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Found 798 results
  1. Content Article
    Patient initiated follow up and remote clinical reviews show promise in alleviating capacity issues and ensuring timely care, with positive patient feedback and early intervention benefits Media interest regularly reports on the three headline performance measures of the NHS; 18-week target, cancer wait targets, and four hour waits in emergency departments. There is, however, another large group of patients that we do not have any targets for and receive no media attention, who Peter Towers, NHS service manager, has termed the “fourth group”. These are the patients who have started their treatment but cannot be discharged back to primary care as they require continued secondary outpatient care.
  2. Content Article
    NHS colleagues are working hard to restore elective care, but data shows that activity for children and young people (CYP) is still below pre-pandemic levels and recovery remains behind rates seen in adult services. The specialties of ENT, dental services, ophthalmology, urology, and trauma and orthopaedics (including spinal surgery) are especially challenged, with the longest waiting lists for surgery for young patients. Getting It Right First Time (GIRFT) has supported NHS England’s drive for CYP elective recovery by developing concise guidance –Closing the gap: Actions to reduce waiting times for children and young people – offering ten actions which can help reduce waiting times for children, as well as quick links to data, resources and best practice case studies. The ten actions address how to improve theatre capacity, increase theatre utilisation and streamline pathways of care, and include practical measure such as adding extra sessions or ‘super events’ for children’s surgery, avoiding procedures of limited medical benefit by using clinical decision tools, and staggering children’s admission times. The guidance links to a series of case studies demonstrating how teams across England have taken innovative measures to address their waiting times.
  3. Content Article
    The Care Quality Commission (CQC) State of Care is an annual assessment of health care and social care in England. The report looks at the trends, shares examples of good and outstanding care, and highlights where care needs to improve.
  4. Content Article
    Urgent funding is required to clear waiting list backlogs and drive Northern Ireland's long-term healthcare transformation, the Northern Ireland Audit Office has said in a new report which outlines the health service's "critical situation" after almost a decade of worsening waiting lists for elective care. The NI Audit Office looked at waiting list data from 2014 to 2023. It found the number of patients waiting for elective care has risen by 452,000 during that nine-year period. The Audit Office also said: "Available information suggests waiting list performance levels are significantly worse in Northern Ireland compared with the other UK regions."
  5. News Article
    The boss of a large acute trust has accused a private provider of ‘overpromising and underdelivering’ after significant problems emerged with a local arrangement which have piled further pressure on its waiting list. Mid and South Essex Foundation Trust recently discovered at least 1,000 cases were being returned to the trust from independent provider Omnes Healthcare following “complications” with a pathway for ear, nose and throat patients. CEO Matthew Hopkins told a board meeting last Thursday: “I think other parts of the country, like us, are seeing independent sector providers in some cases overpromising and underdelivering. The consequence of that is what we’ve seen in the ENT example.” The contract is managed by Mid and South Essex Integrated Care Board, which told HSJ it was “very sorry that some patients may have been waiting longer than they should have been” because of the problems. Read full story (paywalled) Source: HSJ, 6 October 2023
  6. News Article
    The mother of a four-year-old boy with complex needs said she fears he could die waiting for life-changing surgery. Collette Mullan made the claim to BBC Spotlight as it examined the scale of hospital waiting lists. Northern Ireland has the worst waiting times in the UK, with more than half a million cases queued for an outpatient or inpatient appointment. The Department of Health has described current waiting lists as "entirely unacceptable". Óisín, from County Londonderry, has a number of health conditions including cerebral palsy, and is currently waiting for two procedures. He is fed with a tube that carries his food through his nose into his stomach, but since it was inserted six months ago, his mum Collette said he has struggled to breathe. Óisín is now waiting to have the nasogastric tube removed and replaced by a different feeding system which goes directly to his stomach. Collette said she was told it could be a three-year wait for the procedure. She is concerned that Óisín's cerebral palsy puts him at a greater risk of complications, saying she had been warned there was a danger he could aspirate. "He could die. Anything going into his lung really, it could be very dangerous," she said. Read full story Source: BBC News, 3 October 2023
  7. News Article
    Women have faced delays in giving birth due to the ongoing strikes, a major trust’s chief executive has said. Matthew Hopkins, who joined Mid and South Essex Foundation Trust last month, told a board meeting on Thursday that industrial action was having a “significant and growing” impact on patients. He added that this extended beyond delays to outpatient appointments and elective operations, saying: “It is also delaying mums giving birth, because we are seeing delays now in being able to conduct our elective Caesarian sections.” Mr Hopkins said the impact was also “really significant” on staff, with those covering for colleagues “very, very tired”. “It is important we give a very clear message to the two sides of the argument – government and the [British Medical Association] – that we need a light at the end of the tunnel, and staff need a light at the end of the tunnel. “Going into winter, with this continuing disruption for our patients and our staff, is in my view unacceptable.” Read full story (paywalled) Source: HSJ, 28 September 2023
  8. Content Article
    Recent polling from Healthwatch England shows that a fifth of patients referred by a GP for consultant-led care end up in a ‘referral black hole’, with more than two million patients each year having to make four or more visits to their GP before a referral is accepted. The result is that tens of thousands of patients could be on a ‘hidden’ waiting list, meaning that GPs are managing greater clinical risk and a greater number of patients whose conditions are often worsening in primary care, whilst communication between providers and access to diagnostics are often not up to scratch.  This report by the think tank Policy Exchange looks at reforms that could be made to the interface between primary and secondary care in order to improve care and prevent patient harm. It considers how improved flows of information and expertise can: better support growing demand in general practice reduce unwarranted variation in service provision enhance care coordination – particularly for those referred for elective procedures enable opportunities to boost generalist medical skills for a new generation of doctors create opportunities for hospital specialists to deliver a greater proportion of care in primary or community care settings, reducing waiting times and the use of more expensive settings for care.
  9. News Article
    Rishi Sunak’s pledge to cut the NHS waiting list backlog is being threatened by the crumbling concrete crisis as affected hospitals warn they will be forced to shut wards and theatres. Hospitals were told they had buildings prone to collapse in 2019 but four years later they are still dealing with the issue. In a report last year, West Suffolk NHS Foundation Trust leaders said that work to replace reinforced autoclaved aerated concrete (Raac) in its hospitals would hit general surgery, urology, gynaecology and orthopaedic care. Wards have had to close, piling pressure on a crowded A&E as patients can’t be offloaded due to lack of beds, and threatening its ability to hit government targets to reduce waiting lists, it added. The warning comes as Sir Keir Starmer used Prime Minister’s Questions to attack Mr Sunak over the crisis. He argued that “the cowboys are running the country” and asked the PM if he was “ashamed” of the scandal caused by 13 years of “botched jobs”. Read full story Source: The Independent, 6 September 2023
  10. Content Article
    In 2011, the government acknowledged a large treatment gap for people with mental health conditions and sought to establish ‘parity of esteem’ between mental and physical health services. From 2016, the Department of Health & Social Care (DHSC) and NHS England made specific commitments to improve and expand NHS-funded mental health services. NHSE, working with the Department and other national health bodies, set up and led a national improvement programme to deliver these commitments. This report by the House of Commons Public Accounts Committee assesses progress made in delivering these commitments. The report acknowledges that NHS England has made progress in improving and expanding mental health services, but says this was "from a low base."
  11. News Article
    More than 120,000 died waiting for NHS treatment, as backlog hits all-time high. The number of NHS patients dying while waiting for treatment has doubled in five years, new figures suggest. More than 120,000 people died while on waiting lists last year, according to an analysis of health service data. The total is even higher than it was in lockdown, with health leaders saying the pandemic and NHS strikes have made clearing backlogs more difficult. Matthew Taylor, the chief executive of the NHS Confederation, said: “These figures are a stark reminder about the potential repercussions of long waits for care. They are heartbreaking for the families who will have lost loved ones and deeply dismaying for NHS leaders, who continue to do all they can in extremely difficult circumstances." “Covid will have had an impact on these figures – but we can’t get away from the fact that a decade of under-investment in the NHS has left it with not enough staff, beds and vital equipment, as well as a crumbling estate in urgent need of repair and investment.” Read full story (paywalled) Source: The Telegraph, 31 August 2023
  12. Content Article
    In February 2022, NHS England published its Delivery Plan for Tackling the Covid-19 Backlog of Elective Care, aiming for an unprecedented 30% rise in elective activity by 2024-25. In an effort to cut waiting times and the number of people waiting for first appointments, the plan set an improbably ambitious target of reducing follow-up outpatient visits by 25% by March 2023 from 2019-20, to leave more capacity for first appointments. All first appointment waits of over 52 weeks were to be abolished by 2025. In this BMJ opinion piece, David Oliver looks at why the targets are unlikely to be met.
  13. News Article
    More than 120,000 people in England died last year while on the NHS waiting list for hospital treatment, figures obtained by Labour appear to show. That would be a record high number of such deaths, and is double the 60,000 patients who died in 2017/18. For example, the Royal Free hospital in London said it had had 3,615 such deaths, while there were 2,888 at the Morecambe Bay trust in Cumbria and 2,039 at Leeds teaching hospitals trust. Hospital bosses said the deaths highlighted the dangers of patients having to endure long waits for care and reflected a “decade of underinvestment” that had left the NHS with too few staff and beds. Healthwatch England, a patient advocacy group that scrutinises NHS performance, said the number of people dying while waiting for care was “a national tragedy”. Louise Ansari, the chief executive, said: “We know that delays to care have significant impacts on people’s lives, putting many in danger.” Read full story Source: The Guardian, 31 August 2023
  14. News Article
    The number of appointments and treatments postponed by strike action in the NHS in England is nearing one million. The 48-hour walkout by consultants in England last week saw more than 45,000 appointments being cancelled. It brings the total number of postponed hospital appointments since industrial action began in the NHS in December to 885,000. Once mental health and community bookings are included, it tops 944,000. The true total is likely to be even higher, as services have stopped scheduling appointments on strike days and these will not be included in the figures released by NHS England. Alongside consultants, junior doctors, nurses, physios, ambulance workers and radiographers have also walked out at various stages. NHS national medical director Professor Sir Stephen Powis said: "Industrial action continues to have a huge impact on the NHS, and on the lives of patients and their families. This strike took place into a bank holiday weekend, when NHS activity is generally lighter, but many services have for some time avoided scheduling any planned appointments for strike days in order to prioritise emergencies. This means the true impact of this action will be even higher, and as we move into September, the extraordinary cumulative effect of more than nine months of disruption poses a huge challenge for the health service, as staff work tirelessly to tackle the backlog." Read full story Source: BBC News, 29 August 2023
  15. Content Article
    Even those at the top admit the NHS can’t do what is being asked of it today. But it is far from unsalvageable – we just need serious politicians who will commit to funding it, writes Gavin Francis, who shares his experience as a GP in this Guardian long read.
  16. News Article
    Criminal acts of violence at GP surgeries across the UK have almost doubled in five years, new figures reveal, as doctors’ leaders warn of a perfect storm of soaring demand and staff shortages. Police are now recording an average of three violent incidents at general practices every day. Staff are facing unprecedented assaults, abuse and aggression by patients, with surgeries struggling to cope with “unmanageable levels of demand” after years of failure to recruit or retain sufficient numbers of family doctors. Security measures such as CCTV, panic buttons and screens at reception are now increasingly being rolled out across GP surgeries, the Guardian has learned, with senior medics claiming ministers perpetuate a myth that services are “closed”. Last night, Britain’s two most senior doctors condemned the wave of violence and called for urgent action to finally resolve the workforce crisis. “It is unacceptable that GPs and their staff are afraid and at risk of being verbally or physically abused, when they are working amid exceptional pressures and striving to do their best for patients,” said Dr Chaand Nagpaul, chair of the British Medical Association. “GP practices are facing unmanageable levels of demand with 2,000 fewer GPs than in 2015.” He added it was “no surprise” that patients were struggling to get appointments because of the national “lack of capacity” and “lack of historic investment in general practice”. Read full story Source: The Guardian, 31 May 2022
  17. News Article
    It may take seven years to get NHS Wales waiting lists of 700,000 back to 2020 levels, Wales' auditor general has said. The number of patients waiting for non-urgent treatment has doubled since February 2020, just prior to the Covid pandemic. They include Patient Michael Assender, 74, who has spent two years on a waiting list with severe back pain. After struggling with his back, Mr Assender, from Cwmbran, Torfaen, paid £1,500 for a private scan, which revealed he had two slipped discs. "At the moment I'm coping pretty well, taking pills for the pain and trying to stay active," he said. "But something that took me half hour before now takes an hour." Mr Assender said he knew others waiting for surgery who had become depressed and considered taking their lives, adding: "A lot of people out there are in a constant pain and I do pity them." "It's a dire situation really." The Welsh government said it had a plan to deal with backlogs. But Wales' Auditor General Adrian Crompton said: "Just as the NHS rose to the challenge of the pandemic, it will need to rise to the challenge of tackling a waiting list which has grown to huge proportions." "Concerted action is going to be needed on many different fronts, and some long-standing challenges will need to be overcome." Read full story Source: BBC News, 31 May 2022
  18. News Article
    Dozens of patients died or suffered ‘severe harm’ after long waits for ambulances during a three-month period in a health system facing ‘extreme pressure’ on its emergency services. The 29 serious incidents in Cornwall included patients waiting many hours for assistance despite being in “extreme pain”, patients having suspected sepsis, patients in cardiac arrest, and patients experiencing a stroke. The incidents were reported to the Care Quality Commission by staff at South Western Ambulance Service Foundation Trust during an inspection of the Cornwall integrated care system’s urgent and emergency care services. According to the CQC, the pressures on the ambulance service were “unrelenting”, while “significant work” was needed to “alleviate extreme pressure”. This meant there was a “high level of risk to people’s health when trying to access urgent and emergency care in the county”, the report said. Read full story (paywalled) Source: HSJ, 27 May 2022
  19. News Article
    Waiting times for outpatient appointments, hospital procedures, emergency care, GPs and community health services have all hit record levels in Northern Ireland, with health care staff and patients declaring it the "worst ever" crisis to hit health services in the region. The impact of the COVID-19 pandemic, ever-growing patient demand, staff shortages, and the failure to put together a new Executive government following the recent Northern Ireland elections are being cited as the key drivers of the crisis, with health care staff now at breaking point. Speaking to Medscape UK, British Medical Association Northern Ireland (BMA NI) council chair Dr Tom Black said the current crisis in Northern Ireland's health services essentially boils down to "workload and workforce" issues. Waiting lists to access hospital appointments in Northern Ireland were already long before COVID-19, but the pandemic has significantly exacerbated the situation, he noted. Northern Ireland has the worst waiting lists in the UK, with more than 350,000 people currently waiting for a consultant-led appointment – more than half of them waiting over a year, with many waiting two, three, and even more years for an appointment. "We're now heading towards nearly 400,000 on hospital waiting lists, which is a huge number when you consider that is one-in-five of the total population," Dr Black commented. This week a judicial review is due to get underway at the High Court in Belfast after two patients initiated a legal case against the health services over excessive waiting times for access to care. One of the women has been waiting over five years to see a neurologist after being referred by her GP for suspected multiple sclerosis. The case is seeking a judicial declaration that the length of the waiting lists are unlawful and breached their human rights. Read full story Source: Medscape UK, 24 May 2022
  20. News Article
    A struggling ambulance trust could face a ‘Titanic moment’ and collapse entirely this summer if the region’s worsening problems with hospital handover delays are not taken more seriously, its nursing director has told HSJ. Mark Docherty, of West Midlands Ambulance Service (WMAS), said patients were “dying every day” from avoidable causes created by ambulance delays and that he could not understand why NHS England and the Care Quality Commission were “not all over” the issue. He revealed that handover delays at the region’s hospitals were the worst ever recorded, that rising numbers of people were waiting in the back of ambulances for 24 hours, and that serious incidents have quadrupled in the past year, largely due to severe delays. More than 100 serious incidents recorded at WMAS relate to patient deaths where the service has been unable to respond because its ambulances are held outside hospitals, according to the minutes of the trust’s March quality and safety committee. "Around 17 August is the day I think it will all fail,” he said. “I’ve been asked how I can be so specific, but that date is when a third of our resource [will be] lost to delays, and that will mean we just can’t respond. Mathematically it will be a bit like a Titanic moment. ”It will be a mathematical certain that this thing is sinking, and it will be pretty much beyond the tipping point by then.” Read full story (paywalled) Source: HSJ, 25 May 2022
  21. News Article
    Hundreds of thousands of patients referred to specialists by their GPs are being rejected by hospitals and left to deteriorate because there are no appointments available. NHS waiting lists are already buckling under record-high backlogs and now delays are being compounded as local doctors struggle to even get their patients to outpatient services. Patients’ referrals are rejected by hospital trusts if there are no appointment slots available, meaning they get bounced back to the GP who is unable to help with their complex needs, leaving them without the care they desperately need. Clare Rayner, 54, from Manchester, has been left distraught by delays which have hampered the treatment she needs for complex spinal problems. She is still waiting to find out if an upcoming appointment with a neurologist is going ahead after a request for an urgent review from her GP was ignored five times. Outpatient referrals are typically classed as having an “appointment slot issue” (ASI) when no booking slot is available within a specific time frame, under the NHS e-Referral system. According to experts, the situation varies between specialities, but is reportedly particularly bad in areas such as mental health and neurology. Ms Rayner, a former medical teacher who had to retire because of ill health, said: “I’ve been sent all around the country for neurosurgery over the last few years so have been directly affected by being bounced back to my GP." “A unit in London rejected me because they said I lived too far away, which was ridiculous as they take people from all over the UK, and a local consultant just never replied to my GP’s email. Ms Rayner said she has endured “massive delays” to her care which had left her intensely frustrated. “It’s left me with significant deterioration with my spinal problems and that’s been very distressing,” she said. Helen Hughes, chief executive of charity and campaign group Patient Safety Learning, said: “NHS England needs to urgently investigate, quantify the scale of the problem and take action if we are to prevent these capacity problems resulting in avoidable harm for patients.” A target for providers to reduce ASIs to a rate of 4% or less of their total outpatient activity was set by NHS England in 2019. Guidance in subsequent years has seen a move towards the requirement for providers to implement “innovative pathways” to support prevention of ill health. Read full story Source: iNews, 22 May 2022 Related blogs on the hub: Rejected outpatient referrals are putting patients at risk and increasing workload pressure on GPs A child left waiting for ‘urgent’ surgery, a blog by Clare Rayner
  22. News Article
    More than one in five patients at some hospitals are leaving accident and emergency departments before completing treatment, and in some cases before being seen for assessment at all, with the rate across England trebling since before the pandemic. Experts told the Observer that the increase was probably driven by a combination of long A&E waiting times and by difficulties accessing NHS facilities such as GPs, community health services and NHS 111. The figures apply to patients who left A&E before an initial assessment; after an assessment but before treatment started; or before treatment was completed. They include patients who left to find treatment elsewhere. David Maguire, a senior analyst with the King’s Fund health thinktank, linked the rise to patients having difficulty accessing other parts of the NHS and going to A&E instead. “We’re probably talking about things that won’t require an admission, but it’s important that you get seen by someone,” he said. “So for example, somebody’s got a chest pain, somebody’s got some sort of adverse indication that you would want to seek attention for. It’s a perfectly rational thing to do. But it’s a struggle to access at other points [in the NHS], so you default towards A&E.” He added that staff shortages and social care capacity were also contributing factors. “I think it’s a lot of the NHS not functioning properly. Pre-pandemic, there was a certain amount of flex in the system – even with the problems that we were seeing around performance – that meant you could come to A&E with some of these issues. That flex in the system has gone – the capacity has been absorbed by other issues.” Read full story Source: The Observer, 21 May 2022
  23. News Article
    The NHS will miss its target to return cancer treatment waits to pre-covid levels by next March, a national cancer leader has said. When asked at the HSJ Cancer Forum whether the service would be back to “business as usual” performance by next spring, Liz Bishop, who sits on NHS England’s national cancer board, said: “I think it depends on what you mean by ‘business as usual’. “If you mean hitting the 62-day numbers, and the 104-day numbers, by next March, then no. If I am honest, I don’t think we will. “Do I know when that date will be? No, I don’t know. But what I do know is that everyone is working really hard to do it and get there.” NHSE initially said the number of patients waiting longer than 62 days for treatment following an urgent referral would return to pre-pandemic levels by March this year, but has since pushed this back to March 2023. Read full story (paywalled) Source: HSJ, 18 March 2022
  24. News Article
    Nearly 600 patients waited 10 hours or more in the back of an ambulance to be transferred into emergency departments last month – with one taking 24 hours, HSJ can reveal. The 24-hour wait was the longest handover delay recorded in the past year, and probably ever, according to information released by ambulance trust chief executives. In May last year the longest recorded rate was seven hours. This has risen steadily during the year to hit 24 hours in April. In March a patient in the West Midlands had to wait 23 hours. The figures also show 11,000 patients waited more than three hours for handover last month, with 7,000 of them taking more than four hours and 4,000 over five hours. Some 599 waited more than 10 hours. The Association of Ambulance Chief Executives estimates 35,000 patients were potentially at risk of harm from delayed handovers last month, with just under 4,000 of those risking severe harm. This is based on work it did looking at patients waiting more than 60 minutes in 2021 and was a slight fall on March. They are based only on handover delays and do not include harm from patients left waiting for an ambulance response. Hours lost to ambulance handover delays restrict ambulance trusts’ ability to reach other patients waiting for an ambulance in the community. Read full story (paywalled) Source: HSJ, 16 May 2022
  25. News Article
    Tens of thousands of emergency calls are taking more than two minutes to be answered in England amid a crisis in the ambulance service, The Independent has learned. More than 37,000 emergency calls took more than two minutes to answer in April 2022 – 24 times the 1,500 that took that long in April 2021, according to a leaked staff message. April’s figures were slightly down compared to March, The Independent understands, when 44,000 calls took more than two minutes to answer. The deterioration in 999 calls being answered within the 60-second goal comes as ambulance services across the UK have been placed under huge pressures. The latest NHS data showed long delays in response times for ambulance services with stroke or suspected heart attack patients waiting more than 50 minutes on average. Response times are being driven by ambulances being held up outside of A&Es because emergency departments are unable to take patients. In March, there were likely to have been more than 4,000 instances of severe harm caused to patients as a result of ambulances being delayed by more than 60 minutes. Martin Flaherty, managing director of AACE said: “It is no secret that UK ambulance services and their staff are under intense pressure, which is further evidence of the need to secure more funding for ambulance services as soon as possible, continue to find more ways to protect and care for our staff, prevent the depletion of our workforce and above all, eradicate hospital handover delays. “AACE believes that whilst reasons such as overall demand and increasing acuity of patients are certainly contributory factors, the most significant problem causing these pressures remains hospital handover delays. These have increased exponentially and the numbers of hours lost to ambulance services is now unprecedented. For example, in some regions in March, ambulance trusts were losing up to one third of all the ambulance hours they were capable of producing due to hospital handover delays.” Read full story Source: The Independent, 15 May 2022
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