be “supplemented” by system-wide arrangements. Read more Source: HSJ, 19 June 2020
