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News Article
Why Mondays are the deadliest day to go to A&E
Patient Safety Learning posted a news article in News
The number of people dying needlessly in A&E soars on a Monday as hospitals are stretched to the limit and failing to discharge patients at the weekend, new data shows. Figures uncovered by The Independent show an average of 126 patients died every Monday between 2020-2023 – 25% higher than any other day. On a Saturday, the average number of deaths drops as low as 90. Waiting times are also shown to spike massively at the start of the week, with an average of 9,300 patients spending more than 12 hours waiting on a Monday – up to 2,000 more than any other day. Medical experts said the rise in A&E waits can be attributed to people staying away from hospitals during weekends and patients not being discharged from medical care, causing a bottleneck in an already buckling system. The stark statistics also directly contradict repeated government efforts to make the NHS a seven-day service. Multiple coroners have warned the government and health leaders about delays to patients’ treatment and diagnosis due to variations in staffing and access to specialists – particularly over the weekend. Adrian Boyle, president of the Royal College of Emergency Medicine, said the NHS England data clearly signposted an “increased risk” at the start of the week. Another expert said the sharp rise in deaths on Mondays showed an A&E “running constantly in the red zone”. Read full story Source: The Independent, 8 April 2024 -
Content ArticleAbout 40,000 patient pathways have disappeared. But on the plus side, a new and better data series has begun. The referral-to-treatment (RTT) waiting list data has now changed in two important ways. First, about 40,000 patient pathways in community services are now excluded from the RTT data collections, and this accounted for all of the apparent reduction in list size in the latest (February) official RTT data. Second, NHS England has started regular publication of the more detailed and timely (though – for now – less complete and accurate) Waiting List Minimum Data set. This HSJ article looks at those changes in more detail.
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News Article
NHS waiting lists: Rishi Sunak fails on key pledge as 7.5m people languish
Patient-Safety-Learning posted a news article in News
Rishi Sunak has failed to deliver on his key promise to cut NHS waits, the health secretary has admitted, as new figures show that the overall waiting list now stands at 7.5 million. An extra 300,000 patients are waiting for hospital care compared with January last year, when the prime minister pledged that, under his government, “NHS waiting lists will fall and people will get the care they need more quickly” . Victoria Atkins, the health secretary, admitted that Sunak had failed to deliver on his promise but argued: “I don’t think anyone could have thought that it was an easy promise to make and it was going to be easy to achieve.” Read full story (paywalled) Source: The Times, 11 April 2024 -
News ArticleIn the next few days, once the data has been collected, the Government will come out and say that, thanks to its policies, the situation in A&E is improving. Despite estimates released recently by the Royal College of Emergency Medicine that soaring waits for A&E beds led to more than 250 needless deaths a week in England alone last year, the Government will point to declining numbers of patients who breached the four-hour target this March. The four-hour target means we're meant to see and either discharge or admit patients within four hours of their arriving in A&E. But it's a sham, writes Professor Rob Galloway in the Daily Mail. Because, for the past month, the four-hour data has been manipulated, the result of two policies introduced earlier in the month by the Government. Read full story Source: Daily Mail, 3 April 2024
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News Article
The ICSs ‘diverting’ the most GP referrals through controversial model
Patient Safety Learning posted a news article in News
There is huge regional variation in the rate at which health systems are preventing patients joining the elective waiting list through “advice and guidance” to GPs, according to analysis by HSJ. Some systems – including Northamptonshire – have managed to ramp up these “diverts” to such an extent that they now report around one A&G case to every 3.5 cases cleared from the waiting list through treatment or seeing a consultant. This contrasts with others, such as Lancashire and South Cumbria, which only reports one A&G case for every 16 cleared from the waiting list. Advice and guidance involves GPs consulting specialists before making direct referrals and around half the time this results in a referral being avoided. The model is set to be a cornerstone of NHS England’s new outpatient transformation strategy, which is due imminently. Victoria Tzortziou-Brown, vice chair of the Royal College of GPs, said the analysis “confirms reports we’ve heard from our members – that there is too much regional variation in the use of the ‘advice and guidance’”. She added: “Some GPs report that when advice and guidance is properly resourced and well implemented, it can be a helpful tool for improving communications with their colleagues in secondary care. “[But] it is clear that more time, funding and capacity needs to be dedicated to allow clinicians to communicate efficiently and effectively whilst respecting professionalism.” Read full story (paywalled) Source: HSJ, 9 April 2024 Related reading on the hub: Rejected outpatient referrals are putting patients at risk and increasing workload pressure on GPs -
Content ArticleNHS England’s response to claims of excess deaths due to long A&E waits leaves a lot to be desired, writes Steve Black for the HSJ. The Royal College of Emergency Medicine (RCEM) claim that more than 250 A&E patients are dying each week because they waited more than 12 hours to be admitted. If long waits in A&E are killing an extra 250-400 people every week, it is the biggest performance problem in the NHS. NHSE should urgently ask their analysts to rework this analysis with current data to test (or refute) the validity of the claim. The first step to solving a huge problem is admitting the scale of the problem, not denying it exists. This analysis features a refinement of the RCEM estimate that includes estimated mortality from waits between four and 12 hours. This increases the estimate to 400 extra deaths per week compared to the RCEM number of 250.
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News Article
Urology inquiry: Waiting lists greatest source of harm
Patient Safety Learning posted a news article in News
A former consultant at the Southern Health Trust has told an inquiry into urology services that waiting lists are the "greatest source of patient harm". The inquiry was established in 2021 and is examining the trust's handling of urology services prior to May 2020. Aidan O'Brien became a consultant urologist in Craigavon Area Hospital in July 1992. His work is at the centre of the inquiry. Giving evidence on Monday, he said waiting list figures highlighted what "myself and my colleagues [have said] for decades" and described it as a "grossly inadequate service". "If you look at four-and-a-half years for urgent surgery, it is appalling," he told the inquiry. "I don't have a magic solution to the current situation, which is dire." Read full story Source: BBC News, 8 April 2024 -
News ArticleA gran was left lying outside in the cold facing a seven hour wait for an ambulance following a fall before finally being rescued — by firefighters. Betsy Hulme, 83, was left in agony with a broken hip when she tumbled in her back garden in Leek, Staffordshire. Son Steve, 60, a former ambulance technician, dialled 999 only to be told it would be several hours until paramedics could get to them due to long handover delays. After a further three hours of Betsy waiting on cold concrete slabs while soaked in rain water, desperate Steve decided to drive to a nearby fire station to ask for help. Fire crews then came to rescue to lift gran-of-four Betsy into her son's car who took her to hospital where she remains after undergoing a hip repair operation. Dad-of-two Steve, of Leek, has now branded emergency response times as “absolutely disgusting”. He said: "It’s opened my eyes if I’m honest. It’s absolutely disgusting. I’m so grateful and thankful to the fire service - but it really isn’t their job. I can't remember in my time working as an ambulance technician going to someone and saying, 'I’m sorry it’s taken us twelve hours to get here'." “It was never anywhere near those ridiculous times when I worked there until 2000 and something has gone drastically wrong since. I can't speak highly enough of the boys and girls who work in the NHS, it's the people above them. Its systemic change that's needed." Read full story Source: Wales Online, 4 April 2024
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Content ArticleRead the Royal College of Emergency Medicine's general election manifesto. A one page summary is below and the full manifesto can be found at the link at the bottom of the page.
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News Article
Almost 10 million people in England could be on NHS waiting list
Patient Safety Learning posted a news article in News
Almost 10 million people across England could be waiting for an NHS appointment or treatment, 2 million more than previously estimated, according to a survey by the Office for National Statistics (ONS). The ONS survey of about 90,000 adults found that 21% of patients were waiting for a hospital appointment or to start receiving treatment on the NHS. When extrapolated, this equates to 9.7 million people. In January, the waiting list stood at 7.6 million, according to official NHS statistics. The survey found that the delays were most prominent among 16-24-year-olds, one in five of whom said they had experienced waiting times of more than a year. Conducted in January and February, the survey was part of the annual winter coronavirus infection study of adults aged 16 and over. The ONS said the survey was the first of its kind to assess the experiences of adults awaiting hospital appointments, tests or medical treatments. It said the data was experimental, based on self-reported data, and may differ from other statistics on waiting lists. Read full story Source: The Guardian, 3 April 2024 -
News Article
NHS faces ‘avalanche’ of demand for autism and ADHD services, thinktank warns
Patient Safety Learning posted a news article in News
The NHS is experiencing an “avalanche of need” over autism and attention deficit hyperactivity disorder (ADHD), but the system in place to cope with surging demand for assessments and treatments is “obsolete”, a health thinktank has warned. There must be a “radical rethink” of how people with the conditions are cared for in England if the health service is to meet the rapidly expanding need for services, according to the Nuffield Trust. The thinktank is calling for a “whole-system approach” across education, society and the NHS, amid changing social attitudes and better awareness of the conditions. It comes days after the NHS announced a major review of ADHD services. Thea Stein, the chief executive of the Nuffield Trust, said: “The extraordinary, unpredicted and unprecedented rise in demand for autism assessments and ADHD treatments have completely overtaken the NHS’s capacity to meet them. It is frankly impossible to imagine how the system can grow fast enough to fulfil this demand. “We shouldn’t underestimate what this means for children in particular: many schools expect an assessment and formal diagnosis to access support – and children and their families suffer while they wait.” Read full story Source: The Guardian, 4 April 2024 -
Content ArticleLong waiting times for autism and attention deficit hyperactivity disorder (ADHD) assessments can prevent people from getting the vital care and medication they need. Health and education support often relies on a formal diagnosis, without which there can be severe negative consequences. Estimates show that there might be as many as 1.2 million autistic people and 2.2 million people with ADHD in England, and providing them with the right support is no small task. Recent news reports have highlighted a huge rise in demand for autism and ADHD diagnoses amid increased awareness and understanding of neurodiversity. Exploring referrals and waits for autism and ADHD assessments is a key first step to understanding the scale of the issue, which can then be used to drive improvements and change. This blog from the Nuffield Trust looks at what the data is telling us.
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News ArticleKara Dilliway was just three years old when she came down with a common ear infection in October 2022. She recovered quickly, as was expected, but just days after the infection cleared her parents found she was struggling to hear and talk. “We’d noticed she’d just started to say yes and no to things, that’s when we thought something is going on,” says her mother Sam Dilliway, a 41-year-old community care worker from Basildon, Essex. Doctors said she could have glue ear, a common condition in children – fluid build-up had started to cause problems with her hearing, and would need draining. But what should have been a minor ailment has turned into a never-ending ordeal for the family. What was a simple case of glue ear could now leave her with hearing loss for up to two years as she awaits routine treatment. It comes after data released in January found that over 10 million people have been left on NHS waiting lists for basic ear care services. Dr Aymat says that the long-term effects of such conditions being left untreated in children can be severe. While glue ear is unlikely to leave permanent damage, there is always a small risk of permanent hearing loss. However, the developmental effects are far more likely and potentially long-lasting. Read full story Source: The Independent, 1 April 2024
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Content ArticlePrime Minister Rishi Sunak promised speedier care, but specialists believe long waits for hospital beds are costing thousands of lives. The pledge he made in January last year, as one of five priorities on which he said voters should judge him, was that “NHS waiting lists will fall and people will get the care they need more quickly”. New calculations by the Royal College of Emergency Medicine (RCEM) show that, with regard to the broader aim of delivering speedier treatment, his government is falling shockingly short.
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Content ArticleThe NHS England 2024/25 priorities and operational planning guidance reconfirms the ongoing need to recover core services and improve productivity, making progress in delivering the key NHS Long Term Plan ambitions and continuing to transform the NHS for the future.
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News Article
Long A&E wait times lead to more than 250 needless deaths a week
Patient Safety Learning posted a news article in News
More than 250 patients a week could be dying unnecessarily, due to long waits in A&E in England, according to analysis of NHS data. The Royal College of Emergency Medicine analysed the 1.5 million who waited 12 hours or more to be admitted in 2023. A previous data study had calculated the level of risk of people dying after long waits to start treatment and found it got worse after five hours. The government says the number seen within a four-hour target is improving. This is despite February seeing the highest number of attendances to A&E on record, it adds. The Royal College of Emergency Medicine (RCEM) carried out a similar analysis in 2022, which at that time resulted in an estimate of 300-500 excess deaths - more deaths than would be expected - each week. The analysis uses a statistical model based on a large study of more than five million NHS patients that was published in 2021. RCEM president Dr Adrian Boyle said long waits were continuing to put patients at risk of serious harm. "In 2023, more than 1.5 million patients waited 12 hours or more in major emergency departments, with 65% of those awaiting admission," he said. "Lack of hospital capacity means that patients are staying in longer than necessary and continue to be cared for by emergency department staff, often in clinically inappropriate areas such as corridors or ambulances. "The direct correlation between delays and mortality rates is clear. Patients are being subjected to avoidable harm." Read full story Source: BBC News, 1 April 2024 -
Content ArticleThe idea of Emergency care services experiencing seasonal spikes in demand – so called ‘Winter Pressures’ are fast becoming a thing of the past. Instead, long waits have become the new norm year-round, and staff are caring for patients in unsafe conditions on a daily basis. It is well established that long waits are associated with patient harm and excess deaths. Last year the UK Government published a Delivery Plan for the Recovery of Urgent and Emergency Care (UEC) services. A year on, far too many patients are still coming to avoidable harm. New analysis by the Royal College of Emergency Medicine (RCEM) reveals that there were almost 300 deaths a week associated with long A&E waits in 2023.
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Content ArticleThe State of the State blends two forms of research to provide a view of the state from the people who depend on it and the people who run it. To understand public attitudes, Deloitte and Reform commissioned Ipsos UK to conduct an online survey of 5,815 UK adults aged 16-75 between 27 October and 1 November 2023. Quotas were set to reflect the known profile of the UK adult offline population and a boost sample was achieved in each of the UK nations. In total 821 responses were achieved in Scotland, 713 in Wales and 420 in Northern Ireland. For the UK figures, results have been weighted back to the correct proportion for each nation. Where responses do not sum to 100 this is due to computer rounding or questions which require multiple answers to be chosen. To bring a strategic perspective, our qualitative research comprises interviews with more than 100 leaders in government and public services, which is double the number from last year. They include permanent secretaries and other senior civil servants, police chief constables, council chief executives, NHS leaders and elected representatives. The interviews took place between September and December 2023
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News Article
Public satisfaction with NHS at lowest ever level, survey shows
Patient Safety Learning posted a news article in News
Public satisfaction with the NHS has dropped again, setting a new low recorded by the long-running British Social Attitudes survey. Just 24% said they were satisfied with the NHS in 2023, with waiting times and staff shortages the biggest concerns. That is five percentage points down on last year and a drop from the 2010 high of 70% satisfaction. The findings on the NHS, published by the Nuffield Trust and King's Fund think tanks, show once again that performance has deteriorated after a new record low was seen last year. In total, since 2020, satisfaction has fallen by 29 percentage points. Of the core services, the public was least satisfied with A&E and dentistry. The survey also showed satisfaction with social care had fallen to 13% - again the lowest since the survey began. The major reasons for dissatisfaction were long waiting times, staffing shortages and lack of funding. Read full story Source: BBC News, 27 March 2024 -
News ArticleMinisters are being urged to roll out a better testing regime for one of the country’s biggest killers, with the most recent figures showing death rates for chronic obstructive pulmonary disease more than three times higher in some of the most deprived areas of the country. More than 20,000 people a year in England die from chronic obstructive pulmonary disease. The most significant cause of COPD is smoking, but a significant proportion of cases are work-related, triggered by exposure to fumes, chemicals and dust at work. Figures from the Office for National Statistics reveal that death rates from the disease are significantly higher in more deprived areas of the country. The NHS is rolling out targeted lung screening across England for people aged between 55 and 74 who are current or former smokers. The charity Asthma + Lung UK says the checks will identify many people who may have COPD, but there is no established protocol for them to be diagnosed and given appropriate treatment and support. Dr Samantha Walker, interim chief executive at Asthma + Lung UK, said: “Once targeted lung health checks are fully rolled out, millions of people could be told they have an incurable lung disease like chronic obstructive pulmonary disease, but they won’t be given a firm diagnosis or signposted to the right support, which is simply unacceptable. “What we need to see is a national referral pathway in place for those people who show signs of having other lung conditions as part of this screening process to ensure that people with all suspected lung conditions get the diagnosis and treatments that they deserve. We know that people with lung disease will live better, fuller lives with an earlier diagnosis.” Read full story Source: The Guardian, 24 March 2024
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News Article
Social care waiting times revealed for first time in a decade
Patient Safety Learning posted a news article in News
Older people are routinely enduring hidden waits of several months to get essential care and support, according to new figures obtained from government. Waiting time figures for adult social care are not routinely published in England, but last summer the Department of Health and Social Care collected the information from councils for the first time in at least a decade. They have been released to HSJ after a freedom of information appeal, and show average waits of up to 149 days (about five months) in Bath and North East Somerset, with 25 councils (30% of the 85 councils which supplied this information) reporting waits of two months or more. Some people will be waiting much longer than the averages reported. Across the 85 councils which reported average waits, the average of those figures was around 50 days. But the figures released to HSJ show huge variation – with three councils reporting waits of less than 10 days – although this is partly due to recording differences. The lack of clear figures, and absence of national waiting time measures and standards for adult social care, in contrast to the many targets and published figures in the NHS, and has sparked calls for that to be changed. Sir David Pearson, a former integrated care system chair and director of adult social care, who led the government’s Covid-19 care taskforce in the wake of the disaster in care homes in spring 2020, said: “One way of ensuring public confidence is a timely response to need. “Being clearer about a small number of standards and measures would help to achieve this. Of course it has to be associated with the right funding and reform, including supporting the social care workforce”. Read full story (paywalled) Source: HSJ, 25 March 2024 -
News Article
‘Continuity risk’ to abortion services triggers national intervention
Patient Safety Learning posted a news article in News
NHS England has told integrated care board (ICBs) leaders they must intervene over failures in abortion services in their patches amid “unprecedented demand” for such provision, HSJ has learned. NICE guidance states people should be assessed within a week of requesting an abortion, while procedures should take place within a week of assessment. However, NHSE said in a letter to ICBs today that “significant service pressures” have driven up waiting times for surgical abortions – approximately 13% of procedures – to three weeks or longer. NHSE has told ICBs to work with providers to, by July 2024: Respond to cases of “acute service disruption” and instances where rising waiting times risk limiting access to services; Establish referral pathways and procedures to ensure smooth transfers of care between independent and NHS providers when required; Ensure contracts for 2024-25 are sustainable and follow guidance in the NHS payment scheme; and Commission services in a more managed and collaborative way, including coordination of provision locally to bring waiting times in line with NICE standards. Read full story (paywalled) Source: HSJ, 12 March 2024 -
News Article
‘My GP suggested it’: Britons explain why they went private for surgery
Patient Safety Learning posted a news article in News
Private hospitals are caring for a record number of patients paying through their own savings or private medical insurance, according to figures from the Private Healthcare Information Network. Helen, a semi-retired frontline worker in south-east England, spent nearly £50,000 of her retirement savings on major spinal surgery to get her life back after two years of debilitating pain. Helen, 56, began experiencing extreme lower back pain and leg pain in September 2021, triggered by a dog colliding with her leg in the park. Though it was not caused by the trigger, she was diagnosed by the NHS with spondylosis in November 2021, and then a pars defect (a condition affecting the lower spine), and offered scans and physiotherapy. She said six months of physiotherapy, beginning in early 2022, resulted in no improvement, and she was offered pain management and a steroid epidural, which she said also did not help. “I rarely ventured out in these two years … due to the extreme pain I was in when sitting, standing or walking. Life effectively stopped in 2021,” she said. Desperate, she booked a consultation in May 2023 with a neurosurgeon and was told she needed an operation. Helen asked whether it would be possible for the neurosurgeon, who also works within the NHS, to do it on the NHS rather than privately. A referral could be made, she was told – but the surgery was likely to involve a waiting time of 18 months to two years. “My husband and I discussed it, and he said: you’ve already had no life for the last two years, do you really want to wait another two?” She had the spinal surgery in August 2023 and is now managing her pain with over-the-counter medication, rather than the stronger painkillers she was on before. It cost her a staggering £48,345. The financial hit has been huge. “I was absolutely gutted to have to go private. This has knocked us both; we didn’t see us in our lives having to pay for something like this. We’ve managed our finances carefully and always saved where we can. But that lump sum [that we] can access when we retire … That lump sum has just gone now.” Read full story Source: The Guardian, 8 March 2024 -
Content Article
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Ambulances lined up outside hospital Emergency Departments (EDs) are a vivid, and politically embarrassing, indication of inadequate capacity in the NHS. Media reports of diktats demanding that hospital CEOs meet performance targets suggest a desire for action, but are the local solutions being implemented to ease the pressure in the best interest of patient safety? The use of ‘safety cases’ in healthcare has received some interest in recent years but the conclusion drawn by, for example, Leberati and her colleagues,[1] was that while they have some potential value they are "fraught with challenge, highlighting the limitations of efforts to transfer safety management practices to healthcare from other sectors". A survey of the literature suggests that there is a danger of conflating ‘safety cases’ with ‘safety management’ or ‘quality’ systems. Part of the problem might be that safety cases are more a concept rather than a methodology: there is no script to follow. In this blog, Norman MacLeod discusses whether the the current crisis in hospital capacity can be explored through the safety case lens.- Posted
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News Article
Patients facing uphill struggle to see GPs
Patient Safety Learning posted a news article in News
Patients in parts of England are facing an uphill struggle to see a GP, experts say, after an analysis showed wide regional variation in doctor numbers. The Nuffield Trust think tank found Kent and Medway had the fewest GPs per person, followed by Bedfordshire, Luton and Milton Keynes. It comes as ministers have struggled to hit the pledge to boost the GP workforce by 6,000 this Parliament. But the government said it had plans in place to tackle shortages. However, Dr Billy Palmer, of the Nuffield Trust, said: "Solely boosting the number of staff nationally in the NHS is not enough alone - the next government should set a clear aim of reducing the uneven distribution of key staffing groups and shortfalls to tackle unfairness in access for patients." The think-tank report found while the government had met its target to increase the number of nurses by 50,000 this Parliament, the rises had not been felt evenly, with some specialist nurse posts, such as health visitors and learning-disability nurses, seeing numbers shrink. Dr Palmer said minimum numbers of GPs may have to be set for local areas - and better incentives to attract them to those with the fewest. Read full story Source: BBC News, 8 March 2024
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