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Found 1,519 results
  1. Content Article
    A new report published by Carers Scotland shows the devasting impact the health and social care crisis is having on the health of Scotland’s 800,000 unpaid carers. 
  2. News Article
    The trusts with the most patients waiting at least a week after they are ‘ready’ to be discharged can be identified for the first time, following publication of new NHS England data. The new collection shows how long patients are spending in hospital after being deemed fit for discharge, with around 3.7% of all patients in England waiting a week or longer in hospital following their “discharge ready” date — although about half trusts have so far failed to report accurate data. However, there is considerable variation across the country, with six trusts recording more than double the national average in terms of the proportion of patients declared medically fit for discharge being delayed by a week or more. Sarah-Jane Marsh, NHSE’s national director for urgent and emergency care, told HSJ in February that NHSE would aim to set a “baseline” for the discharge-ready data. HSJ understands NHSE will revisit the idea of a new target based on how long patients wait for discharge after they are “ready”, using the new collection, when more trusts are publishing data. It is also planning to publish data based on responsible local authority in future, given councils’ major role coordinating social care support for some people awaiting discharge. Read full story (paywalled) Source: HSJ, 23 November 2023
  3. News Article
    Health systems are still struggling to meet their financial plans, despite hundreds of millions being raided from investment budgets to help balance the books. Senior leaders in most regions said the cash falls short of their existing financial gaps. Earlier this month, NHS England announced that £800m would be made available to integrated care systems (ICSs) to offset the additional cost of strikes. HSJ understands ICSs reported a combined deficit that was £1.5bn worse than planned in the six months to October, which implies a gap of several hundred million pounds unless systems can report substantial surpluses for the second half of the year. HSJ spoke to senior sources in all seven regions, with more than half saying their systems would still fail to deliver breakeven, despite the funding transfers. A source in the South East said their system’s share of the funding “won’t touch the sides”, adding that NHSE was playing “hardball”. Another local source said they had identified a set of “nuclear options” to balance the books, but these would be “catastrophic for quality of care and/or nigh-on impossible to deliver”. Read full story (paywalled) Source: HSJ, 22 November 2023
  4. Content Article
    The latest Care Quality Commission (CQC) report on the state of care in England is far from an encouraging read.1 Although the healthcare system is under serious strain, maternity services are among the areas identified as especially challenged. The problems identified in maternity care, while shocking, come as no surprise. The sector is seeing repeated high profile organisational failures and soaring clinical negligence claims, together with grim evidence of ongoing variation in outcomes, culture, and workforce challenges and inequities linked to socioeconomic status and ethnicity. In this BMJ Editorial, Mary Dixon-Woods and colleagues discuss why it's time for a fresh approach to regulation and improvement.
  5. News Article
    Medics who are not qualified doctors have been used in senior roles at Birmingham Children's Hospital. Physician associates (PAs) have worked as the responsible clinician in the liver unit with a consultant on call. The RCPCH said it had heard the concerns of its members and the need for a clearly defined physician associate roles and training pathways. The doctors' union, the British Medical Association, called for a delay on recruitment of PAs until the group was properly regulated and supervised. The trust running the hospital said the physician associates did not work in isolation and only did the role with the right level of experience. Introduced in 2003, the PA role involved supporting doctors so they could deal with more complex patient needs. Usually, physician associates have a science degree and do a two-year post-graduate qualification. They are not doctors and are not allowed to prescribe drugs. The role is currently unregulated with the government planning legislation for regulations to be introduced before the end of 2024. PAs have worked at Birmingham Children's Hospital for 10 years but the BBC saw rotas which show them on tier two - normally a rota for senior doctors called registrars. PAs were not allowed to work unsupervised overnight and there were consultants on call at all times to offer advice, they said. Dr Fiona Reynolds, the trust's chief medical officer, insisted the safety and quality of care offered to children, young people and families remained a priority for everyone at the trust and would not be compromised. "Although small in number, [the PAs] skills and dedication to offering the best for our patients complements that of their colleagues in all fields - all of which are hugely valued by our trust," she added. Read full story Source: BBC News, 21 November 2023
  6. News Article
    The public inquiry into the Lucy Letby murders will seek changes to NHS services and culture next year despite the fact that formal hearings are likely to be delayed until the autumn. Inquiry chair Lady Justice Thirlwall will issue an update message later today. In it she will stress the inquiry will “look for necessary changes to be made to the system of neonatal care in this country in real time and at the earliest opportunity, avoiding delays in making meaningful change”. HSJ understands Lady Thirlwall will look to agree on some changes, based on the inquiry’s evidence gathering and discussions with the sector before it begins oral hearings – which are unlikely to start for at least a year due to ongoing legal action. Lady Thirlwall will say the legal constraints mean its early work will focus on the experience of families who were named in the cases already heard; and “on the effectiveness of NHS management, culture, governance structures and processes, as well as on the external scrutiny and professional regulation supposed to keep babies in hospital safe and well looked after”. She said, “I want this to be a searching and active inquiry in the sense that it will look for necessary changes to be made to the system of neonatal care in this country in real time and at the earliest opportunity, avoiding delays in making meaningful change”. Read full story (paywalled) Source: HSJ, 22 November 2023
  7. Content Article
    With Whitehall paymasters showing less faith in the organisations that hold the budgets for health and social care in England, Mark Dayan describes five ways that such tensions behind the scenes can impact on the running of services: Promising and planning. Ministerial direction. Frontline first. Too much too late. Enough already.
  8. News Article
    Two young people facing mental health crises were left on paediatric wards for months while different agencies across a health system struggled to find appropriate placements. The patients – who were both autistic and had learning disabilities, with special educational needs – were admitted to Maidstone and Tunbridge Wells Trust (MTW) last year after attending emergency departments more than 10 times within a two-month period. They were left on a paediatric ward – one of the patients for four months – as this was the “only available place of safety as opposed to the optimum setting to meet their needs,” according to Kent and Medway Integrated Care Board’s “learning review” of children and young people with complex needs, which the two cases prompted. The review, which HSJ obtained under a Freedom of Information request, revealed several problems with joint working, despite a multidisciplinary team meeting regularly to discuss the young patients’ needs. Since the review, a new escalation process has been introduced, urgent mental health risk assessments in the community have been enhanced and a three-month pilot of a self-harm service has been implemented at Tunbridge Wells Hospital, part of MTW. Read full story (paywalled) Source: HSJ, 17 November 2023
  9. News Article
    Forcing some medical staff to work through industrial action under new anti-strike laws could end up harming patient care, hospital trust leaders have said, as ministers claimed their new measures would keep public services running over Christmas. NHS Providers, which represents hospital, mental health and ambulance trusts, said there was a significant risk it would damage relationships between staff and employers that are already very challenged, in a way that could affect patients. In a submission to the consultation on minimum service levels in hospitals, it said: “Our key concern is that rather than strengthening services as intended, the legislation proposed would worsen relationships between employers and staff, and between trusts and local union representatives to the longer-term detriment of patient care.” Read full story Source: The Guardian, 17 November 2023
  10. News Article
    England's healthcare regulator has told BBC News that maternity units currently have the poorest safety ratings of any hospital service it inspects. BBC analysis of Care Quality Commission (CQC) records showed it deemed two-thirds (67%) of them not to be safe enough, up from 55% last autumn. The "deterioration" follows efforts to improve NHS maternity care, and is blamed partly on a midwife shortage. The Department for Heath and Social Care (DHSC) said £165m a year was being invested in boosting the maternity workforce, but said "we know there is more to do". The BBC's analysis also revealed the proportion of maternity units with the poorest safety ranking of "inadequate" - meaning that there is a high risk of avoidable harm to mother or baby - has more than doubled from 7% to 15% since September 2022. The CQC, which also inspects core services such as emergency care and critical care, said the situation was "unacceptable" and "disappointing". "We've seen this deterioration, and action needs to happen now, so that women can have the assurance they need that they're going to get that high-quality care in any maternity setting across England," said Kate Terroni, the CQC's deputy chief executive. The regulator has been conducting focused inspections because of concerns about maternity care. These findings are "the poorest they have been" since it started recording the data in this way in 2018, Ms Terroni said. Read full story Source: BBC News, 16 November 2023
  11. Content Article
    Cancer affects one in two people in the UK and the incidence is set to increase. The NHS is facing major workforce deficits and cancer services have struggled to recover after the COVID-19 pandemic, with waiting times for cancer care becoming the worst on record. There are severe and widening disparities across the country and survival rates remain unacceptably poor for many cancers. This is at a time when cancer care has become increasingly complex, specialised, and expensive. The current crisis has deep historic roots, and to be reversed, the scale of the challenge must be acknowledged and a fundamental reset is required. The loss of a dedicated National Cancer Control Plan in England and Wales, poor operationalisation of plans elsewhere in the UK, and the closure of the National Cancer Research Institute have all added to a sense of strategic misdirection. The UK finds itself at a crossroads, where the political decisions of governments, the cancer community, and research funders will determine whether we can, together, achieve equitable, affordable, and high-quality cancer care for patients that is commensurate with our wealth, and position our outcomes among the best in the world. In this Policy Review, published in the Lancet, Aggarwal et al. describe the challenges and opportunities that are needed to develop radical, yet sustainable plans, which are comprehensive, evidence-based, integrated, patient-outcome focused, and deliver value for money.
  12. News Article
    Hospital bosses in England are warning a lack of funds means they are having to scale back on plans to open extra beds to cope with winter. The warning, from NHS Providers, which represents managers, came after the Treasury rejected pleas for an extra £1bn to cover the cost of strikes. Recruitment to plug gaps in the workforce was also having to be put on hold, NHS Providers said. But the government said winter planning was on track. It pointed out the goal to open 10,000 "virtual" hospitals beds had been met. This is where doctors remotely monitor patients with conditions such as respiratory and heart problems who would otherwise have to be in hospital. Progress was also being made on opening 5,000 new permanent hospital beds - a 5% increase in numbers, the government said. "We recognise the challenges the NHS faces over the coming months, which is why we started preparing for winter earlier than ever," a Department of Health and Social Care spokesman added. But NHS Providers said the steps being taken may be insufficient. Read full story Source: BBC News, 14 November 2023
  13. News Article
    Scotland's largest health board has been named as a suspect in a corporate homicide investigation following the deaths of four patients at a Glasgow hospital campus. NHS Greater Glasgow and Clyde (NHSGGC) informed families of the development via a closed Facebook group set up during a water contamination crisis. The board confirmed it had received an update from the Crown Office. But it added there was no indication prosecutors had "formed a final view". Police Scotland launched a criminal investigation in 2021 into a number of deaths at the Queen Elizabeth University Hospital (QEUH) campus, including that of 10-year-old Milly Main. The Crown Office and Procurator Fiscal Service (COPFS) instructed officers to investigate the deaths of Milly, two other children and 73-year-old Gail Armstrong. Milly's mother previously told a separate public inquiry into the building of several Scottish hospitals that her child's death was "murder". A review earlier found an infection which contributed to Milly's death was probably caused by the QEUH environment. Read full story Source: BBC News, 13 November 2023
  14. Content Article
    “Crisis,” “collapse,” “catastrophe” — these are common descriptors from recent headlines about the NHS in the UK. In 2022, the NHS was supposed to begin its recovery from being perceived as a Covid-and-emergencies-only service during parts of 2020 and 2021. Throughout the year, however, doctors warned of a coming crisis in the winter of 2022 to 2023. The crisis duly arrived. In this New England Journal of Medicine article, David Hunter gives his perspective on the current state of the NHS.
  15. News Article
    New data suggests around 700,000 cases on the elective waiting list relate to patients who are on at least four different pathways, and NHS England says personalised care plans must be developed to treat them more efficiently. NHSE has published new data that reveals the overall referral to treatment waiting list, of 7.8 million cases, is made up of 6.5 million individual patients. The difference is due to some patients waiting for more than one treatment. Stella Vig, NHSE’s clinical director for secondary care, told HSJ around 2-3% of the individual patients on the waiting list are on four to five pathways or more. Read full story (paywalled) Source: HSJ, 9 November 2023
  16. Content Article
    In the windowless room where he spends 24 hours a day, lying in the bed he cannot leave, Nicholas Thornton reaches for his laptop and begins to type. It is the only way he can communicate. For more than 10 years, this 28-year-old has been trapped in dementia care units and A&E wards, abused by nurses and held in padded rooms. In all this time, he’s never had the care he needs. The 28-year-old is bedbound, unable to move and unable to speak, the effects of more than 10 years trapped in hospitals and units that cannot care for his needs. Nicholas, who is autistic and has a learning disability, has been moved again and again since he was first sectioned aged 16, ferried between units hundreds of miles from his family’s home in Essex. His story comes as a four-year-long independent inquiry, led by House of Lords peer Sheila Hollins, condemns the government for failing to address the “systemic” failures that have led to people with learning disabilities being locked away in hospitals in solitary confinement for up to 20 years.
  17. Content Article
    The Independent Sector Complaints Adjudication Service (ISCAS) provides independent adjudication on complaints about ISCAS subscribers. ISCAS is a voluntary subscriber scheme for the vast majority of independent healthcare providers.
  18. News Article
    A report highlights that maternity and neonatal services are often regular agenda items at board meetings, but the quality and quantity of information that is presented and the subsequent discussion (or lack thereof) doesn’t lead to effective oversight. The shocking and distressing stories emerging from the Lucy Letby case in August 2023 shone a light on the “cover-up culture” in the NHS. Although deliberate harming of babies is thankfully exceedingly rare, some of the issues raised in this case echo concerns that trusts are failing to react to signs of poor performance in maternity and neonatal services. Responsibility ultimately lies with trust boards which have a statutory duty to ensure the safety of care. However, the actions (or inactions) of leadership have come up frequently in inquiries and reviews. Read full story (paywalled) Source: HSJ, 7 November 2023
  19. Content Article
    The Department of Health and Social Care has published a letter, final report with recommendations, and a proposed code of practice framework from Baroness Hollins on the use of long-term segregation for people with a learning disability and/or autistic people. In her scathing report, Baroness Shelia Hollins said: “My heart breaks that after such a long period of work, the care and outcomes for people with a learning disability and autistic people are still so poor, and the very initiatives which are improving their situations are yet to secure the essential funding required to continue this important work."
  20. Content Article
    Throughout this series of Fundamental Care podcasts, a panel of key opinion leaders and passionate healthcare staff from the UK will discuss and debate evidence based best practices at the core of the day-to-day challenges faced in healthcare, not only for patients but also for healthcare workers themselves.
  21. News Article
    NHS England ‘lacks a clear vision’ on a key part of its health inequalities agenda and is not holding trusts to account for delivering an ‘inclusive recovery’, a study by the King’s Fund has concluded. The think-tank’s report, which represents one of the most comprehensive analyses on the subject to date, said system leaders had not made the case for change “strongly or clearly enough to convince clinicians and other staff to consider inequalities” when tackling elective backlogs. The think-tank said it had undertaken the research to investigate to what extent local NHS organisations had taken an “inclusive approach” to managing waiting lists, as NHS England had ordered them to do in August 2020. The research team said in a statement alongside the report: “There has been a lack of a clear vision from national leaders on why inclusive recovery is important for delivering better and fairer services for patients and the public. “The report calls on the government to pay greater attention to inclusive recovery to ensure progress is made so that patients can be treated fairly, no matter their background.” Read full story Source: HSJ, 8 November 2023
  22. News Article
    Priory Healthcare faces legal action following the death of a vulnerable man who was hit by a train after leaving Birmingham’s Priory Hospital Woodbourne in September 2020. Matthew Caseby, 23, detained under the Mental Health Act, escaped the hospital by climbing a 2.3-metre fence. The inquest jury, which heard the University of Birmingham graduate should have been under constant observation but was left alone, reached a conclusion that his death “was contributed to by neglect”. Concerns were raised about the hospital's record-keeping, risk assessments, and fence safety. Following the inquest, the Care Quality Commission (CQC) charged Priory Healthcare with two offences under the Health and Safety Act 2008, related to failing to provide safe care and treatment, and exposing a patient to avoidable harm. Read full story Source: ITV, 6 November 2023
  23. News Article
    Long waits in A&E departments may have caused around 30,000 ‘excess deaths’ last year, according to new estimates. Using a methodology backed by experts, HSJ analysis of official data has produced an estimate of 29,145 ‘excess deaths’ related to long accident and emergency delays in 2022-23, up from 22,175 in 2021-22, and 9,783 related deaths in 2020-21. For the first time, the analysis has also produced estimates of excess mortality related to long A&E delays for every acute trust. The data suggests the rate of excess deaths from 2022-23 has so far continued into 2023-24. The analysis followed a methodology used in a peer-reviewed study published in the Emergency Medicine Journal, which found delays to hospital admission for patients of more than five hours from time of arrival at A&E were associated with an increase in all-cause mortality within 30 days. Data scientist Steve Black, one of the authors of the EMJ study, said: “Long waits in A&E should never happen and 12-hour waits should be something like a never event. They should be intolerable anywhere. If we want to fix them it’s helpful to know which trusts have the worst problems with long waits.” Read full story (paywalled) Source: HSJ, 7 November 2023
  24. Content Article
    Structural, economic and social factors can lead to inequalities in the length of time people wait for NHS planned hospital care – such as hip or knee operations – and their experience while they wait. In 2020, after the first wave of the Covid-19 pandemic, NHS England asked NHS trusts and systems to take an inclusive approach to tackling waiting lists by disaggregating waiting times by ethnicity and deprivation to identify inequalities and to take action in response. This was an important change to how NHS organisations were asked to manage waiting lists – embedding work to tackle health inequalities into the process. Between December 2022 and June 2023, the King’s Fund undertook qualitative case studies about the implementation of this policy in three NHS trusts and their main integrated care boards (ICBs), and interviewed a range of other people about using artificial intelligence (AI) to help prioritise care. It also reviewed literature, NHS board papers and national waiting times data. The aim was to understand how the policy was being interpreted and implemented locally, and to extract learning from this. It found work was at an early stage, although there were examples of effective interventions that made appointments easier to attend, and prioritised treatment and support while waiting. Reasons for the lack of progress included a lack of clarity about the case for change, operational challenges such as poor data, cultural issues including different views about a fair approach, and a lack of accountability for the inclusive part of elective recovery. Taking an inclusive approach to tackling waiting lists should be a core part of effective waiting list management and can contribute to a more equitable health system and healthier communities. Tackling inequalities on waiting lists is also an important part of the NHS’s wider ambitions to address persistent health inequalities. But to improve the slow progress to date, NHS England, ICBs and trusts need to work with partners to make the case for change, take action and hold each other to account.
  25. News Article
    A mental health trust at the centre of several care scandals has ‘turned the dial’ on improvement, its chief executive has said, following the Care Quality Commission noting some progress but retaining a ‘requires improvement’ rating The CQC said earlier this month that improvements had been made at some services at Tees Esk and Wear Valleys Foundation Trust, including for its forensic secure inpatient service, where the rating was raised from “inadequate” to “good”. But the improvements were not enough to shift its overall “requires improvement” rating. Chief executive officer Brent Kilmurray argued the CQC report was evidence the trust was going in the right direction following a number of highly critical reports relating to patient deaths, but he also told HSJ it was a “challenge” for the trust to “tell a balanced story around where we are making progress”. TEWV has recently admitted care failings relating to the deaths of two inpatients in 2019 and 2020, following prosecution from the CQC. The trust will go on trial for alleged failings relating to another death in February next year. Read full story (paywalled) Source: HSJ, 6 November 2023
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